Treatments for vulvar cancer can also affect the vagina.
Radiation therapy targeted to the vulva can make the area tender during treatment and for a few weeks afterwards. In the long term, this irritation can cause scarring, which may make the vagina drier, narrower, shorter and less flexible (vaginal stenosis).
Surgery for vulvar cancer may cause scar tissue to form around the outside of the vulva, narrowing the entrance to the vagina. This can make intercourse painful.
Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts that have changed.
Tips for managing changes to the vagina
- Keeping the vagina open and supple can make vaginal sex more comfortable, but it is important even if you don’t plan to be sexually active. It will allow your doctor to do a vaginal examination at follow-up visits to check for a recurrence of cancer, as well as regular cervical screening tests.
- If cancer treatment has narrowed or shortened the vagina, you may be advised to use a vaginal dilator to help keep the vagina open and prevent it from closing over.
- Vaginal dilators are tube-shaped devices made from plastic or rubber. They come in different sizes. Begin with the smallest dilator and progress to larger ones as each size becomes more comfortable.
- Find a quiet, private place. Using a water-based lubricant, slowly insert a dilator into the vagina. Leave it there for 5–10 minutes. You will need to do this 3–5 times a week, usually for many months.
- Your nurse, doctor or physiotherapist will provide the dilators or let you know where to buy them, and give you more detailed instructions about when and how to start using them.
- Ask your doctor if applying a hormone cream or a vaginal moisturiser will help with vaginal discomfort and dryness. Hormone creams are available on prescription, while vaginal moisturisers are available over- the-counter from pharmacies.
- Some women like to use vibrators (available from sex shops and online) to gradually widen the vagina. Talk to your treatment team if you would prefer to use vibrators instead of vaginal dilators.
- Although dryness, shortening and narrowing of the vagina can make sexual intercourse uncomfortable or difficult, having intercourse regularly – if you are able to and want to – may help keep the vagina open.
- Using a water-based or silicone-based lubricant, such as Sylk, Pjur or Astroglide, and trying different sexual positions can help. Learn more tips on managing sexual changes.
- Some women do not have a sexual partner or do not feel emotionally or physically ready to have penetrative sex after cancer treatment. If you’re in this situation, talk to your doctor about using dilators to keep your vagina open.
Prof Jonathan Carter, Director, Gynaecological Oncology, Chris O’Brien Lifehouse, and Professor of Gynaecological Oncology, The University of Sydney, NSW; Ellen Barlow, Clinical Nurse Consultant, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Dr Dani Bullen, Clinical Psychologist, Peter MacCallum Cancer Centre, VIC; Wendy Cram, Consumer; Dr Tiffany Daly, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Raymond Terrace (ROPART), South Brisbane, QLD; Kim Hobbs, Clinical Specialist Social Worker, Westmead Centre for Gynaecological Cancer, Westmead Hospital, NSW; Anya Traill, Head of Occupational Therapy and Physiotherapy, Peter MacCallum Cancer Centre, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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