Is There Sex After Cervical Cancer?

Sex after cervical cancer treatment

Linda Eckert, M.D., an OB-GYN, professor at University of Washington’s Departments of Obstetrics and Gynecology and Global Health and author of Enough: Because We Can Stop Cervical Cancer, said “[Healthcare providers] tend to think of cervical cancer as curable in the long term, but the changes brought on by treatment can be devastating. Sex isn’t talked about enough — and it should be.”

In one study, most cervical cancer survivors reported having satisfying sex lives after treatment. But finding a satisfying sex life after cervical cancer treatment may require changes. Warnings about the potential side effects of treatment and their possible impacts on sexuality, both physical and emotional, are often lacking. Yet this information might help survivors mentally prepare as well as take necessary steps to make adjustments.

Cervical cancer treatment effects on sexual organs

Cervical cancer treatment depends on what stage the cancer is when it’s found. If it’s found early, there are surgical options for treatment that generally result in the vagina becoming shorter. But, according to Eckert, the vaginal tissue “is forgiving and stretchy” when there are no changes to the reproductive system’s hormones. However, a later stage diagnosis will often add radiation and chemotherapy to the treatment. Radiation can sometimes cause “devastating” scarring, change the vagina’s shape and flexibility, and even change the vaginal discharge.

Sex should be part of the treatment conversation

Christy Chambers was diagnosed with stage 4b cervical cancer. Her treatment plan included low-dose chemo and external radiation, followed by immunotherapy. She had many side effects with her treatments but was told she had “no evidence of disease” in May 2023.

“I was very nervous to resume sex,” Chambers said. “Even though I didn’t have internal radiation, the treatment still altered the internal structure of my vagina. The internal depth was shorter and smaller, also very dry and tight. My partner was very patient, but I felt guilty we had to suspend sex often due to my discomfort.”

Chambers said nobody on her medical team mentioned intimacy, and it wasn’t addressed in the information packet the hospital gave her. “The medical team mentioned it two years after I’d finished treatment,” she said.

Barb DePree, M.D., director of the Women's Midlife Services at Holland Hospital and a member of HealthyWomen’s Women’s Health Advisory Council, said sex often isn’t discussed after a cervical cancer diagnosis because many healthcare providers focus first and foremost on successful cancer treatment and don’t think of the cervix as being majorly involved in sexual encounters. However, she said, “It’s helpful to take a minute before treatment starts to understand what might change. … It’s realistic to put out there that sex therapy and pelvic floor therapy might be part of recovery.”

Eckert said that patients don’t know enough to ask upfront about potential effects on their sexuality and sex lives. “With a cancer in the genital region, it’s up to the doctor to bring up the potential changes to sexuality, desire, function and accommodation.”

Eckert said the survivors she interviewed for her book mainly got information about post-treatment sex from other survivors. “They were rarely told, except by other survivors, that aggressive and early use of dilators, for instance, can help with vaginal changes. Or they may not be prepared to be hit with treatment-induced menopause, and that’s going to have a rapid effect on estrogen levels and vaginal integrity.”

Paguio found an OB-GYN who listened and understood her challenges, and recommended that she see a physical therapist who specifically works with pelvic floor issues. “I had reservations,” she said. “It sounded strange. I didn’t think it would work.” But the physical therapist convinced her to come for 10 sessions and leave if it didn’t help.

“After the fifth session I saw an improvement,” Paguio said. She and her husband also saw therapists individually to cope with anxiety around the cancer and its impact on their lives, including their sex lives.

“I realized I had apprehensive anxiety before sex,” Paguio said. “Therapy allowed me to tell my husband I’m not in the mood. Because if I’m not in the mood, it isn’t going to feel right, and it is just going to be a bad experience. Therapy helped us keep the lines of communication open.”

Chambers also found pelvic floor therapy helpful. “I wish I’d known about it sooner as it may have made the return to intimacy easier,” said Chambers, who also recommended finding sex and couples therapy.

It’s important to remember that intimacy doesn’t always have to include penetrative sex. There are other ways to be intimate, like finger play, oral sex and even just cuddling. Part of your communication with your partner should be discussing what options you’re both comfortable with.

It took Chambers and her husband around three months after they resumed intimacy to resume penetration. “Lubrication was key and we did quite a lot of finger play and stimulation until I was relaxed enough [to feel desire],” Chambers said.

Finding the right support

The sooner you address any sexual impact of treatment, the better results you can get restoring full function. DePree recommended early use of dilators if vaginal tissue is feeling less responsive or tight. “The longer you go without addressing it, the harder it is to reverse the changes,” DePree said.

Pelvic floor therapists can show women how to use vaginal dilators to expand and relax the vaginal tissue. These physical therapy specialists can also help women find vaginal moisturizers and lubricants that work well for them. A vaginal moisturizer is used daily — like moisturizers used on the skin — to help vaginal tissue stay supple, while lubricants are used only during sex, to reduce friction. When returning to penetrative sex, Eckert recommended early use of dilators and depth-control devices.

“Your life after cancer will never be what it was, but you can definitely create a new normal,” Chambers said. “Be open and honest with each other. Associating intercourse with pain will make you want to find a solution less and less. If it’s causing pain, stop and find a remedy. Experiment and find what works for you.”

Finding support can also be tremendously helpful. Eckert said survivor groups can be valuable for information sharing, and an empathetic medical team can do wonders. “Find a gynecologist who is not only comfortable talking about survivorship but recognizes that survivorship continues all your life.”

This educational resource was created with support from Merck.