GYNE & Sexuality10 4/9/03 10:28 AM Page 1 Gynecologic Cancer Foundation 401 North Michigan Avenue Chicago, IL 60611 Tel: 312.644.6610 Fax: 312.527.6658 E-mail: [email protected] Women’s Cancer Network Web Site: www.wcn.org Toll-Free Gynecologic Cancer Information Hotline: 1.800.444.4441 Renewing Intimacy and Sexuality After Gynecologic Cancer The Society of Gynecologic Nurse Oncologists 6024 Welch Avenue Fort Worth, TX 76133 Tel: 321.434.8639 Fax: 321.434.5338 Web site: www.sgno.org GCF and SGNO gratefully acknowledges Amgen for their generous support of this brochure. GYNE & Sexuality10 4/9/03 10:28 AM Page 3 Over 80,000 sexual expression, such as touching and women a year kissing. Intimacy refers to the physical or are diagnosed with emotional closeness shared with another individual. Self-esteem and body image a gynecologic are important factors that define how a cancer each year. woman feels about herself. Sexuality is important to one’s identity. Cancer The challenge for the woman with cancer treatment may interfere with desire and and her healthcare team is to balance the functioning, but it cannot take away an desire for the best possible treatment individual’s sexual self. This booklet will while maintaining quality of life. When offer some general information that can describing “quality of life” most adult be discussed further with your healthcare women include desires for intimacy and provider. Effective communication is satisfying sexual relationships as part the important for the woman, her partner, vibrant full life that they hope to and her healthcare team. preserve or regain. Cancer affects an individual’s total being, including How will surgery affect my sexual functioning? physical, emotional, spiritual, and sexual There are different treatments depending on the type wellness. Many types of cancer treatment of cancer diagnosis. The three most common gynecologic cancers are endometrial (also called can affect a woman’s response to intimacy uterine), ovarian, and cervical cancers. Most sexual disruption from these types of cancers are related to and sexuality. Sexual functioning can be surgical interventions, such as hysterectomy (removal affected by illness, pain, anxiety, anger, of uterus), bilateral salpingectomy-oophorectomy (removal of both fallopian tubes and ovaries, or stressful relationships, medications, and BSO), and vaginal resection. Abdominal scars and cultural norms. Sexuality not only refers surgical incisions can interfere with how a woman views her body, making her uncomfortable in an to sexual intercourse, but other means of intimate situation. The vaginal canal may be shorter 1 2 GYNE & Sexuality10 4/9/03 10:28 AM Page 5 after a hysterectomy causing discomfort with sexual seeking to regain sexual function. Surgical diversion of intercourse. However, the elasticity of the vagina gives the urine flow, vulvectomy, surgical removal of the it the ability to stretch during intercourse. clitoris, and vaginal reconstruction are included in this group. Women recovering from these procedures The removal of both ovaries in a premenopausal will want to ask their surgeon frank questions about woman will cause menopause or the lack of ovarian sexual recovery. Whenever possible, include your function. If estrogen is not replaced, vaginal dryness partner in these discussions. and vaginal atrophy (shrinkage) may occur causing discomfort with intercourse and pelvic examinations. The use of water-soluble vaginal lubricants and How soon after a hysterectomy can I moisturizers often improves comfort. Regular vaginal have sex? intercourse will help to preserve normal Most patients can resume sexual intercourse in vaginal length. approximately four to six weeks after an abdominal or vaginal hysterectomy. It is important for the surgical incision at the top of the vagina (often called the vaginal cuff) to have adequate healing and cessation of Cancer affects an individual’s vaginal spotting and discharge. total being, including Will there be pain the first time I physical, emotional, spiritual have sex after a hysterectomy? and sexual wellness. The fear of pain after surgery is a common concern for a woman and her partner. After surgery there may still be pain and discomfort, in addition to fatigue that can interfere with sexual pleasure. Finding a Special surgical considerations comfortable position to reduce discomfort is A colostomy (a surgical diversion from the intestine important. Some recommendations are positioning the that creates a pouch outside the skin) is indicated in woman on top or in a side-lying position to control rare situations for advanced cancer. This will not depth of penetration, and decrease abdominal interfere with the woman’s sexual functioning but discomfort at the incision site. Placing pillows under may affect body image. Feeling comfortable with the knees or behind the small of the back may your body, is part of feeling sexual. Some women use increase comfort. Dilators are recommended for sexy clothing to cover areas that makes them feel women with narrowing of the vagina, if intercourse is unattractive. For more specific information on sex not an option. For women not interested in sexual with ostomies, talk to an enterostomal nurse who has intercourse, other forms of pleasure include self or advanced training on ostomy care and sexuality issues. manual stimulation, and oral sex. In addition to colostomies, certain other surgical procedures can cause special challenges for a woman 3 4 GYNE & Sexuality10 4/9/03 10:28 AM Page 7 The use of water based lubricants, which can be uterus, cervix, and ovaries should expect to achieve purchased without a prescription, and/or vaginal orgasm after most cancer treatments. estrogens (prescribed by your physician) may reduce discomfort from vaginal dryness. If a woman is having post-operative pain from surgery or cancer How will radiation affect my related-pain, pain medication prior to sex may sexual functioning? ease discomfort. The effects of radiation are specific to each individual and depend on the dose and the area treated. Radiation to the pelvis or abdomen may cause side Will sex feel any differently to my effects such as fatigue, nausea, diarrhea, bladder partner after surgery? inflammation, and vaginal swelling that may interfere Your partner will not be able to determine that you with sexual desire. Delayed side effects may include had a hysterectomy. The vagina is quite elastic and diarrhea, vaginal discharge, swelling of the legs, and comfort can be achieved even if the vagina is vaginal narrowing. Frequent intercourse is an shortened from surgery. Lubrication to the vagina will excellent way to minimize the vaginal narrowing and make penetration more gentle and pleasurable. maintain the elasticity of the tissues lining the vagina. Intimacy refers to the physical or emotional closeness shared with another individual. Will the ability to have an orgasm Other than intercourse, vaginal dilators can be used to be affected by the surgery? maintain normal vaginal size. Water soluble vaginal The nerves responsible for having an orgasm will not lubricants may be needed for vaginal dryness. be affected by having a hysterectomy. Some of the physical changes associated with arousal, such as fullness in the labia and vaginal lubrication may not Is it safe to have sex while I am be as prominent or easily triggered if hormone levels still receiving radiation treatments? are low or after radiation treatment. Talk to your Radiation is not contagious, nor will you or your partner; provide assurance that these changes are partner become radioactive if you have sex during this caused by your surgery and that they do not mean time. During pelvic radiation, the vagina may be that you have lost interest in sex or that you do not temporarily tender to touch, or swollen, due to find your partner desirable. Together you can find sunburn-like effect. The use of lubricants may ways to adjust to these changes. Women who were increase comfort. Many women find that they need to able to achieve an orgasm prior to removal of their take a temporary break from vaginal intercourse 5 6 GYNE & Sexuality10 4/9/03 10:29 AM Page 9 during and shortly following radiation treatment. comfortable with one’s self is the first step to a After a short time of healing (commonly 2-4 weeks) healthy sexual self. be reassured that sexual relations will be comfortable again. The following are recommendations for improving libido and intimacy during chemotherapy: How will chemotherapy affect my 1. Plan for it, by scheduling a ‘date night’. sexual functioning? 2. Set the mood for intimacy (i.e. candles, bubble Chemotherapy does not directly cause sexual bath, soft music, romantic movies). dysfunction, however side effects from treatment such 3. To reduce fatigue, plan a nap prior to the occasion. as fatigue, nausea, mouth sores, and diarrhea, may 4. If symptoms such as nausea or pain occur from interfere with mood and desire. Not all chemotherapy treatment, take medication an hour before causes the same side effects and the treatment having sex. prescribed will depend 5. Discuss with your physician the use of testosterone on the specific cancer and/or estrogen based products (i.e. creams) as an diagnosis and stage. option to enhance your libido. Chemotherapy may 6. Touching, kissing, cuddling, or using massage cause low white blood and/or oils may be more desired and fulfilling counts 7-10 days after than intercourse. treatment, resulting in 7. Ask your doctor about medications to reduce an increased risk for anemia and white blood cell depletion or to infection. Women may combat depression, anxiety or severe fatigue. be more vulnerable to 8. Experiment with your partner finding means of infections (i.e. respira- sexual pleasuring that may or may not result in tory, gastrointestinal, and vaginal) during the 7-10 day orgasm or sexual intercourse. The goal is to keep period after receiving chemotherapy.