Women's sex life and fertility
Radiotherapy to your lower tummy (abdomen) or pelvis can affect your fertility and sex life.
Fertility
The ovaries are in the lower part of your abdomen, in the area between your hips (the pelvis).
Radiotherapy to this area may affect your womb and can stop your ovaries from working. If you haven’t already been through the menopause, this means your periods stop and you won’t be able to become pregnant (you become infertile).
The risk of infertility depends on the dose of radiation to your ovaries, your age (the risk is higher the older you are), and if you have chemotherapy with the radiotherapy.
Finding out that treatment for your cancer may leave you infertile can be extremely distressing if you had hoped to get pregnant in the future. Your doctor and nurse will support you and talk about possible options.
It is sometimes possible to move the ovaries out of the treatment area before radiotherapy begins. This is called ovarian transposition. It is usually done by keyhole (laparoscopic) surgery. Ovarian transposition may prevent an early menopause.
You can see a fertility specialist before you start cancer treatment. They can talk to you about the possibility of freezing your eggs, embryos or ovarian tissue. You could possibly use your eggs in the future if you wanted to try to have a child through a surrogate (another woman carries the developing baby).
Menopausal effects
Symptoms of the menopause often start during your course of radiotherapy or shortly afterwards. Symptoms include:
- hot flushes and sweats
- dry skin
- dryness in the vagina
- loss of energy
- irregular or no periods
- less interest in sex
- mood changes or feeling very sad
There are some things that can help to relieve menopausal symptoms. These include:
- hormone replacement therapy (HRT) - replaces hormones that are at lower levels due to menopause
- hormone cream - oestrogen vaginal cream can help with vaginal dryness
Going into early menopause can be very upsetting. It can help to talk over your fears and worries with your partner or a friend. Try to talk to your radiotherapy team or specialist nurse if you are having problems.
The Cancer Research UK nurses can give information and support. You can contact them on 0808 800 4040, from 9am to 5pm, Monday to Friday.
Some of the women’s organisations on our general organisations list can also give help and support.
Your sex life
Pelvic radiotherapy can make the tissues in your vagina less stretchy. This is called fibrosis. Fibrosis can narrow the vagina, making it uncomfortable and difficult to have sex and vaginal examinations in the future.
Using vaginal dilators after treatment might help to prevent this. The advice to start using dilators varies depending on the radiotherapy centre; ask your radiographer, doctor or nurse about dilators.
Using dilators
Dilators are smooth tube shaped objects with a rounded end, made of plastic or metal. They come in different sizes. You start with the smallest size first.
For the first 6 months
Use dilators with a water soluble lubricating gel at least twice a week and up to twice a day, for 3 to 10 minutes each time.
Between 6 and 12 months
Use dilators once a week.
After 12 months
Use your dilators occasionally as long as you are not having any difficulty.
Alternatives to vaginal dilators
Sexual intercourse also helps to keep the vagina open and is a good alternative to using dilators.
You might prefer to use your fingers or a vibrator to help stretch your vagina. If water soluble lubricants do not give enough lubrication for comfortable intercourse you may want to try a silicone based lubricant. These give more lubrication and are usually fine to use after any vaginal irritation caused by radiotherapy has settled down.
A small amount of bleeding is usual when you first start using a dilator but contact a health professional if you have a lot of bleeding or pain.
Voice over: Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to.
This video is about the side effects you might have if you are a woman having radiotherapy to the pelvis or abdomen.
Louise: The abdomen, the tummy, can be affected by radiotherapy, but it depends on which particular part of that we are treating as to what side effects you may experience. If we are treating the upper part of your abdomen and we are irritating your stomach, sometimes you can experience a little bit of nausea, potentially a little bit of vomiting.
This would normally start quite early on if it is going to be a problem and the doctor would prescribe you some medication to help with that.
Carla: I felt sick constantly. I was having Complan drinks and smoothies and milkshakes with fruit and things in. Jelly sweets, anything that had got sugar in that I could suck on or chew on.
And ice cream. I know it was like October/November when I had my treatment, but I was having ice cream every day.
Louise: If your bowels are being irritated by the radiotherapy, you may find you end up a little bit more gassy. Flatulence might be a bit of an issue and sometimes you can find you can end up with some diarrhoea.
Carla: I started to get really, really bad diarrhoea. And they were giving me Imodium-type tablets to combat that.
With the wind, the wind's horrible. It's not nice at all, as a lady, to have wind. There’s tablets available that I can take for that.
Louise: If you do find that you are having some issues with your bowels, always consult with the team before you take any action. It might be they recommend you make some small dietary changes to help with this, cutting out foods which are very high in fibre or very spicy foods.
If you're having issues with diarrhoea, they may also recommend some particular medication to help with that.
Some radiation treatments to the pelvis may also cause some irritation to your bladder, so you might find you need to pass urine more regularly. It may also be more urgent with you passing smaller volumes. Sometimes you may find that there's a little pain or discomfort when you're urinating, or you can't fully empty your bladder like you would do normally.
Carla: If I need to go, I need to go, and if I can't go, I've got to have pant-liners in.
Louise: We would highly recommend during your radiotherapy that you stay well hydrated. We would recommend you drink up to 2 litres of water or squash a day to ensure that this happens.
Drinks to avoid would include anything containing caffeine, so any kind of tea or coffee or decaffeinated drinks, fizzy drinks and alcohol as they all naturally aggravate your bladder.
Radiotherapy can unfortunately have an impact on a woman's sex life. This is because you can end up with some vaginal drying and also you can find that the tissues in the vagina can become a little bit tight as a result of the treatment. The radiotherapy team will support you during treatment to help with any of these particular symptoms.
Carla: You're given dilators when you first finish your treatment and you have to use it for 10 minutes every day just to keep the scar tissue from sticking together and causing an obstruction.
Louise: These are little tubes that are inserted into the vagina that just gently help stretch the tissue to prevent any scar tissue from building and any shrinkage of the muscles. We can also give you some lubrication to help with any sexual activity as well. This can help you moving forward with both your sex life, but also with future internal examinations.
Infertility is a possible side effect of radiotherapy. If you are concerned about infertility after treatment, before you do start any radiotherapy, it's best to talk to the team and they can talk you through potential fertility treatments, such as storing your eggs prior to starting treatment.
It's always best to be open with partners when you're going through any kind of treatment, especially as this may have an impact on them too. It means that you can work through the problems together.
Voice over: If you’re experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
