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Enjoying Sex after Womb Cancer

Enjoying Sex after Womb Cancer | Jo Divine

Womb Cancer, also known as Endometrial or Uterine Cancer, is the fourth most common cancer in females in the UK, accounting for 5% of all new cases of cancer in females and according to Cancer Research UK there were 8,617 new cases of uterine cancer in 2012. It is a common cancer that arises from the endometrium (the lining of the uterus or womb) and affects the female reproductive system.

In 90% of cases, the first sign is most often vaginal bleeding not associated with a menstrual period.The earlier womb cancer can be detected, the chances of it being cured increase greatly.

Even if your smear test is normal, any abnormal bleeding should be checked by your doctor.

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Sexual impact of Womb Cancer

Having womb cancer impacts on your sex life, with many women experiencing sexual problems that affect their relationships, as well as their ability to enjoy sexual intimacy and pleasure.

Treatment varies but normally involves undergoing a total hysterectomy to remove your uterus and ovaries, in addition to having chemotherapy and radiotherapy. However not all women require chemotherapy or radiotherapy.

Menopausal Symptoms

Undergoing a hysterectomy will cause a surgical menopause, leading to a decrease in oestrogen which affects your sexual function and brings about symptoms normally experienced during the menopause. Many of the side effects of cancer treatments can bring about symptoms of the menopause, such as hot flushes, night sweats and vaginal dryness, all of which can affect your sexual relationships. Not everyone experiences the same symptoms of the menopause.

Menopausal symptoms often affect younger women who have had womb cancer, making them mourn not only the loss of their uterus and ovaries but their ability to have children if treatment leaves them infertile.

Fertility

Discussing all your fertility options prior to treatment is important such as preserving your ovaries,freezing your eggs or egg donation. Your consultant or Oncology Nurse Specialist will be able to offer help and advice as to what you can do. Counselling can help too.

More advice is needed for younger women about their fertility and what options are available to them to preserve their fertility. This is often overlooked or considered an afterthought when younger women have a cancer diagnosis but being unable to have children affects both your physical and mental health, which in turn, impacts upon recovery and quality of life post treatment.

A new Psycho-Oncology analysis of the published literature (2017) indicates that many cancer patients are not receiving support for fertility sparing choices or advice and recommends that all cancer patients of reproductive age should be provided with fertility information and referrals for fertility preservation. One of the reasons is that oncologists oncology may lack appropriate fertility knowledge and be unsure whose role it is to provide fertility support.

The Daisy Network offers advice and support to younger women who experience Premature Ovarian Insufficiency which may be as a result of cancer treatment and surgery.

A survey by Breast Cancer Care (2016) found that 53% of younger women were not given the chance to discuss the possible impact of their treatment on fertility despite national guidelines recommending younger women should be offered fertility preservation before starting breast cancer treatment.

The Royal College of Obstetricians and Gynaecologists published a scientifc paper about Fertility Sparing Treatments in Gynaecological Cancer (February 2013) offering options for women undergoing gynaecological cancer treatment and surgery.

Loss of libido

Many women being treated for womb cancer find that their libido decreases or disappears completely as a result of their treatment. Chronic fatigue, physical changes to their body, lack of confidence about the way their body feels and looks after surgery or constant worry and anxiety about their diagnosis, treatment and future can all cause libido to plummet.

Take time to explore what works for you sexually and seek medical advice if you feel that the problem is not resolving itself. Often the medication for womb cancer can impact upon your libido. If you think this may be the case, discuss it with your GP who may be able to change you to an alternative drug with fewer side effects.

Take your time

There is no time limit as to when your sex life returns to normal. Getting back to normal can take time and sex may not feel the same as it did before cancer treatment. For some couples,it can be better as they become more intimate, something that may have been missing from their relationship before treatment.

Talk to your partner

Talking about your problems with your partner and doctor is important but some women find their partners feel uncomfortable discussing their sex life. It is not always easy to talk about sex, but finding the right environment for both of you is essential. You need to consider how you share sexual pleasure and what has changed within your relationship. Talking to each other about sexual concerns and finding ways in which to overcome them can be good, but some couples struggle to have these conversations.

If you find you cannot talk to your partner or your doctor, ask to be referred for counselling. Psychosexual therapy is available on the NHS but waiting times can be lengthy so if you are able to, you may wish to pay to see a private therapist.

Problems that can occur

Vaginal Dryness

Having a total hysterectomy, chemotherapy or radiotherapy will send you into a medical or surgical menopause and can cause a decrease in vaginal secretions, making you feel less lubricated during sex.

One of the most common complaints during the menopause, vaginal dryness, can affect nearly all women, young or old, at some time during their life. Many women are too embarrassed to discuss the problem or seek help. Yet, using lubricants makes sex feel more pleasurable and last longer both for men and women.

Be aware that many well known sexual lubricants contain glycerine or glycol. Avoid lubes containing glycerine (a natural sugar) if you suffer from” vaginal”: or bladder infections as it can irritate the skin. Parabens and propylene glycol aren’t recommended ingredients as they can be oestrogenic. We don’t know the long-term effects of accumulative use of parabens in sex toys and lubes as not enough research has been conducted at present.

Some products available on prescription contain parabens or glycerol, or are not pH balanced to that of the vagina flora so always ask what they contain before being prescribed by your doctor. You can always ask to change to another product if you find the prescribed lubricant is affecting your vagina health.

Always check the label for the ingredients if buying from the high street or chemist.

If you find your lubricant isn’t helping, switch to another one. There are several different products available on prescription so find one that suits you.

After cancer treatment you may become more prone to thrush so choose a skin safe sexual lubricant.

Some popular water based brands including KY jelly and other well known brands, frequently prescribed and recommend by healthcare professionals can exacerbate vaginal dryness or vaginal atrophy. This is because they have a high osmolarity due to their ingredients so draw moisture away from the walls of the vagina rather than lock it in and hydrate them.

We recommend YES organic lubricants as they are very similar to the natural secretions of the vagina, pH balanced to the pH of the vagina and completely organic. If the water based formulation isn’t helping, try the oil based lubricant which is thicker and lasts longer, however, like all oil based lubricants, it isn’t condom safe.

You can create a double glide effect by using the water based on top of the oil based lubricant. This allows you to enjoy comfortable, pleasurable sex which lasts longer too.

YES VM vaginal moisturiser is pH balanced, glycerine and glycol free making it ideal as it is so soothing on the delicate tissues of the vagina and helps to restore the pH of the vagina which may become unbalanced, leading to vaginal infections.

You may wish to consider a silicone based lubricant which feels more slippery and can be used with condoms. Silicone based lubricants cannot be used with silicone sex toys as they can damage the silicone of the toy.

It is important to use a product that is designed for internal use. Products you find in kitchen and bathroom cupboards are not sexual lubricants and have not been designed with this in mind, although often touted as such by some HCPs and beauty bloggers. Just because you can eat a food stuff does not mean it is suitiable for vaginal use.

Overcoming Vaginal Tightness

Undergoing a hysterectomy can leave the vagina feeling shorter and tighter, making sex painful or uncomfortable. HCPs will offer medical dilators to help stretch the tissues of the vagina but many women dislike them as they feel very clinical and uncomfortable to use.

At Jo Divine we recommend using medical dilators with a vibrator. Used in conjunction, dilators and vibrators offer different experiences for many women. Medical dilators can help to stretch the tight tissues of the vagina whilst a vibrator can promote blood flow to the healing tissues and feel pleasurable too, especially on the clitoris.

If you struggle with dilators, consider trying a slim vibrator to begin with, and move onto a slightly bigger product or CalExotics Inspire Silicone Dilators. Once you have overcome any vaginal tightness, you’ll have a few sex toys to play with!

Some women consider using a vibrator as too sexual and prefer to use medical dilators to treat their condition. However, many women feel as if their body gets hijacked by HCPs during cancer treatments and they are no longer in control.They just want to feel sexual again after undergoing months, if not years of medical treatment and surgical intervention, and for them, using a vibrator is a less clinical way to enjoy sexual pleasure and intimacy again.

Decreased Sexual Sensation

Decreased sexual sensation may occur following gynaecological surgery, chemotherapy and radiotherapy, affecting your ability to orgasm. You may find you take longer to have an orgasm or not at all. Many women think they can only orgasm through penetrative sex, yet 70% of women orgasm through clitoral stimulation.

Explore ways in which to orgasm after surgery or cancer treatment through manual masturbation or using a sex toy.

Many sex toys offer different sexual sensations and levels of stimulation, so you need to decide what your sexual needs are before buying a sex toy.

The vibratory power of a small clitoral vibrator is stronger than what you can achieve through manual stimulation and offers differing sexual sensations. Using a small bullet vibrator on your clitoris or getting your partner to wear a vibrating cock ring during sexual intercourse can increase your sexual pleasure, which in turn, increases the chance of having an orgasm.

Some vibrators, designed solely for external use, such as the Doxy Massager,
which is also a body massager, offer extremely strong vibrations that are sure to create an orgasm in anyone!

The Satisfyer Pro 2 is an incredibly powerful clitoral stimulator that uses pulsation waves to gently caress and suck your clitoris, you just place it over your clitoris and allow the waves to gently tease your clitoris. It is ideal for those struggling to orgasm due to decreased sexual sensation as it will not desensitise your clitoris after prolonged use, something which may happen when using a classic vibrator.

The Satisfyer Pro Plus Vibration combines air pulsation wave stimulation with vibratory power whcih creates a completely unique sexual sensation.

Rabbit vibrators combine both clitoral and vaginal stimulation which can be controlled independently, offering you sexual stimulation exactly where you want it.

Sex isn’t just about penetration!

Great sex without intercourse

It is a common misconception that “normal” sex requires intercourse but this can leave some couples feeling frustrated if they are not able to have full penetrative sex. Even just spending time together, cuddling, kissing, non coital touching, massage, caring or talking to each other can increase intimacy.

“Normal sex” doesn’t exist, people should just do whatever feels good and have fun doing it!

Many HCPs fixate on penis in vagina sex (PIV) rather than discussing other non penetrative ways to enjoy sexual pleasure and intimacy through non penetrative practices, such as masturbation, mutual genital touching or oral sex.

Often when penetrative sex is off the menu, many couples enjoy a more fulfilling sex life by focusing on the many other ways they can make love, such as mutual masturbation using lubricants, oral sex, using sex toys, reading erotic fiction or watching naughty films, and light bondage. Being adventurous with your sex play can make sex feel more exciting,fun and introduce you to different sexual sensations and experiences too.

How do I suggest using a sex toy to my partner?

Introducing a sex toy into your sex play may seem like a daunting thought but using a sex toy can help you enjoy sexual pleasure and be fun too. Contrary to popular belief, most men aren’t daunted by their partner using a sex toy.

And you don’t need to choose the biggest sex toy you can find!

Many clitoral stimulators and slim vibrators offer strong vibratory power and can be slipped between you both during sex play. Using a vibrator on yourself whilst your partner is watching can be incredibly sexy and arousing or let them take control. Many men gain great pleasure from being able to stimulate their partner in this way if full penetrative sex is not possible.

I suggest you explore using a sex toy by yourself, especially if you have post-op scarring to find out what feels good, where you feel sensitivity or discomfort and to get the right pulse and vibration setting to suit your needs, before letting your partner join the fun, then you can show them exactly where it feels good.

Think about what your product is made from

We only recommend skin safe products, made from silicone, glass, metal or ABS plastic. Rubber, jelly and latex sex toys should be avoided as they contain chemicals which may be harmful to health and are porous, making then difficult to clean, thus increasing your risk of infection.

Silicone products are also much gentler on the delicate tissues of the vulva and vagina, feeling velvety smooth and easy to insert with lubricant.

Sex toys for couples play

Having womb cancer can make some women feel they are neglecting their partner. Why not treat your partner so you can have fun playing together. Same sex couples will probably have some sex toys in their bedside drawer but consider their size, perhaps invest in a slimmer vibrator or dildo if vaginal tightness is an issue or your partner is concerned about sex feeling uncomfortable or painful. Using a sex toy on your partner, be they male or female can be very arousing, so enjoy some extended foreplay.

Often considered a taboo subject, male sex toys offer great sexual health and pleasure benefits. Some men find that having a partner with womb cancer can affect their own sexual performance due to the fear of hurting their partner during sex or the constant worry about the disease and its treatment. Show your partner what feel good and where it may be uncomfortable.

Using an external couples toy can help you both enjoy sexual pleasure and stimulation.

Talking Sex in the NHS

At the request of a consultant urogynaecologist and women’s health physiotherapist, and in consultation with them about products, we created a health brochure that can be given to women containing sex toys, lubricants and pelvic floor exercisers that can help with a whole range of gynaecological problems such as vaginal tightness, vaginal dryness, postoperative scarring, decreased sexual sensations and symptoms of the menopause that can and do occur after womb cancer treatment.

Many women’s health physiotherapists do an amazing job of helping women overcome sexual problems caused by cancer treatment so ask your GP or gynaecologist to be referred to a women’s health physiotherapist if you haven’t seen one.

Psychosexual counsellors also work with cancer patients and their partners to help them alleviate their sexual issues by offering a variety of therapies that can help. Couples counselling is also invaluable when dealing with the loss of your fertility and not being able to have children.

With a combination of help and treatment from a range of HCPs and self help through using sex toys and lubricants, you can enjoy good sexual pleasure and intimacy.

Don’t give up!

As a sexual health and wellbeing writer, I never give up on looking for ways to help people enjoy sexual pleasure and intimacy and neither should you.

The fabulous Kaz Molloy set up Womb Cancer Support after struggling to find help and support during and after treatment. Despite being the 4th most prevalent female cancer, there is no national charity or campaign for Womb Cancer.

Useful Websites

AskEve: www.eveappeal.org.uk – online and phone support by specialist oncology gynaecology nurses
Association of Chartered Womens Health Physiotherapists :www.csp.org.uk
GRACE: Gynae-Oncology Clinical Research and Excellence: www.grace-charity.org.uk
Dr Louise Newson, menopause specialist : www.menopausedoctor.co.uk
The Daisy Network- www.daisynetwork.org.uk- charity for premature ovarian insufficiency
British Menopause Society- thebms.org.uk
Royal College of Obstetrics and Gynaecology- www.rcog.org.uk
Menopause Support : menopausesupport.co.uk
Henpicked : www.henpicked.net
Jennifer Young : www.beautydespitecancer.co.uk
HipHeadWear : www.hipheadwear.co.uk

Lydia Brain was diagnosed with a inflammatory myofibroblastomic tumour in her uterus at the age of 24. Undergoing surgery she was put into a surgical menopause and is infertile. As an advocate and campaigners for GRACE and Trekstock champion she is using her experience to raise awareness about having womb cancer as a young woman, recognising the symptoms and why HCPs need to take notice of your symptoms whatever your age. You can follow Lydia @lid_jar

Cancer and Fertility : www.cancerandfertility.co.uk This has been set up by Becki McGuinness who was left infertile by aggressive cancer treatment when she was just 23 years old. Now 30, she’s launching a national campaign to ensure women facing cancer are given all the fertility options she should have had

I spoke at the Daisy Network conference about sexual intimacy and pleasure in June 2017