Enjoying sex after vulval cancer
Having vulval cancer can impact upon your sex life and the way in which you feel as a woman as your clitoris is one of the most sexual parts of your body. Undergoing vulval surgery can make you feel less sexual or womanly, affecting your sexual intimacy and pleasure and your relationship too.
It may take several months before you feel like having sex or begin to enjoy it again. Sex can feel different following surgery, as it may be painful or uncomfortable and you may experience a decrease in sexual sensation. You may also experience a decrease in libido as a result of going through the menopause due to cancer treatments which can affect your sex life.
Many women are able to enjoy a satisfying sex life following vulval surgery and treatment, but everyone is different so go at your own pace.
If you view exploring different ways in which to enjoy sexual intimacy and pleasure as a sexual adventure, you may find yourselves experiencing a wider range of sexual sensations and levels of intimacy that you might not have had prior to having cancer.
Talk to your partner
Talking to your partner about how you feel about the changes to your body can help your relationship. You might feel that they are no longer be attracted to you and won’t want to have sex again. They might be avoiding sexual intimacy with you, not because they aren’t attracted to you, but as a result of their own fears and worries about hurting you during sexual intercourse and not knowing where and how to touch you. They may also think you won’t be interested in sex anymore.
Being honest and trusting each other can help the healing process and enable you to resume your sex life again.
Some women feel uncomfortable being naked in front of their partner or feel discomfort when touched by their partner in their genital area, often as a result of scarring but also as a side effect of chemotherapy, radiotherapy and drug therapy which can make the body feel sensitive or painful to touch.
Research by Ussher et al (2013) found that having a supportive partner has a positive affect upon sexual intimacy which is hugely beneficial. Many partners of women who had undergone surgery which affected their breasts, genitals or female organs demonstrated that the importance of the acceptance of bodily changes, telling their partner they were still beautiful, touching and cuddling them, benefited their sexual relationship and help speed up recovery.
If you find it difficult to talk to your partner, you may benefit from speaking to a counsellor so ask your doctor or oncology nurse specialist (ONS) to refer you for counselling.
Worrying about future relationships
If you are not in a relationship at the moment you may be worried about meeting someone new and having an intimate relationship with them so speak to your ONS about putting you in contact with someone who has experienced this who can offer you advice or refer you to a counsellor.
Feeling sad
Following any treatment for cancer it is very common for people to feel sad or very low in mood. Many women experience a sense of loss following gynaecological surgery, which can impact upon their sexuality. It takes time to accept what has happened to your body but and with support from family, friends and healthcare professionals you will overcome these feelings in time.
If your mood changes to one of feeling depressed, you should seek medical advice. Depression is an illness just like any other so speak to your partner, family, friends, ONS or doctor. You may be prescribed a short course of antidepressants or offered counselling to help you get through this period of your recovery.
You may not require antidepressants but HRT. The change in your hormone levels through the menopause can leave you feeling depressed and low so speak to your GP about taking Hormone Replacement Therapy (HRT) if you are able to or want to or explore alternative ways to balance your hormones through dietary changes, exercise and natural supplements.
Allow your body to heal
As with any gynaecological surgery, you need to allow plenty of time for your body to heal before you try to resume any form of sexual intercourse. Getting used to how your genital area look and feels takes time. Many women believe that they will never experience an orgasm again if their clitoris has been removed but this isn’t the case. By exploring different ways to stimulate your body, you can enjoy increased sexual pleasure whilst having lots of fun too!!
Ways to orgasm
Before you consider having sex again, take time to explore your body in front of a mirror. You may find it hard to look at your genitals as they will appear different depending on the extent of surgery you required.
Either alone or with your partner for support, explore your genitals through gentle touch and massage. Using a lubricant will make this feel more comfortable, such as YES organic lubricant which nourishes the delicate tissues of the vulval area.
Your vagina and clitoris are both highly absorbant so it is advisable to avoid using products that contain substances which can cause irritation or an allergic reaction, just as you would with cosmetics and hygiene products. Some sexual lubricants available on prescription and frequently prescribed by GPs contain glycerin, glycols and parabens.
To ensure you don’t experience any adverse reaction to your lubricant, always choose a pH balanced lubricant such as “YES”: which is available on prescription, the water based lubricant and the vaginal moisturiser so ask your GP to prescribe it for you. They come in both tubes and easy to use applicators.
It is recommended that you avoid ingredients such as parabens, petroleum-based ingredients (found in petroleum jelly), glycerin and glucose (often found in flavoured lubricants), as these can promote yeast infections and leave your vagina feeling itchy, sore and uncomfortable.
Always stop if you feel pain or discomfort.
By doing this you will begin to feel where you still have sensation, what feels comfortable and what doesn’t. Show your partner what feel good as many partners can feel anxious about touching their partners for fear of causing pain and will be more than happy to be told what feels good and where to avoid.
Spending time together in this way can help strengthen your intimacy and enables you to find out what feels pleasurable. Depending on the extent of surgery and possible nerve impairment, using a small vibrator on this area can offer you greater stimulation and help you to orgasm if you notice that you now have decreased sensation.
Scar tissue may feel less sensitive initially but sensation to this area should return over time.
A small clitoral vibrator, such as JeJoue Mimi Soft or RO-90 Bullet can offer strong vibratory power and increases sexual stimulation when gently massaged over the vulval area. You may find that some areas are very sensitive to touch so just concentrate on what feel comfortable and sexually pleasurable. Involving your partner by allowing them to watch or even take control of the clitoral vibrator will help to strengthen your sexual intimacy and increase your sexual pleasure!
Vaginal orgasms- finding your G-spot or not!
If this level of clitoral stimulation doesn’t work for you or you have had a radical vulvectomy and no longer have a clitoris, try using an G-Spot vibrator to enjoy vaginal orgasms. These are shaped to offer stimulation to sensitive areas within the vagina, often referred to as the G-spot but disputed by many. However, discovering the sensitive are withn your vagina can give you an alternative way to enjoy orgasms.
Although 75% of women enjoy orgasms through clitoral stimulation, many experience vaginal or G-spot orgasms internally.
Located on the upper wall of the vagina just behind the pubic bone, the G-spot can be quite tricky to stimulate during normal penetration with a partner- you may need to experiment with certain positions or try using a vibrator. Some vibrators are designed to stimulate the G-spot,such as the OhMiBod Cuddle or Je Joue Uma just finding it can be tricky but you will know when you have!
One of the best ways to get to know yourself better is to explore first with your fingers: or, even better, get a partner to help you. The surface of the G-spot’s skin is slightly tougher than the rest of the vagina and is often described as feeling like the outside of a walnut shell. You may feel a sensation of needing to pay a visit to the bathroom when applying pressure to it; however, this is an entirely normal feeling as the G-spot is located right next to the urinary tract. An important factor in gaining pleasure from the G-spot is simply to relax and let your body move in the way that it wants to so take your time, get comfortable and explore.
Even if you don’t have a G-spot orgasm, using a vibrator can still feel extremely pleasurable so don’t focus on getting an orgasm, enjoy all the pleasurable sensations coursing through your body.
A-Spot Orgasms
Commonly known as cervical orgasms, the A-Spot is high up inside your vagina near your cervix, hence the name. It can be quite difficult to reach through mutual masturbation unlee your partner has long fingers but using a sex toy with a longer shaft can help such as the Fun Factory Lady BI which has been designed for A-Spot stimulation. Some women find this area senstive to touch but many enjoy the different sexual sensations it can create when stimulated.
Ways to overcome painful sex
Some gynaecological surgical interventions can lead to postoperative scarring, causing vaginal tightness, and loss of sensation which may cause discomfort or pain, both of which can be alleviated using a medical dilator, vibrator and organic lubricant.
Often surgical intervention and drug treatment can cause your vagina to shrink, making it feel tight, which can cause pain or discomfort during sexual intercourse.
Vaginal Tightness
If you find penetrative sex uncomfortable or painful, you can use either medical dilators, silicone dilators, a slim a vibrator or a combination of both to help your vagina to stretch.
Some women prefer to use medical dilators to treat their condition rather than a vibrator which they consider to be sexual.
However, some women like to use a slim vibrator, such as Picobong Zizo, OhMiBod Cuddle and Slinky Pinky which feels less clinical. Many women 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 way to enjoy sexual pleasure and intimacy again.
Medical dilators and vibrators can be used in conjunction with each other as they 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.
If you find the hard medical dilators uncomfortable the CalExotics Inspire Silicone Dilator Kit is made from incredibly soft silicone and ideal for helping vagina tightness. Gently tapered, they are shaped to make insertion into your vagina easier than with a straight dilator. You can even slip a small vibrator through the loop handle to create vibrations along the shaft of the dilator too. Using both water based and oil based YES organic lubricants, you can create a Double Glide effect to make use of the dilators more comfortable.
Vaginal Dryness
Vaginal dryness affect most women at some point in their life as levels of vaginal secretions differ between individuals which can be affected by stress, anxiety, hormonal changes due to contraception or pregnancy and medical or surgical interventions.
Jozkowski et al (2013) found that 9 out of 10 women felt that sex was more comfortable, pleasurable and simply better when using lubrication.
Using a good lubricant, such as YES organic lubricants can alleviate vaginal dryness and make sexual intercourse feel more pleasurable.When choosing a vaginal lubrication you need to take care what you are using and avoid any which may contain substances which may cause an allergic reaction.
When choosing a vaginal lubricant, don’t just go for the cheapest one on the shelf, check the ingredients for glycerin and parabens as these both cause imbalance to the vagina flora leading to infection or irritation, exaccerbating the problem further. Even some available on prescription contain glycerin which can cause the growth of thrush.
Frequently recommended by GPs and HCPs, KY is a well known brand of lubricant. However, it contains both parabens and glycerin, which can cause thrush. It is not pH balacned to the vagina and having a higher osmolality than the cells in the body, it draws moisture out of the walls of the vagina rather than hydrating them, exacerbating vaginal dryness, not helping it. This can leave the body vulnerable to infection, so could actually increase your risk of catching an STI.
Some women prefer a silicone lubricant which feels silky smooth on their vulval area. However, silicone lubricants cannot be used with silicone sex toys.
Often HCPs recommend vaseline or coconut oil. YES organic oil based lubricant is pH balanced to the vagina and is rgeat for gently massage, mutual mastubration and safe to use with sex toys. Always remember that any oil based products will damage condoms.
Some lubricant companies will send out free samples for you to try which is a good idea to find one that works for you. Before using a product we always recommend a skin test to avoid any irritation, stinging, itching or allergic reaction.
Great sex without intercourse
It is a common and slowly changing misconception that “proper” sex requires intercourse but this can leave some couples feeling frustrated if they are not able to have full penetrative sex following surgery and medical treatment.
Sex without intercourse can allow many couples to enjoy a more fulfilling sex life and often enjoy a level of sexual intimacy they might not have experienced before cancer. With intercourse off the menu, you can focus on the many amazing ways you can enjoy sexual pleasure by using mutual masturbation, body massage, sex toys, reading erotic fiction, light bondage and just trying different positions.
By rethinking how you enjoy sexual intimacy and pleasure there are so many ways you can discover what feels good for you so be adventurous!
Having vulval cancer is life changing but by rethinking the way in which you enjoy sexual intimacy and pleasure, you can continue to have a sex life- let your imagination run wild, be adventurous and experiment with what works for you. Have fun!
At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with sexual issues. Working with medical professionals, we hope to encourage patients and HCPs alike in talking more freely about sexual problems. A health issue doesn’t mean your sex life will have to stop!
Please give us a call or email if you would like a copy or take a look at the article and video link above.
Useful Websites:
Vulval Cancer Awareness this is a fabulous support group set up by Clare Baumhauer who had stage 3 vulval cancer for women with vulval cancer
AskEve: www.eveappeal.org.uk – online and phone support by specialist oncology gynaecology nurses
Pelvic, Obstetric and Gynaecological Physiotherapy :www.pogp.csp.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
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