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, it may be painful or uncomfortable because of scar tissue, and you may experience a decrease or change in sexual sensation. You may also experience a decrease in libido as a result of going through the menopause due to the impact of cancer treatment

Many people find ways 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 deeper levels of intimacy that you might not have had before 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.

Being honest and trusting each other can help the healing process and enable you to resume your sex life again.

Many people 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 delicate tissues of the vulval area and vagina feel sensitive or painful to touch.

Research by Ussher et al (2013) found that having a supportive partner has a positive effect 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 psychosexual therapist so ask your doctor or oncology nurse specialist (ONS) to refer you, or you can find a private practitioner at COSRT (see resources below)

Worrying about new or future relationships

If you are not in a relationship currently, 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 therapist.

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, 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 experience a low mood, so speak to your GP about taking Hormone Replacement Therapy (HRT) if you can 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 looks 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 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, become less well lubricated, making it feel tight, which can cause pain or discomfort during sexual intercourse.

Do you have an Intimate Regime?

Just as you have a skin care regime, adopting an intimate regime can really help.

Using vaginal oestrogen if you can or wish to, your GP or oncologist/ONS can discuss what they are and prescribe them, an irritant free vaginal moisturiser such as YESVM or Sutil Luxe or Rich, an irritant free sexual lubricants like YES and SUTIL and only washing with water. Some people may prefer to use a gentle emollient you can buy OTC or get on prescription from your GP.

No one needs an intimate wash!

Vaginal Dryness

Vaginal dryness affects most people 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, sexual side effects to some medication and medical or surgical interventions.

We know that lubricated sex play is much more pleasurable, however choosing a sexual lubricant can be a minefield as there are so many products. So, what lube should you use?

What Lube should I use?

It’s all about finding what works for you, however, your vagina and vulval area are both highly sensitive and absorbent, so it is advisable to avoid using products that contain ingredients which can cause irritation or an allergic reaction, just as you would with cosmetics and hygiene products. Some sexual lubricants and moisturisers available on prescription and frequently prescribed by GPs contain glycerin, glycols and parabens, dyes, perfume and even alcohol.

When choosing a vaginal lubricant, don’t just go for the cheapest one on the shelf, check the ingredients for glycerin, glycols and parabens as these cause imbalance to the vagina flora leading to infection or irritation, exacerbating the problem further. Even some available on prescription contain glycerin, which can cause the growth of thrush.

You need to become an ingredients detective when choosing a lube and moisturizers and always check the label or ask your GP what the ingredients are in the products they prescribe or recommend buying OTC. Remember, many medical and healthcare professionals have no education about what is an irritant free lubricant or vaginal moistruier and will just prescribe or recommend products they know even if they contain poor ingredients

Do not assume just because a product is slippery that it is suitable for sex play or to moisturize your vulva and vagina with.

SUTIL LUXE is a silky smooth water-based lubricant that moisturizes, nourishes and soothes our most intimate areas, as well as lubricating for sexual pleasure. This fabulous water-based lubricant gently cushions and glides, blending seamlessly with your own natural lubrication during sex. Being water-based, it is easy to wash off, too.

Free from irritating ingredients and hormone free, it is perfect for anyone, including those not able to have hormone replacement therapy and post cancer treatment, not only as a sexual lubricant but also as a vaginal moisturiser and can be used with any sex toy or dilator.

Made with eco – certified ingredients, SUTIL is committed to creating natural and organic cosmetics that are not only great for your skin, but also derived from renewable resources and manufactured using environmentally friendly processes. Even the sleek tube is biodegradable.

YES organic lubricants is another excellent irritant free lubricant brand that nourishes the delicate tissues of the vulva and vagina. YESWB is a water-based lubricant which is close to your own natural lubrication. It is not as long-lasting as SUTIL but can be reactivated with water, or you can apply more if you need it.

“YESOB”: is an irritant free oil-based lubricant made from skin safe play oils. Perfect for longer lasting play, with dilators and sex toys, YESOB is great for vulva massage too

You can use both YESWB and Sutil with YESOB TO create a Double Glide effect which makes use of dilators more comfortable and sex play feel more pleasurable

Often HCPs recommend Vaseline or coconut oil. YES organic oil-based lubricant is pH balanced for the vagina and is great for gentle massage, mutual masturbation and safe to use with sex toys. Always remember that any oil-based products will damage condoms.

Some people prefer a silicone lubricant, which feels silky smooth on their vulval area. However, silicone lubricants cannot be used with silicone sex toys. However, silicone lubes do not get absorbed into the tissues of the vulva and vagina, they just sit on the skin until they are washed off, so may not be suitable if you want a product that moisturizes and nourishes the healing tissues of the vulva and vagina

Before using a product, we always recommend a skin test to avoid any irritation, stinging, itching or allergic reaction. We sell 10ml samples tubes of Sutil Luxe and Rich, 3–4 uses, as a little goes a long way, so you can try it to see if it is suitable.

Vaginal Tightness

The vagina can feel tight post op which, in turn, can make any penetration, with a speculum, fingers, a toy or penis uncomfortable or painful, so using either medical dilators, silicone dilators, a slim a vibrator or a combination can really help. You may be shown how to use dilators by your ONS or be referred to a pelvic health physio who can teach you how to dilate. Daily dilation is so important to gently stretch the tissues of the vagina to prevent them shrinking and becoming tight.

Many people find a suitable time of day and private place to dilate, some do it whist watching TV, others after a warm bath, it is important to find a routine and place, whatever suits you. Dilation takes time, so do not force dilators or slim sex toys into your vagina, you will damage the tissue and make it sore. Take your time, and go at your own pace.

Always stop if you feel pain or discomfort.

Medical or silicone dilators, silicone dildos and vibrators can be used together as they offer different experiences for many women. Dilators/dildos can help to stretch the tight tissues of the vagina, whilst a vibrator can promote blood flow to the healing tissues, boost sensation and feels pleasurable.

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 Jo Divine IMMY 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.

Some people find the hard plastic medical dilators uncomfortable to use and prefer to use the CalExotics Inspire Silicone Dilator Kit, 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 such as the IMMY through the loop handle to create vibrations along the shaft of the dilator too.

If penetrative sex feels painful, the Ohnut is an ingenious product made from 4 stretchy silicone rings designed to act as a buffer and prevent deep penetration. These comfy modular rings are worn around the base of a penetrating partner and compress down — like a bumper. Rings can be added or removed at any time to enjoy pleasurable, pain-free sex.

You can find all our slim vibrators, dilators, OhNut and lubricants in our health brochure too

Enjoying an Orgasm and Sexual Pleasure

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.Even though you may have little or no vulva tissue, there are many ways to enjoy sexual pleasure, solo and with a partner.

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, or SUTIL Luxe which nourishes the delicate tissues of the vulval area.

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 feels 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 feels 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

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 sensitive areas within 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 like the outside of a walnut shell. You may feel a sensation of needing to pee 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 unless your partner has long fingers, but using a sex toy with a longer shaft can help such as the Fun Factory Lady BI or Rocks-Off Regala which have been designed for A-Spot stimulation. Some women find this area sensitive to touch, but many enjoy the different sexual sensations it can create when stimulated.

Great sex is so much more than penetration

It is a common and slowly changing misconception that “proper” sex requires intercourse, but this can leave some couples feeling frustrated if they cannot have full penetrative sex following surgery and medical treatment. Sex is whatever feels pleasurable.

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.

Discovering other erogenous zones on your body can be very stimulating, you may find you love having your toes sucked, your neck nibbled or even orgasm through nipple stimulation. Sensual touch with lips, tongues, body massagers, ticklers, silky ribbons and velvety material, especially when blindfolded can heighten all your senses, send your arousal sky-high and pulse racing. Food foreplay is so much fun too!

You may find your kink side and love temperature play or fireplay.

Listening to audio porn, watching erotic films or reading erotica, viewing erotic art, whatever stimulates all those sexual sensations, try it, you might like it!

There are so many ways you can discover what feels good for you, so be adventurous and most of all, have fun!

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

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 and Emma Norman who has Lichens Sclerosus
Lichen Sclerosus & Vulval Cancer UK Awareness also has a closed Facebook group

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