The female body and sex

A woman's sex organs are on both the inside (uterus, cervix, and ovaries) and outside of the body (vulva). The breasts, nipples, and other areas of the body can also be sensitive to touch.

When you are sexually aroused, your body goes through different stages. Cancer or cancer treatment can cause physical and emotional changes that affect your sex drive. This may make it harder to reach orgasm.

Changes to sex hormones can cause:

• lower sex drive
• tiredness
• vaginal dryness
• problems urinating

Your doctor can give you advice on the different ways to cope with these physical changes.

Our sex drive is closely linked to how we feel. If you are anxious or depressed about cancer, it may be difficult for you to become sexually aroused. It can be useful to talk to someone about these feelings.

Effects of surgery on women

Surgery of any type can impact your sex life. Having an operation in the sex parts of your body can cause certain changes:

Hysterectomy – surgery to remove both the uterus and the cervix This can affect the way a woman feels during orgasm.

Radical trachelectomy - surgery to remove the cervix and some of the surrounding areas. This will make the vagina shorter.

Oophorectomy - surgery to remove an ovary. This will provoke symptoms of menopause such as reduced sex drive.

Cystectomy - surgery to remove the bladder. The surgeon may also eliminate some of the surrounding areas such as the uterus, ovaries, and part of the vagina.

Abdominal-perineal resection - surgery to remove cancer of the rectum. This may make vaginal sex uncomfortable.

Lumpectomy or mastectomy - surgery to remove part or all of the breast. This will affect body image and may affect the way you see yourself as a woman.

Surgery affecting visible areas such as the face can have an impact on your sexual self-esteem.

Effects of radiotherapy on women

Radiotherapy can cause side effects that affect your sex life. They can cause skin reactions. The treated area can become painful and develop an itchy or stinging sensation, which may make sex difficult. This can also affect the way you see yourself.

Radiotherapy can also cause extreme tiredness. This can continue for weeks or months. You may find you are too tired to have sex.

Radiotherapy in the pelvic area (anus, rectum, bladder, vagina, vulva, cervix, or uterus) can cause these side effects. These may include:

• diarrhea and nausea
• pain or bleeding in the bladder or rectum
• vaginal bleeding
• hormonal changes

Most of these side effects are temporary, and there are ways to cope with them. However, if your ovaries are affected by radiotherapy, this may cause permanent menopause.

Effects of chemotherapy on women

- Chemotherapy and sexuality

Chemotherapy is the administration of cancer-fighting medication (cytotoxic drugs) to destroy cancer cells. Some of the side effects of chemotherapy can reduce your sex drive. These side effects include feeling unwell, weakness, depression, tiredness, and a lack of energy. Many of these can be eased or stopped with drugs.

There is generally no medical reason to stop having sex during chemotherapy. But if you have a low number of platelets or have a low blood cell count, you may be advised to refrain from having penetration intercourse until your blood tests show an improvement.

- Effects of chemotherapy

Some antiemetic pills can cause a low sex drive. Once you stop taking them, your libido should return.

Some chemotherapy drugs can affect the nerves in the hands and feet. This is called peripheral neuropathy. It can cause tingling or numbness and pain

If your hands are uncomfortable or numb, you may find sexual contact or certain sexual positions to be difficult. Peripheral neuropathy is usually temporary, though it can be permanent.

Once you finish chemotherapy, your sex drive usually comes back with time. However, if the chemotherapy has caused your hair to fall out, if you have lost weight, or if you have a central line or PICC, you may not feel very sexy.

Tiredness may bring about a lower sex drive and reduce arousal during sex. Some medicines can help increase your sex drive and boost arousal. You can discuss this with your health-care team.

- Hormonal changes

Chemotherapy can reduce the amount of hormones that the ovaries produce. You may notice changes in your period, which can sometimes stop altogether. Even if your period stops, it is important that you talk to your doctor about contraceptive measures. This is because it is still possible to become pregnant, even with an irregular menstrual cycle. You should use a reliable barrier contraceptive method throughout your entire treatment and for up to one year later.

Hormone changes can cause menopausal symptoms, including hot flashes, irritability, sleep disturbances, and vaginal dryness. Yeast infections are common in women having chemotherapy, especially if they are taking steroids or potent antibiotics to prevent infection. Your doctor can prescribe treatment for this.

Changes to your normal hormone levels may bring about a lower sex drive and reduce arousal during sex. Some medicines can help increase your sex drive and boost arousal. You can discuss this with your health-care team.

Effects of hormone therapy on women

- Hormone therapy and sexuality

Some cancers are influenced by the hormones produced naturally by the body, which is why hormone therapy is given to change hormone levels. The hormones that are most commonly affected by cancer or its treatment are sex hormones:

• Estrogen.
• Progesterone.
• Testosterone.

Some hormone therapy drugs are given as pills, while some come as injections.

- Tamoxifen and anastrozole

Tamoxifen and anastrozole are often given as part of breast-cancer treatment. They can cause side effects that resemble the symptoms of menopause. The symptoms of menopause include:

• Hot flashes
• Dry skin
• Vaginal dryness or irritation
• Vaginal discharge
• Feeling down
• Anxiety
• Being less interested in sex

If you are taking tamoxifen or anastrozole, you may experience some of these side effects, very few of them, or none at all.

- Other hormone therapies

There are many hormone therapies whose side effects can affect your sex drive, such as tiredness and vaginal dryness.

A drug called goserelin is sometimes given to women who have not entered menopause yet. Goserelin lowers the amount of sexual hormones produced by the ovaries, causing their period to stop and provoking menopausal symptoms while they are taking the drug. Goserelin can also reduce your sex drive. Goserelin is usually take over two years, and your sex drive gradually returns once you stop taking the drug. The other side effects will also go away.