Enjoying sex after cervical cancer

Read about the author Samantha Evans

Every year in the UK, over 3,000 women will be diagnosed with cervical cancer.

Having undergone treatment for cervical cancer, the thought of having sex may be the last thing on your mind, but for some women, sexual intimacy and pleasure plays an important part in their relationship. No one has to give up on enjoying pleasurable sex after a cancer diagnosis and treatment.

The impact of surgery, chemotherapy or radiotherapy can affect the way in which you now view your body and your sexuality, in addition to impacting upon your relationships, both physically and emotionally. This can affect upon your sexual desire and arousal, as well as your ability to have penetrative sex and reach orgasm.

Anyone, including younger women who have cancer, can experience a surgical or medical menopause, which can affect their sex lives. Coping with a cancer diagnosis and going through debilitating treatment, to be left with a low or no libido and physical symptoms, is life changing. Some women may be infertile after treatment, impacting further upon their health. However, there are ways in which to overcome menopausal symptoms that affect your sex life

If you find you are experiencing sexual problems, it is important to talk to your doctor or clinical nurse specialist (CNS) who can offer you practical advice or refer you for psychosexual counselling. However, not all healthcare professionals are comfortable talking about sex, so you may need to ask to talk to one who is.

Rethinking the ways in which you enjoy sexual intimacy and pleasure through self-help can help you to continue to enjoy a good sex life, or even experience a better one.

It is important to realise that getting back to sex after treatment is a gradual process. Taking your time and going at your own pace will ensure a greater success at returning to normal sexual activity. Also, having a supportive partner can speed up the recovery process too.

Great sex without intercourse

Sex is so much more than penetration, people enjoy sexual pleasure in so many ways. If you enjoy penetration, but it is not possible whilst you are recovering then focus on masturbation, massage, oral sex, intimate touching, cuddling and kissing to maintain intimate connection.

A study by Ussher et al (2013) explored renegotiation of sex in people with cancer and their partners, and found that 70% of the participants reported the exploration of non-coital sexual practices such as masturbation, mutual genital touching or oral sex and considered these to be just as satisfying as coital sex.

Renegotiating non-coital sex includes:

*Communication: Talking to each other about sexual concerns and finding ways in which to overcome them.
*Embracing intimacy: cuddling, kissing, non-coital touching, massage, spending time together, caring or talking to each other
*Exploration: exploring non-penetrative sexual practices, such as masturbation, mutual genital touching or oral sex
*Using sexual or medical aids such as vibrators, lubricants, dilators, male sex toys.

Communication is key

This is important in any relationship, not just after cancer. The way in which you communicate with each other can affect your relationship: often, one partner will highlight a problem or issue that the other partner has never considered or may consider to be trivial. 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.

Being honest about how you feel will help you both to overcome any sexual difficulties together. Your partner may be worried about hurting you during sex, whereas you may be anxious about them no longer desiring you.

Many people worry that their cancer will come back, so talking to a therapist or counsellor may help you to overcome your feelings.

Enjoying sexual intimacy

Even if you don’t feel sexual, you can still enjoy intimacy by cuddling, kissing and touching each other. Snuggling up on the sofa or in bed can feel so good and may lead to more intimate touching.

Some women feel uncomfortable being naked in front of their partner or feel discomfort when touched by their partner, either on the site of their surgery due to scarring or as a result of chemotherapy and drug therapy, which can make these parts of the body sensitive or painful. Just cuddling together can create feelings of intimacy between you, even if you don’t feel sexual.

Many couples consider intimacy, including cuddling, kissing, non-genital touching, massage, spending time together, caring and talking to be more important than penetrative sex. Often, some couples realise that intimacy did not play a part in their relationship before cancer and enjoy discovering it after treatment.

Keeping the intimacy going between you can help you get through this period until you feel that your sexual desire is returning. However, if you continue to feel like this for a longer period of time, or it’s affecting your relationship, seek medical advice.

Where has your Libido Gone?

Your sexual libido can go AWOL post treatment, leaving you struggling to become aroused or even want to have sex. Drug treatment and post surgical fatigue can both impact upon your libido. You also may be taking medication which can decrease sexual libido and can affect your ability to become aroused, such as oral contraception and antidepressants, so speak to your doctor about changing to an alternative with less side effects.

Feeling too tired for sex is common, so make sure you get plenty of rest, good sleep and enjoy intimacy at different times of the day if you find you’re flagging by bedtime

It may be helpful to talk to a psychosexual therapist to find ways to increase your sexual arousal, such as mindfulness and visualisation.

Focus on ways which help you become aroused such as mutual masturbation using lubrication and sex toys, reading erotic fiction, watching a naughty film together, and light bondage.

Audio porn is a great way to get your sexual imagination going and can really boost arousal.

Spend longer enjoying foreplay, savouring the sensation of each other’s body.

Use a Good Lube

Changes to the delicate tissues of the vulva and vagina due to depleting oestrogen levels and scarring post op can make sex feel painful. The tissues become less well lubricated, less flexible and often scar tissue can lead to vaginal tightness. Sex should never be painful and if it is, stop. Painful sex is not pleasurable sex, unless you’re enjoying consensual BDSM!

Often lack of arousal can be a problem, and you may find it takes time to become aroused, so spend time using an irritant free sexual lubricant for mutual masturbation and intimate touch. Concentrate on cuddling, intimate touch, massage kissing, and not just on the lips!

Many people are really cautious about what they eat and use on their skin following cancer treatment, and the same applies to your intimate health and sexual pleasure.

The vast majority of sexual lubricants contain irritating ingredients including glycerin which can cause thrush, especially for those who are prone to it, and it is a common issue following cancer treatment, during and post menopause. It also makes lubricants feel sticky, which is neither sexy nor pleasurable.

Propylene glycol is a well-known irritant, not just for vulvas and vaginas, but on penises and inside anuses too. This is often what causes the stinging when people first use a lube, and it can make lubricants feel sticky too.

Parabens are preservatives used in so many products including those designed for intimate use, yet they are weak hormone disruptors so are best to avoid.

Alcohol is very drying to the skin, and even more so to the delicate tissues of our vagina and vulva.

Dyes, perfumes and glitter are often included, none of which are beneficial to your vagina or vulva health.

Many brands use different ingredient descriptions to conceal what their product contains, so you have no idea what is in it. My view is if you don’t know what an ingredient is, don’t buy it or use it.

The same goes for lubricated condoms, often people think they have a condom allergy, but they are actually allergic to the lubricant ingredients or the ingredients in the lube they’re using with the condom. Irritation can occur if the condom isn’t the right fit too.

Just because a product is slippery doesn’t mean it’s suitable for sex, but we frequently hear about kitchen and bathroom cupboard products being used and even being recommended by some HCPs despite having never been designed for sexual use, many contain irritating ingredients and can cause infections, some will also damage sex toys and condoms too. Stick to eating your vegetable oils and just use your face, body, and hand creams for the body parts they were designed for! Keep vegetable oils for your salad, baby oil for your body and petroleum jelly for your lips! If you’re prone to thrush, do not use coconut oil, keep it for cooking or to use on your external skin.

What Lube can I use?

Ingredients matter when it comes to your intimate health and sexual pleasure. You may be given lube and moisturiser samples by your CNS or prescribed a product by your GP. However, do not assume these products are skin safe, as many HCPs have no training or education about the products they are recommending. Always check the ingredients as some products on prescription contain irritating ingredients mentioned above

A good sexual lubricant should feel natural, not intrusive. Any product that causes stinging, itching or burning, wash off immediately.

Water-based lubricants are the closest to your own natural lubrication, they are easy to wash off, can be used for any sexual activity, used with any sex toy material including silicone toys and are condom compatible. Our lubricants are irritant free, don’t leave any residue and can be reactivated during sex play with a little water if they begin to dry out

“Wish I had discovered Sutil Luxe years ago… really nice and will definitely buy again. It was so good, both me and my husband overslept this morning!”

SUTIL LUXE is a silky smooth water-based long-lasting lubricant that moisturises, 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, and its long-lasting formulation means you do not need to keep reapplying it or reactivating it with water. Interacting with your own natural lubrication, it makes you feel more lubricated, which makes any sex play feel more pleasurable.

Free from irritating ingredients and hormone free, and made from botanical and organic ingredients 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.

SUTIL Rich is water-based and thicker in formulation. Designed with a pH suitable for both anal and vaginal use, the new “Rich” formulation has enhanced viscosity to ease penetration and soothe dry, delicate tissues.

SUTIL Rich contains small amounts of Horny Goat Weed — a herbal aphrodisiac — that is added, along with Siberian Ginseng and Jujube nut. Traditionally, these herbs are used to increase strength, energy, stamina and vitality, but they also help to boost immune functions and have natural antibiotic and antiseptic properties to fight infection. Horny Goat Weed is also a vasodilator, which promotes blood flow and increases natural lubrication.

Depending on your sensitivity, you may feel a warm, slightly tingly sensation when using SUTIL Rich and if you are new to SUTIL we would recommend trying SUTIL Luxe first (or trying both – we have 10ml testers of both available).

We also sell YES water-based lubricant made from organic and irritant ingredients, easy to wash off, safe to use for all sexual activities, pH balanced to that of the vagina flora, free from any smell, taste, colour and are non-staining.

Oil-based lubricant is longer lasting, but are not suitable for use with latex condoms. Don’t use oil-based products that have never been designed for sexual use, as they will destroy condoms and your vagina and anal health.

YES Oil-Based Lubricant is plant-based, free from any irritating ingredients, has a much thicker consistency, suitable for water play, great for anal play, highly moisturising to the skin and can be used with our water-based lubricants to create a Double Glide effect. It can also be used to protect the delicate tissue of the vulva if you experience dryness, soreness or feel uncomfortable and is great to use when swimming in chlorinated or seawater which many cause irritation.

You can apply your lubricant with fingers, a partner’s finger, on sex toys, and we have a pack of 2 Lube Tubes to help you insert your lubricants and vaginal moisturisers

Moisturise Your Vagina

In addition to using an irritant free lubricant, it is important to use an irritant free vaginal moisturiser. An irritant free vaginal moisturiser can really help those who are unable to use local oestrogen or do not wish to do so, and can be used with local oestrogen too. Just as you have a skin care regime, it is important to have an intimate regime. You can use local oestrogen, vaginal moisturisers, sexual lubricants and only wash your vulva with water to keep your vagina and vulva happy and healthy post treatment.

A vaginal moisturiser is different from a sexual lubricant, as it is longer lasting and designed to nourish the tissues of the vulva and vagina. It works by slowly releasing water, where needed, rehydrating dry mucosa. When used regularly, it restores the natural protective acidity of the vagina. It is not designed for sex play, although Sutil Luxe and Rich can both be used as sexual lubricants. Just as you moisturise your face and body, it is recommended to use a vaginal moisturiser internally every 3-4 days and moisturise your vulva as necessary, this may be daily or every few days.

Again check what your CNS/GP has prescribed or recommended as not all moisturisers are irritant free. We only recommend YESVM, SUTIL Luxe and SUTIL Rich because ingredients matter when it comes to your intimate health. These moisturisers are free from any irritating ingredients as mentioned above.

Only Wash Your Vulva With Water

Following cancer treatment, the tissues of our vulva and vagina can shrink as the levels of oestrogen deplete, leaving them less flexible, less well lubricated, which can make penetrative sex feel painful and more prone to infections including thrush and bacterial vaginosis in addition to becoming sore and irritated. Many people reach for an intimate wash, use shower gels, bubble bath, bath oil and bath bombs believing they can ease these symptoms but only exacerbate their vagina and vulva health issues.

You also need to avoid perfumed menstrual products and scented condoms!

Your vagina is self-cleaning, so you cannot wash it. The intimate hygiene industry was created for a problem that doesn’t exist, our smelly vaginas. In fact, the vast majority of these products do more harm than good, irritating the delicate tissue of the vulva and vagina which leads to itching, soreness and exacerbating vaginal dryness. Many products can cause thrush and bacterial vaginosis, as they destroy the friendly bacteria that protect our vulva and vagina.

If you feel you need to wash with a product, ask your GP to prescribe a gentle emollient

Vaginal Tightness

Post-operative scarring can cause vaginal tightness and loss of sensation, which may cause discomfort or pain. If you have had a hysterectomy, your vagina shortens, which may make penetration feel uncomfortable or painful.

Medical dilators or trainers tend to be the treatment of choice by healthcare professionals, but these are made from hard plastic which can feel uncomfortable to use, which is why some people prefer to use our silicone dilator kit which feels less clinical.

Some people prefer to use medical dilators to treat their condition whilst many like to combine using their dilators with a slim vibrator/dildo. Used with our skin safe irritant free lubricants using dilators and slim sex toys can help you to regain your sexual function and enjoy pleasurable penetrative sex.

For many, using a vibrator can help them feel sexual again after undergoing months, if not years, of medical treatment and surgical intervention and is a way to enjoy sexual pleasure and intimacy again. Vibrators promote the blood flow to the tissues of the vulva and vagina, which, in turn, boosts natural lubrication and sexual sensation. This helps the tissues to become more flexible and lubricated.

Both medical dilators and vibrators are great to use with each other, as they offer different experiences. Dilators or trainers can help to stretch the tight tissues of the vagina whilst a slim vibrator, such as Picobong Zizo, OMB Cuddle, Jo Divine IMMY can promote blood flow to the healing tissues and feel pleasurable too, especially on the clitoris. Clitoral stimulation can help you to relax, making insertion of medical dilators easier.

If you prefer to use dilators, the CalExotics Inspire Dilator Kit offers 5 dilators that are ergonomically curved and easy to use. Unlike most medical dilators, they are made from flexible, skin-safe, velvety soft silicone. The easy-to-use loop handle makes them comfortable to hold, and the gentle tapered shape and varied sizes allows you to increase the insertion size at a rate that is comfortable to you.The IMMY also fits through the lop handle of the 3 smaller dilators, which makes them vibrate too.

If penetration feels painful, explore different positions, such as being on top to give you more control or a snugly spooning position.

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. Rings can be added or removed at any time to enjoy pleasurable, pain-free sex. Being incredibly stretchy, Ohnut is suitable for any penis size, including those who are more well-endowed.

Struggling to Orgasm

You may find it more difficult or that it takes longer to orgasm or your orgasm does not feel as strong as a result of diminished sexual sensation as a result of treatment or if you have had your cervix and uterus removed, so using a sex toy can help, for solo enjoyment or couples’ play.

Tell your partner how and where you like to be touched as you may feel discomfort being touched in certain areas, guiding them to the exact spot and using the right amount of pressure. You may need more or less pressure. Using an irritant free lubricant can make clitoral stimulation feel more pleasurable, especially if your vulva or vagina feels sore.

For the majority of people, their clitoris remains intact and as 70% of women orgasm through clitoral stimulation, try a small bullet style vibrator or clitoral stimulator on your clitoris during foreplay or sexual intercourse to increase your sexual stimulation. A strong body massager, such as the Doxy produces powerful vibrations, ideal when you have decreased sensation in your clitoris.

Air pulse and sonic wave toys have changed the way in which many people enjoy an orgasm and sexual pleasure. Both can be turned down really low if hypersensitivity is an issue, and have 12 levels if you prefer stronger stimulation. They are a great way to get sex play started because they promote the blood flow to the clitoris, which boost arousal and sexual sensation, some are APP controlled so you can pass control of your sexual pleasure to a partner too.

The Satisfyer Pro 2 uses sound wave technology and gently caresses your clitoris instead of stimulating it through vibrations. Some women may find they can become desensitised when using a conventional vibrator for long periods of time, whereas the Satisfyer works in an entirely different way to stimulate the clitoris.

The LELO SONA 2 most popular clitoral stimulator gently teases and caresses the clitoris into submission, sending its sonic wave sensation through the whole of the clitoris which sits around the vagina.

Using a G-spot vibrator can help you to enjoy vaginal orgasms if you are unable to have one during penetrative sex-explore your body with a sex toy to discover new-found sexual sensations.

Invest in a sex toy for your partner, so they can enjoy the fun too! Je Joue Mio is a vibrating cock ring that stimulates the clitoris at the same time, so double the pleasure for both of you!

Couples’ toys are fun too!

Although considered to be the result of sex, having an orgasm isn’t always the most important part of sex play so if you find you are unable to orgasm, switch off the chatter in your head and just concentrate on all the pleasurable sexual sensations running through your body.

Don’t give up your sex life after cervical cancer because there is always a way to enjoy sexual intimacy and pleasure-you just need to become more imaginative and creative with your sex play, incorporating ideas that you have never used before.

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 or a cancer diagnosis doesn’t mean your sex life will have to stop!

We work with several cancer charities including Trekstock who offer advice, information and support for anyone going through cervical cancer. We also work with the Menopause Charity, who have excellent information about Menopause and Cancer

Useful Websites

Eve Appeal : www.eveappeal.org.uk/gynaecological-cancers/ovarian-cancer
Jo’s Trust : www.jostrust.org.uk
Trekstock
The Menopause Charity
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
Cervical Screening : www.cervicalscreen1.wordpress.com

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

You can find out about the cancer charities and support groups we work with

You read more about the work we do with healthcare professionals here

You can read about our menopause work, including talks, events and books I have contributed to