Enjoying Sex after Womb Cancer

Read about the author Samantha Evans

Womb Cancer, also known as Endometrial or Uterine Cancer, is the fourth most common cancer in females and non binary people in the UK, accounting for 5% of all new cases of cancer in females and according to Cancer Research UK, there were around 9,700 new uterine cancer cases in the UK every year, that’s 27 every day (2016-2018). 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 whatever your age.

How does Womb Cancer affect your sex life?

Many people experience sexual problems that impact upon their sexual function, including vaginal dryness, vaginal tightness, decreased sexual sensation, body image issues, fatigue, low libido, recurrent genitourinary infections or irritation, fear about painful sex, not just from themselves but their partner too in addition to changes in their relationship. Often the underlying worry is, “will the cancer return?” which can affect 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 which can lead to a surgical or medical menopause. However, not everyone require chemotherapy or radiotherapy.

The impact of medical or surgical intervention instantly sends people into a medical or surgical menopause which impacts upon sexual function, intimacy and pleasure, however there is plenty of practical advice and suitable products that can help you to continue to enjoy sex alone or with a partner.

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.

Often womb cancer in younger people is early-stage or low grade and prognoses is good.

“The available evidence suggests that fertility-sparing treatment is effective and does not appear to worsen the prognosis. If an eligible patient strongly desires fertility despite the risk of recurrence, the clinician should consider fertility-sparing treatment with close follow-up” (Clinical and Experimental Reproductive Medicine, Dec 2020)

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 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, relationship 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. (See the Game Changers below, toys that can really help to boost your libido and arousal)

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 people 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 or you may wish to see a private therapist. Some cancer centres have psychosexual therapists, so ask your CNS.

How do I overcome Sexual Issues?

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 people are too embarrassed to discuss the problem or seek help. Yet, using lubricants makes sex feel more pleasurable and last longer.

Vaginal dryness and irritation leading to painful sexual intercourse is a common complaint, so using a good lubricant can help, in addition to local oestrogen or if you are unable to use topical vaginal oestrogen products.

Ingredients Matter

It’s really important to be aware of the ingredients of your lubricant as the vast majority contain many irritating ingredients including glycerin, which can cause irritation and exacerbate thrush even some available on prescription, propylene glycols, well known vaginal irritants which cause stinging, not just on the vulva and vagina but on the penis and anus, parabens which are hormone disrupters, dyes, parufmes, glitter and alcohol. Be aware that some brands will use describe ingredients differently and also ensure that you’re using a product that is designed for internal use.

Some popular water-based 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.

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 suitable for vaginal use.

YES organic lubricants are odourless, tasteless and feel sensuous on the skin and don’t leave sticky residues behind.

They both offers nourishing qualities that are kind to the skin, rapidly relieving dryness and discomfort, and is pH balanced to maintain good vaginal health.

Using YES oil-based lubricant first and applying YES water-based lubricant one on the top creates a “double glide”: affect, which feels more comfortable and can help sex last longer. However, oil-based lubricants are not latex condom compatible, so stick to water-based lubricant if you are using them.

YES also come in handy applicators making it easy to get the lubricant right inside your vagina.

Cancer treatments impact upon the level of vaginal lubrication you produce, so using YES VM is ideal for restoring moisture and the pH balance of your vagina. Coming in handy 5ml dose applicators, it lasts up to 3 days per application and being bio-adhesive means it releases moisture where needed. You can also use our handy lube applicator too.

SUTIL LUXE is a silky smooth water-based lubricant that moisturises, nourishes and soothes our most intimate areas, as well as lubricating for sexual pleasure. Feeling like a silicone lubricant without the silicone, 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 post 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.

Some people prefer a silicone lubricant which feel more slippery and can be used with condoms, making it a great alternative to oil based lubricants. Silicone lubricants should not be used with silicone sex toys as they can damage the material of the toy.

Often people are unsure how to use their lubricant or vaginal moisturiser and it is all about finding what works for you. Always do a skin test before using any lubricant or moisturiser and wash any product off immediately if it stings, burns or irritates.

Only Wash with Water

It’s important to avoid intimate washes ( not that anyone should use one) and intimate hygiene products because, just like lubricants and vaginal moisturisers they all contain irritating ingredients that exacerbate vaginal dryness and can cause irritation and infections. I call bath bombs thrush bombs because they contain many irritating ingredients! It is also best to avpoid using perfumed menstrual products and scented condoms too. If you really feel you need to use a wash, ask your GP to prescribe a gentle emollient or buy one OTC but please check the ingredients first.

Painful Sex is not Pleasurable Sex.

Undergoing a hysterectomy can leave the vagina feeling shorter and tighter, making sex painful or uncomfortable. Many people are advised to use medical dilators to help them stretch the tissues of the vagina but often find these uncomfortable or feel too clinical as they are made from hard plastic.

A gentler alternative to medical dilators, the Inspire Silicone Dilator Kit offers 5 graduated dilators made from velvety soft silicone which are extremely flexible, unlike hard medical dilators and very gentle on the delicate skin of the vulva and vagina. 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.

Many women combine the use of the Inspire Dilators with the Slinky Kama as it can be used for clitoral stimulation to help relaxation of the vagina whilst using the dilator and it slips into the loop handle which in turn, makes the dilators vibrate. The vibrations promote blood flow to the tissues of the vagina and stimulates the nerves to help sexual sensation too.

It is also ideal to use on yourself or a partner to maintain intimacy as the flexible silicone sleeve can be removed, and you can just use the bullet on your clitoris, nipples, a partner’s clitoris or penis. You can also try a simple bullet vibrator on its own too.

Medical dilators, vibrators and dildos can be used in conjunction with each other as they offer different experiences. 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. Dildos can offer a realistic shape, more akin to that of a penis.

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 and have some fun.

If you struggle with dilators, consider trying a slim vibrator to begin with, and move onto a slightly bigger product. We frequently recommned PicoBing Zizo as do many of the HCPs we work with, because it is smooth with a gently tapering head, simple to use and the size of an average penis which is helpful for those wishing to get back to penetrative sex. Once you have overcome any vaginal tightness, you’ll have a few sex toys to play with! You can also incorporate using your slim toy into your sex play, using you to relax before any penetrative sex play.

Some people have a partner who is more well-endowed so often use a bigger sex toy to help them enjoy pleasurable sex.

The OHNUT is an ingenious device, 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. It is incredibly stretchy, making it suitable for any penis size, especially those who are more well-endowed. Ohnut can be used with a condom, just pop the condom on first, then the Ohnut on top with a little lubricant.

You may want to consider different sexual positions like being on top or a spooning position control the depth of penetration. Use pillows and cushions to find a position that is comfortable for your and your partner.

Decreased Sexual Sensation

Decreased sexual sensation can occur following gynaecological surgery, chemotherapy and radiotherapy, affecting your ability to orgasm. You may find you take longer to have an orgasm or your orgasms feel less strong. You may notice areas of decreased sensation inside your vagina due to scar tissues, so massaging that area with a vibrator can help to promote healing, stretch any tight tissues and increase sensation.

I often recommend regular masturbation because it feels really good, it promotes the blood flow to the vagina and vulva, increasing your natural lubrication and boosting your arousal, it boosts your immunity, reduces stress, helps you sleep, eases pain, helps you to connect with a partner, but you don’t need a partner to enjoy it, increases your chance of enjoying an orgasm during penetrative sex, it connects you with your own sexuality, it boosts your libido, it’s safe so no risk of getting a sexual transmitted infection or pregnant, it’s free, hassle-free, pleasurable and lots of fun!

Using a sex toy offer different sexual sensations and levels of stimulation and are fun to use alone or with a partner.

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!

Simple classic vibrators are great for both internal and external use too.

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

The Game Changers

Sonic waves /air pulse toys have tranafomred the way in which people enjoy orgasms. They are fantatsic for anyone struggling to orgasm and a great way to boost libido as they promote blood flow and sensation to the tissues of the vulva and vagina, all of which helps arousal.

The LELO SONA 2 is a sonic wave stimulator relying on SenSonic technology. The silicone absorbs sonic waves and pulses and transmits them back to the clitoris. These waves stimulate the internal and external parts of the clitoris, gently teasing and caressing the clitoral tissue. The sensation is totally different to vibration, and it really is a game changer for those who struggle to orgasm or have decreased sexual sensation. For more experienced users, it offers an intriguing variation.

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 which creates a completely unique sexual sensation.

We only recommend skin safe products, made from silicone, glass, metal or ABS plastic. Rubber, jelly and latex sex toys are made from materials that may be harmful to health, degrade over time and with some lubricants. They are also 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.

The fabulous Liz O’Riorden, a breast surgeon who had breast cancer and co-author of The Complete Guide to Breast Cancer: How to Feel Empowered recommends getting yourself a “bag of tricks” or intimacy bag including silicone dilators, a simple bullet vibrator and irritant free lubricants and moisturisers.

Sex isn’t just about penetration!

“Normal sex” doesn’t exist, people of all ages enjoy 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, intimate touching or oral sex.

Often when penetrative sex is off the menu, many couples enjoy a more fulfilling sex life by focusing on 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 partners aren’t daunted by their partner using a sex toy.

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 partners gain great pleasure from being able to stimulate their partner in this way.

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.

Sex toys for couples play

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 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 couple’s 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 patients containing sex toys, lubricants and dilators 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.

I often give talks to HCPs in the NHS and private practice to help them feel more confident talking about sex, what lubricants to recommend, suitable sex toys that can help people regain their sexual function, and they signpost their patients to our website and myself for more advice and product recommendations.

We work with and recommend many pelvic health physiotherapists who can help with any pevic health issue caused by cancer treatment, and you can ask your GP or gynaecologist to refer you, or you can find a private physio.

Psychosexual therapists 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!

No one has to give up on enjoying pleasurable sex when they ahve cancer and post treatment. Sex is meant to be noisy, messy, embarrassing, concentual, pleasurable and most of all fun! As a sexual health and wellbeing expert, I never give up on helping people enjoy sexual pleasure and intimacy, and neither should you.

Please give us a call at Jo Divine, email or DM if you would like more advice or a brochure, we’re always happy to help. You can also follow and message me on social media @samtalkssex on Instagram and Twitter where I post helpful videos and posts including talks and events with the cancer charities we work with. We also have a facebook page too.

The fabulous Kaz Molloy set up Womb Cancer Support after struggling to find help and support during and after treatment. Womb Cancer Support was the very first cancer charity we started working with at Jo Divine and are very proud to be part of the amazing work Kaz does in helping so many people. Despite being the 4th most prevalent female cancer, there is no national charity or campaign for Womb Cancer.

I also recorded an episode with Dr Liz O’Riordan all about sex, cancer and so much more on her podcast Don’t Ignore The Elephant which may be of interest too.

Useful Websites

Peaches Trust
AskEve: www.eveappeal.org.uk – online and phone support by specialist oncology gynaecology nurses
Trekstock
Pelvic, Obstetric and Gynaecological Physiotherapy
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
Jennifer Young : www.beautydespitecancer.co.uk
HipHeadWear : www.hipheadwear.co.uk
The Menopause Charity

Lydia Brain was diagnosed with an 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