Female Sexual Dysfunction: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources.

What is female sexual dysfunction?

Cancer and its treatment can affect many different aspects of your life. One area of your life that might have changed is your ability to have or enjoy sex. These changes are sometimes referred to as sexual dysfunction caused by cancer or its treatment.

Cancer doesn't always cause sexual dysfunction in survivors. Survivors respond to sexual dysfunction in different ways. If you are frustrated and want to find ways to manage the sexual dysfunction that you experience, this document has information that may help you.

There are many different causes for sexual dysfunction after cancer. Whether the cause is physical or emotional, there may be ways to treat and manage your sexual dysfunction. You can discuss treatment options with your health care team.

You may find it difficult to discuss sexual dysfunction with your health care team. It can feel uncomfortable or embarrassing. But your health care team can answer your questions. You can talk to them about how sexual dysfunction is affecting your life after cancer.

What are some signs of female sexual dysfunction?

Some signs of sexual dysfunction women may experience after cancer include:

Loss of desire for sex
Negative thoughts and feelings during sex
Difficulty reaching climax
Vaginal dryness and tightness
Pain during sex or when your genital area is touched

The symptoms listed above aren't always medical emergencies. You may wonder if you should bring them up to a member of your health care team. But all of your concerns are important. If you are experiencing pain or if sexual dysfunction makes your life less enjoyable, you should discuss your concerns with a member of your health care team. You may feel more comfortable if you write down your questions before your appointment and bring them in. Your health care team can talk to you and answer your questions about all of your health problems, including sexual dysfunction.

When does female sexual dysfunction appear?

Most sexual dysfunction in cancer survivors follows cancer treatment. You may have decided that you want to wait a while after your treatment until you have sex. That is understandable. But if you want to begin having sex again and are experiencing any of the symptoms listed above, you might have a sexual problem that can be helped.

Sometimes sexual dysfunction caused by radiation to the pelvis may take longer to develop. You may not notice any dysfunction until months or years after you finish treatment. If you notice any changes in your ability to have or enjoy sex during your survivorship, you can discuss your concerns with your health care team.

What causes female sexual dysfunction after cancer?

There are many different causes of sexual dysfunction in cancer survivors. Some are physical causes and some are caused by changes in how you feel about yourself, your body or other aspects of your life after cancer.

There are certain types of cancer, like those that affect your sexual organs, that put you at risk for sexual dysfunction after cancer. About half of survivors of breast cancer or cancer in the pelvic area (cervix, ovaries, uterus, bladder, colon, and vagina) develop long-term sexual dysfunction. However, most sexual dysfunction is caused by the treatment for cancer and not the cancer itself. Even if you didn't have a type of cancer that affects your sexual organs, the treatment you received might put you at risk for sexual dysfunction.

Some of types of treatment for cancer that may cause sexual dysfunction:

Chemotherapy can damage the ovaries, causing hormonal changes and temporary or permanent menopause in younger women (alkylating drugs are most likely to cause damage)
Hormone therapy
Radiation to the vagina, cervix or uterus
Surgery or radiation therapy for cancers in the pelvic area (bladder, colorectal, cervical, ovarian, uterine, vaginal or vulvar cancer)
Side effects of medicines used to treat pain, nausea, depression or anxiety

Sometimes cancer treatment causes physical changes in a woman's body that affect how she feels about herself or her body. This can also contribute to sexual dysfunction. Women who were uncomfortable with their sexuality or had tension in their relationship before cancer often have problems regaining a satisfying sex life after treatment. Working with a mental health professional may help improve how you feel about yourself and improve the sexual dysfunction you might be experiencing.

Some of the emotional causes for sexual dysfunction can be:

Feeling sad or depressed
Feeling unattractive
Stress in your relationship with your partner
Difficulty feeling good about yourself because of changes in your body

The table below lists more information about some of the causes of sexual dysfunction. This table doesn't provide all of the information about the many possible causes for sexual dysfunction in cancer survivors, but it does provide you with information that you may want to discuss further with your health care team.

Physical Damage to Your Body From Cancer or Treatment	Type of Cancer Treatment That May Cause the Damage	Type of Sexual Dysfunction It May Cause
Low testosterone levels	Common if a woman's cancer treatment causes premature menopause in younger women Greater damage with higher dosages of chemotherapy, pelvic radiation, if both ovaries are removed in surgery or if a woman is over age 35	Loss of desire for sex Trouble feeling excited or sexual pleasure with touch Trouble reaching orgasm
Low estrogen levels	Menopause happens when the ovaries no longer make estrogen. After cancer treatment, younger women may have a sudden, early menopause. Women who had already been in menopause but were taking estrogen replacement may need to stop this treatment if they had breast cancer Tamoxifen, the most common hormone treatment used for breast cancer, does not decrease estrogen levels, but rather blocks estrogen from entering breast cells Hormone therapies like raloxifene (Evista) or letrozole (Femara) may cause vaginal dryness	Loss of vaginal lubrication and expansion with sexual excitement. Normally as blood rushes into the vaginal walls, the lining of the vagina produces moisture and the vagina opens up, becoming a third deeper. Lack of estrogen also causes hot flashes, which may disturb a woman's sleep, making her tired, irritable, and less interested in sex
Damage to blood flow to the vaginal walls and vulva	Scarring from pelvic radiation therapy can decrease blood flow to the vagina and vulva Women who had bone marrow transplants from a donor can have vaginal scarring from graft vs. host disease	Dryness of the vulva and vagina Loss of vaginal length Slow-to-heal sores on the vaginal walls Tight bands of scar tissue that narrow the vagina These may all cause pain with sexual activity, especially during intercourse
Damage to the cervix or its nerve-supply	Radical hysterectomy removing the uterus, cervix, upper vagina, and some nearby ligaments Some operations that include hysterectomy as well as removing the bladder and/or colon	Research on sex after hysterectomy does not show related sexual dysfunction
Removal of part or all of the vulva or vagina	Partial or total vulvectomy to treat cancer of the vulva Partial or total vaginectomy to treat cancer of the vagina, cervix, bladder, or colon	Loss of pleasure with removal of areas sensitive to caressing Pain if the vaginal entrance gets narrow with scar tissue Lack of sexual sensations in a vagina reconstructed using other body tissues

Are there successful treatments for female sexual dysfunction?

There are many different treatment options that may help you with sexual dysfunction. If you think that sexual dysfunction is interfering with your ability to enjoy life after cancer, you might want to consider finding ways that you feel comfortable discussing your sexual dysfunction with your health care team. Ask for a longer appointment so you will have time to bring up sensitive questions. Sexual dysfunction may not go away on its own. Your health care team can help you learn more about the treatment options available and how to improve your ability to have and enjoy sex again.

Sometimes treatments do not work and your sexual dysfunction may continue to affect you. This can be very frustrating and upsetting for both survivors and their partners. Intercourse is only one way of sharing pleasure and closeness with your partner. Some survivors who can't have sex find they still enjoy cuddling and caressing their partner. You might want to try other ways of sharing pleasure and feeling closeness with your partner.

You have a right to sexual health, and you can work with your health care team to treat sexual dysfunction. However, you do not have to be sexually active in order to stay healthy.

What can be done to manage sexual dysfunction?

The most important factor in choosing a cancer treatment is its ability to control cancer. However, your sexual health is also important to you. If you are worried about sexual dysfunction after your treatment, talk to your health care team about different therapies. When sexual dysfunction does occur, you and your partner can overcome them with open communication and mutual affection, as well as with help from your health care team.

For more information on managing female sexual dysfunction, see Suggestions.

This document was produced in collaboration with:
Leslie R. Schover, Ph.D.
Professor of Behavioral Science, UT M. D. Anderson Cancer Center

Works Cited

American Cancer Society. "Sexuality and Cancer: For the Woman with Cancer and Her Partner." Atlanta: American Cancer Society, 2001 (99-rev. 07/01-50M-no. 4657-HCP).

Andersen, Barbara L. "Surviving Cancer: The Importance of Sexual Self-Concept." Medical and Pediatric Oncology 33 (1999): 15-23.

Ganz, Patricia, Julia A. Rowland, Katherine Desmond, et al. "Life after breast cancer: Understanding women's health-related quality of life and sexual functioning." Journal of Clinical Oncology 16 (1998): 501-14.

Grumann, Mareile, Robert Robertson, Neville F. Hacker, and Greta Sommer. "Sexual Functioning in Patients following Radical Hysterectomy for Stage IB Cancer of the Cervix." International Journal of Gynecologic Cancer 11 (2001): 372-80.

Jensen Pernille T., Mogens Groenvold, Marianne C. Klee, et al. "Longitudinal Study of Sexual Function and Vaginal Changes after Radiotherapy for Cervical Cancer." International Journal of Radiation Oncology, Biology, and Physics 56 (2003): 937-49.

National Ovarian Cancer Coalition. Ovarian Cancer: Sexuality and Intimacy. Boca Raton, FL: 2003.

Schover, Leslie. Sexuality and Fertility after Cancer. New York: John Wiley & Sons, 1997.

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