For more information about adapting to life with a stoma, ask your treatment team or contact your local stoma association.

Effects on fertility

Although the vulva is a part of the female sex organs, in most cases treatment for vulvar cancer does not affect fertility. If you are concerned, ask your doctor for advice.

Sexuality, intimacy and vulvar cancer

Having cancer doesn’t mean you are no longer a sexual person. However, treatment such as surgery, chemotherapy and radiotherapy can affect your sexuality. This includes your interest in sex, your ability to give or receive sexual pleasure, how you see yourself and how you think others see you. Some of these effects are temporary, whereas others are permanent. All can be managed or controlled.

If you are concerned about changes to your sex life, it is important to talk to your partner. They may feel that, if they raise the topic, they might place too great a demand on you or make you feel guilty.

You can also talk to your healthcare team about the potential challenges you may face having vulvar cancer. Knowing what changes may occur, and addressing them if they affect you personally, will help you overcome or adjust to the changes.

If you are experiencing a sexual problem because of cancer treatment, you may find it helpful to discuss it with your doctor, or you may feel more comfortable talking to a hospital counsellor, social worker or psychologist.

Cancer Australia has developed a booklet on intimacy and sexuality for women with gynaecological cancer, to support women (and their partners) in understanding and addressing issues of intimacy and sexuality following the diagnosis and treatment of gynaecological cancer. It aims to empower women so they can ask questions that they may otherwise avoid asking due to embarrassment or other concerns.

The Cancer Council Helpline – 13 11 20 – can also put you in touch with a counsellor or a sex therapist and can provide a copy of the booklet Sexuality, intimacy and cancer.

After surgery

Many women feel shocked and upset by the idea of having treatment to one of the most intimate and private parts of their body. You may experience a wide variety of emotions, including anger, fear and resentment, all of which are normal.

When these feelings are combined with the physical effects of treatment, you may find that the closeness of your relationship with your partner is affected. It may also take time to feel interested in, and comfortable during, sexual intimacy.

Sharing your feelings can bring you and your partner closer together. You may also find it reassuring to talk to someone else who has been through the same experience.

Physical changes

Women who have had vulval surgery have different feelings about looking at the vulva afterwards. Some women don’t want to look at the area. Others want a nurse to be with them when they look for the first time. A nurse can explain what has happened to the area and can offer professional support and advice.

Some women prefer to look alone or with a partner, friend or relative. Whoever you choose, make sure it is someone you trust and can talk to openly about your feelings.

If you decide to look at the vulval area, it is natural to feel shocked by the changes. If the labia have been removed, you will be able to see the opening to the vagina much more clearly. If the clitoris has been removed, there will now be an area of flat skin without the usual folds of the vulva.

Taking your time

Although the area of the operation usually heals within about 6 weeks, the emotional effects will probably take much longer to deal with. This will require gentleness and sensitivity from yourself and the people close to you.

It may be some months before you begin to enjoy sexual activity again. Don’t be surprised if you feel very unsure about it. Remember that you need to make yourself and your healing a priority. Allow yourself to say no to any kind of sexual contact that does not feel right.

Physical problems

People’s sex lives often change during and after cancer treatment. You may find that your interest in sex is diminished, and you may also experience some physical sexual problems.

Sometimes surgery causes scar tissue to form around the outside of the vagina, narrowing the entrance to it. Radiotherapy can cause scarring and narrowing of the vagina itself. Both situations may produce pain during intercourse, but using plenty of lubricant and trying different sexual positions can help. Water-based and nonperfumed lubricants are best.

Using a vaginal moisturiser 2 or 3 times a week may help. A hormone cream can also help keep vaginal tissue supple and lubricated. These creams are available on prescription from your doctor.

If you don’t feel like having sex, or you find penetration uncomfortable, let your partner know.

If pain is a problem for you, plan sexual activity for the time of day when your pain is lowest. If you are using pain medication, take it shortly before sex so it will be in full effect during lovemaking. Use positions that put minimal pressure on the painful areas of your body and allow you to control the depth of penetration. Learn relaxation techniques to help stop the muscles tensing up.

If it is still too painful, talk to your doctor. The Cancer Council Helpline (13 11 20) can also let you know where you can get help and support for this problem.

Effect on orgasms

You may worry that, if your clitoris has been removed, you won’t be able to have an orgasm. This is not necessarily the case, but you may need to take time to explore different ways to climax. There are many other parts of your body that, when caressed, can increase sexual excitement and lead to orgasm. The breasts, inner thighs, feet and buttocks are all very sensitive areas of the body.

You and your partner can still be intimate without trying to have intercourse or reaching an orgasm. Sharing your feelings for each other in intimate ways such as cuddling, kissing, stroking and massage can often be as satisfying as full penetration and climax.

Tips:

• Think about pleasurable sexual experiences, watch romantic or erotic DVDs, or read sexy literature to stimulate you.
• Guide your partner’s hands or fingers to areas that arouse you.
• Consider using an electric vibrator to give you extra stimulation to help you reach orgasm.
• Focus on your breathing to help you relax and focus on the pleasure of the whole experience.
• Tighten and relax your vaginal muscles in time with your breathing during penetration or while your sensitive areas are being stroked.

Your doctor or nurse may be able to discuss this with you. You may also wish to speak to a sex therapist or counsellor experienced in this area.

Regaining sexual confidence

For many women, sex is more than arousal, intercourse and orgasms. It involves feelings about intimacy and acceptance, as well as being able to give and receive love.

If we are not comfortable with the way we feel about our bodies, this may affect our confidence and desire for sex. Some women worry about being rejected by a current or future partner because of changes to their body, whether these changes are visible or not.

It is sometimes difficult to communicate sexual needs, fears or worries with your partner in an intimate relationship. If your vaginal cancer treatment involves treatment to the vulva, you may find it even more difficult. But, you may be surprised and encouraged by the amount of tolerance, trust, tenderness and love that exists between you.

However, problems can arise because of misunderstandings, differing expectations, and different ways of adapting to changes to your sex life. If this happens, you may find counselling helpful, either with your partner or on your own. You may be able to work through these challenges towards a new closeness and understanding.