It is not uncommon for treatment of leukemia or lymphoma to cause changes in your sexuality and sex life. Like any other type of side effects, the kinds of changes you will experience are hard to predict. Some changes may impact both sexes. Loss of desire for sex, pain, changes to your appearance and loss of fertility are issues that affect men and women alike. However, there are a few sexual side effects of blood cancer treatment that are specific to women.
Premature menopause is a common side effect of chemotherapy and radiation therapy. Damage to the ovaries, permanent or temporary, can cause a decrease in the hormone estrogen, which leads to symptoms of menopause -- which might include vaginal dryness, vaginal tightness, loss of menstrual periods, hot flashes, and changes to the vaginal tissues. Symptoms of premature menopause tend to be more severe than natural menopause, which progresses more slowly.
In some cases, your healthcare provider may choose to put you on a hormone replacement pill or patch to relieve some of these symptoms. If not, they may choose to order a medication to lessen the severity of the hot flashes, such as a selective seratonin reuptake inhibitor (SSRI). Many women also find that relaxation techniques and guided imagery can help to overcome the discomfort.
You may choose to try a vaginal lubricant or moisturizing cream or jelly to help with the vaginal dryness. “Oh My,” “Replens,” “K-Y jelly,” and “Astroglide” are examples of this type of product. You can use these several times a day to relieve symptoms and in particular before intercourse to make you are more comfortable. Petroleum jellies such as Vaseline are not recommended for this purpose.
Radiation to the pelvic area can also cause changes to your vaginal tissues. You may find that you are more tender in the genital area, or that your vagina is more tight or dry than usual. In addition to vaginal moisturizers, your radiation oncologist or nurse may recommend a vaginal dilator. These dilators are inserted into the vagina for a few minutes each day to help prevent the tissues from tightening up too much.
Graft versus host disease following allogeneic stem cell transplant can also affect the vaginal tissues. In addition to the effects that the high-dose chemotherapy can have on the function of your ovaries, stem cell transplant can have a big impact on your sex life. Treatment of the graft versus host disease using steroids or immune suppressing drugs may help to resolve the symptoms. Your healthcare provider may recommend the use of vaginal dilators at this time as well.
Decreased immunity is a side effect of leukemia or lymphoma as well as treatment for those illnesses. Infection prevention is extremely important at this time. During sexual intimacy, ensure that germs from your anal area do not come into contact with your vagina or urethra through touching or contamination of sex toys. This in addition to emptying your bladder after sex can help reduce the risk of developing a urinary tract infection.
You may be at higher risk of contracting sexually transmitted infections when your immune system is low. Be sure to use a barrier such as a condom for all sexual activity involving a partner. Genital herpes and genital wart infections can flare up when your immunity is decreased.
A low immune system with the addition of antibiotics and steroids that you might receive as part of your therapy creates a prime breeding ground for vaginal yeast infections. Wearing breathable cotton underwear and loose bottoms can help reduce the risk.
When you feel ready to resume sexual activity with your partner, set aside some quiet relaxation time and go at your own pace. If something does not feel good (or does!) let your partner know and explore together. You may decide to begin with some light touching, and avoid intercourse. The important thing is to not rush or allow each other to become frustrated.
While it is not unusual for women to have changes to their sex life and sexuality while undergoing treatment for a cancer diagnosis, many feel uncomfortable talking about it with their healthcare provider, let alone their partner. There may be physical changes that are getting in the way, or even emotional roadblocks. At this time, when your relationship may already be strained as a result of your new stressors, it is important to communicate with your partner about how you are feeling about sex. Open up the topic for discussion and you may be surprised to hear that they may share many of the same anxieties that you have, or you may realize that you had nothing to worry about after all.
Katz, A. (2009). Woman Cancer Sex. Oncology Nursing Society: Pittsburgh, PA.
Katz, A. (2007). Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Professionals. Oncology Nursing Society: Pittsburgh, PA.