Sexual pain

Sexual pain is a common problem following cervical cancer treatment. It is important to let your consultant or CNS know if you are experiencing pain during intercourse so they can identify or eliminate possible medical reasons.

Pain with intercourse is called dyspareunia. You may experience pain during penetration if you’re not fully aroused. You may also find that some sexual positions are more painful than others; for example, those that involve deep penetration. Pain can impact on all areas of sexual response. The fear and experience of pain can reduce desire, hinder arousal and orgasm, and reduce satisfaction, due to discomfort and a delay in your body returning to normal following sex.

As highlighted in other sections, you may have difficulty in becoming aroused. This can be as a result of insufficient stimulation and psychological factors, as well as the physical and hormonal factors that hinder natural lubrication. If this is the case you may need to use additional lubrication.

Vaginal dryness due to hormonal changes may improve with a course of local oestrogen and you will need to discuss this with your GP, consultant or CNS. Alternatively, vaginal moisturisers used two to three times a week will help to keep the vagina moist; although you may still need to use lubrication during penetration.

When using lubrication, try to incorporate it into foreplay making it part of your sexual routine. There are different types of lubrication available: 

  • Water-based lubricants are the most common. They may need to be frequently reapplied and you need to bear in mind they dissolve in water so they shouldn’t be used if the sexual activity involves water (e.g., in the shower).
  • Silicone lubricants last longer and do not need to reapplied as often as water-based lubricants and they can be used in water.
  • Oil-based lubricants also last longer than those that are water-based, but they will not hydrate vaginal tissue and they should not be used with condoms. Sometimes oil- and water-based lubricants can be used together.

Many can be purchased online if you feel awkward buying these in a shop.

Following radiotherapy, women are usually advised to use dilatation therapy to maintain vaginal function. International guidance recommends using dilators [1], vibrators, fingers or similar shaped devices if you are not having vaginal intercourse at least weekly. The evidence on frequency and duration of dilation varies from three minutes twice a week to up-to 10 minutes twice a day, stopping at two years post treatment if there are no problems (there is new evidence to show that dilation therapy can be beneficial for longer than two years, your CNS will be able to advice you about what is right for you). It’s thought that dilation therapy prevents or treats vaginal stenosis (or narrowing of the vagina) and breaks down adhesions; the evidence isn’t conclusive, but it’s best practice with the current information HCPs have available.

Sometimes the fear of pain during penetration will result in involuntary spasms of your pelvic floor muscles, which are the muscles you tense to stop yourself passing urine. This can mean that you are more likely to experience pain around the entrance to your vagina due to muscle tension. Doing pelvic floor exercises (often together with the insertion of a lubricate finger or dilator/vibrator) and concentrating on the release rather than the squeeze can help. Mindfulness, relaxation and deep breathing exercises are other techniques suggested by sex therapists to help with this problem.

Certain sexual positions can be more painful than others. Your vagina may be shorter as a result of surgery and the cushioning of your pelvis is reduced if you’ve had your womb removed, making deep penetration either with a partner or with a sex toy painful. Talking to your partner and considering experimenting with different positions can help. Being on top during sex can be more comfortable because it means you can control the depth and rate of vaginal penetration.

If you’ve had exenteration surgery or your vagina has been significantly damaged because of radiotherapy or fistulas you may have had or been offered vaginal reconstruction. The aim of reconstruction is to maintain sexual function and restore body image. You may have issues with pain and will have altered sexual sensations. Specialist support should be available and you should ask if you need it.

Psychological factors can also affect your sexual experience, internal thoughts and feelings can maintain a negative cycle causing continued sexual difficulties and resulting in painful or unsatisfactory sex. Good communication with your partner, if you have one, is essential. You may benefit from extra support and guidance professionally in order to explore and help you understand your fears, feelings and thoughts, as well as for suggesting interventions that may help to move you forward.

You may like to visit our useful links page on sex and relationships. 


Reference

1. International Clinical Guidance Group, 2012. International Guidance on Vaginal Dilation after Pelvic Radiotherapy, Oxford: Owen Mumford.

Date last updated: 
11 Feb 2015
Date due for review: 
11 Feb 2018

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