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Painful sex after cervical cancer

Painful sex is known as dyspareunia. It is a common problem that can be created or made worse after cervical cancer treatment.

We hope this information about what can cause painful sex and ways to manage it is helpful. If you have a partner, you may find it helpful to read this page together or separately.

On this page:

Causes of painful sex

Painful sex is a common problem for many women and people with a cervix, whether or not they have had a cervical cancer diagnosis . However, it can be a problem that is created or made worse after cervical cancer treatment.

Physical impacts of cervical cancer treatment

Surgery and radiotherapy or brachytherapy can both cause hormonal and vaginal changes. This may make the vagina narrower and shorter, which is called vaginal stenosis . Or the vagina may become dryer and less stretchy than it was before, which is called vaginal atrophy . 

If you have had surgery to remove all or part of the cervix, the womb and the upper part of the vagina, this may also have changed the physical sensations in your genitals. 

Understandably, these changes can make intimacy and particularly penetrative sex more difficult, uncomfortable and painful.

Psychological impacts of cervical cancer treatment

Treatment can also affect how you feel about your body and sexuality, which can make sex less appealing. This could cause sex to be painful if it makes it difficult to become aroused. 

If sex you’ve had has been painful, or you are worried it will be, that fear can have a knock-on effect on other areas of your sex life. It could make it harder to feel relaxed or in the moment, which can result in involuntary spasms of your pelvic floor muscles (vaginismus). This tension can then make any pain worse. All of this can create a cycle of distressing, uncomfortable and unsatisfying sex – or it may put you off trying to have sex at all. 

The good news is that there are ways to break this cycle and have a sex life that works for you. As well as the information on this page, you may find it helpful to read our information about other sexual problems:

Lubrication

Difficulty getting aroused and reduced vaginal lubrication are a common cause of painful or uncomfortable sex. You could start out by using a lubricant and focusing on the intimacy tips that could help sex or masturbation to feel more comfortable. 

There are different types of lubricant available. You might want to try out a few different options to see what works and feels best for you and, if you have one, a partner. 

As a general rule, it’s a good idea to avoid lubes with lots of chemicals like perfumes or flavourings. These can irritate your already sensitive vagina and make the skin feel sticky or tacky instead of smooth and moist. 

Water-based lubricants

Water-based lubricants are the most common types of lubricant. They usually don’t cause as many side effects as some other types of lubricant . They are also safe to use with condoms and dental dams. 

Water-based lubricants don’t last as long as silicone or oil-based lubes, so may need to be reapplied frequently. They cannot be used in water, so be careful not to use them in the bath or shower.

Silicone lubricants

Silicone lubricants can be used in water and don’t need to be reapplied as often as water-based types. They are safe to use with condoms and dental dams.

It is best to avoid using silicone lubricant if you are using silicone sex toys, as they can break down the rubber over time.

Oil-based lubricants

Oil-based lubricants last longer than water-based types, but cannot be used with condoms or dental dams. Your healthcare team may suggest you avoid using oil-based lubricant, as they don’t hydrate the vaginal tissue and can cause irritation . 

If oil-based lubricant doesn’t cause irritation, you may find it helpful to apply it and then apply a water-based lubricant over the top. This can give a slide and glide sensation, which may help to make sex feel more comfortable.

Getting lubricant

You should be able to get water-based lubrication for free by prescription. Explain your situation to your GP – it can help to include that the painful sex is a result of cervical cancer treatment.

If you would prefer to buy lubricant yourself, there are lots of different options available that can be ordered discreetly and conveniently online. Some companies even offer samples, so you can try before you buy.

HRT and vaginal moisturisers

For hormonal issues related to going through early menopause, your GP may able to prescribe hormone replacement therapy (HRT) or a local oestrogen. You apply these to the vagina as a cream or gel and they help to reduce symptoms like vaginal dryness. Alternatively, you may be treated using vaginal moisturisers. These are usually applied two to three times a week and help keep the vagina moist.

Only using lubricant might not solve the problem, but remember there are treatments and therapies you can try as well. The best solution for you will depend on the exact cause of the problem, which is why it’s important to speak to your GP or healthcare team.

Dilators

You may already have been advised by your healthcare team to use dilators to keep the vaginal tissues stretchy, the vagina open and comfortable for sex, if that is important to you. Dilators are commonly used after pelvic radiotherapy or brachytherapy, as well as for other conditions like involuntary pelvic floor spasms (vaginismus). Using dilators is sometimes called dilation therapy.

How to use dilators

Dilation therapy involves gently inserting tampon-shaped plastic tubes (dilators) into your vagina. It aims to prevent or treat any narrowing of the vagina (vaginal stenosis). Dilators come in different sizes, so you can start with a very small one and build up as it becomes more comfortable. 

It’s possible to practise dilation therapy using your fingers, vibrators or similar shaped devices. It’s a good idea to use lubricant to make it more comfortable. 

You may find it useful or even arousing to practise dilation with your partner. This can be another way of building intimacy and reconnecting with your body together. But using a dilator doesn’t have to be sexual. You may find it more helpful to do a relaxing activity while you are dilating, such as, watching television, listening to music or practicing mindfulness.

When and why to use dilators

There is limited evidence on how effective dilation therapy is, but it is usually recommended based on the existing research   . Your healthcare team will tell you how long and how frequently you should use dilators, as it depends on your treatment and personal situation.  This could be between 3 minutes twice a week, to up to 10 minutes twice a day. Dilation is usually recommended for up to 2 years after your treatment, but there’s some evidence that it can be beneficial for longer than that .

Getting support

Your clinical nurse specialist (CNS) should talk you through dilation therapy, and can give more personalised advice that’s tailored to your needs and circumstances. Don’t be afraid to ask for more information or advice if you’ve got any questions or concerns. You might find it useful to read our online Forum for dilation tips and experiences. 

Get dilation tips from our Forum > 

Pelvic floor exercises

Fear of pain can sometimes cause vaginismus – involuntary pelvic floor spasms, which increases muscle tension and may make pain worse around the entrance of your vagina. Doing pelvic floor exercises which focus on releasing, rather than squeezing, can help your pelvic floor muscles to relax. 

These are different from the type of pelvic floor exercises you may have used previously to improve bladder control. These focus on squeezing the muscles, rather than relaxing them. A pelvic physiotherapist or a sex therapist may be able to help you with getting the technique right. 

Pelvic floor exercises can often be used alongside dilation therapy, as well as breathing exercises or other relaxation techniques.

Read about vaginismus on the NHS website >

Different sex positions

You might find that certain positions are more painful than others when it comes to penetrative sex. Talk to your partner and experiment with different, more comfortable positions. Be honest about what’s working or not working for you, and don’t be afraid to let your partner know if something is painful. A loving and supportive partner would rather stop and try something different than continue hurting you. 

For vaginal sex, try positions that let you control the movement, depth and speed of penetration. For example, being on top.

Alternatively, you might prefer to stick to shallow or no penetration. This is a perfectly valid choice. There’s far more to sex and intimacy than just penetrative sex, and there are many ways of giving and receiving pleasure that don’t involve penetration. In fact, you may get the most pleasure from clitoral  stimulation. You could ask your partner to use a finger, tongue or vibrator on your clitoris, or do it yourself, for a really satisfying experience if penetrative sex is too painful.

Psychosexual therapy

Psychological factors can play a role in both the desire to have sex and how aroused you become. By this, we mean your thoughts and feelings about sex and other things in your life. If you’re feeling anxious, stressed, tired or are having issues in your relationship, it may be difficult to relax enough to feel aroused and ready for sex.

Your thoughts and feelings interact with the physical sensations in your body. This can cause a cycle of painful and unsatisfactory sex. Whether it’s anxiety about the cancer coming back, or low self-esteem because of changes to your body, talking these issues through with a professional psychosexual therapist may help to break down some of the emotional barriers getting in the way of your sex life. This could be done alone or with a partner, if you have one.

Read more about relationships and cervical cancer > 

Getting support from healthcare professionals

It is important to let a healthcare professional know about anything impacting your sex life, including painful sex. Their role is to support you and make sure you have a good quality of life after diagnosis and treatment – and this includes your sex life.

Speaking to your hospital healthcare team

If you are still under the care of your healthcare team at the hospital, speak to your CNS or consultant about the issues you’re having. They can assess and identify the problem, and suggest ways to manage it or refer you to a specialist. 

Speaking to your GP

If you have been discharged from the care of your hospital healthcare team, you can still access support through your GP surgery. Speak to your GP or a practice nurse that you know, trust and feel comfortable with. You can explain that sex has been painful since you had treatment for cervical cancer. They may be able to prescribe something to help, suggest ways to manage it, or they might refer you to a gynaecologist, menopause specialist or psychosexual therapist.

Read more about getting support for sex and relationships > 

More information and support about painful sex

Whatever you try, remember that communication and honesty is key. This might be particularly tricky and uncomfortable if you’re in a new relationship or have just started dating someone. When and how you talk about your experience with cervical cancer is entirely up to you, but don’t keep going with sex if it’s causing you pain or suffer in silence. 

Seeking help for painful sex can feel uncomfortable, but there are techniques, therapies and treatments that could help you get your usual sex life back. We have a page with lots of suggestions for where to get that support. 

Read more about getting support for sex and relationships > 

If you’re aren’t sure where to start, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.

Check the opening hours > 

Our 1-to-1 service offers a private way to get support over email, phone call or video call. Although we can’t offer sex therapy or relationship counselling, we can talk through your personal situation, as well as helping you process your feelings and think about next steps. We also welcome partners to use our 1-to-1 service, so if you are a partner reading this or think yours would benefit from some extra support, get in touch. 

Access our 1-to-1 service > 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. It even has a section dedicated to relationships. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

If you have general questions about sex after cervical cancer, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • Araya-Castro, P. et al (2020). Vaginal Dilator and Pelvic Floor Exercises for Vaginal Stenosis, Sexual Health and Quality of Life among Cervical Cancer Patients Treated with Radiation: Clinical Report. Journal of Sex and Marital Therapy. 46;4. pp.513-527.
  • Mitchell, KR. et al (2017). Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG. 124;11. pp.1689-1697.
  • Morris, L. et al (2017). Radiation-induced vaginal stenosis: current perspectives. International Journal of Women's Health. 9. pp.273-279.
  • Edwards, D. and Panay, N. (2015). Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric. 19;2. pp.151-161.
  • Law, E. et al (2015). Prospective study of vaginal dilator use adherence and efficacy following radiotherapy. Radiotherapy and Oncology. 116;1. pp.149-155.
  • Miles, T. and Johnson, P. (2014). Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database of Systematic Reviews.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]

Read more about how we research and write our information >

"Dilators were perhaps my biggest challenge! There were so many women struggling with them."
Read Lisa's blog
Date last updated: 
28 Oct 2020
Date due for review: 
28 Oct 2023
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