Hear from Dr. Philippa Kaye, a GP with a particular interest in children’s, women’s and sexual health, talks about the about effect a cancer diagnosis can have on your sex life along with the tips and advice that can help.

Cancer tries to hijack everything, from your home life, your work life, to your actual life! Your sex life is part of that, and while many people expect there to be a drop in their sex drives while they are recovering from surgery, or undergoing chemo or radiotherapy, they are often surprised that there can be an ongoing impact on your sex life.

Vaginal dryness is a common issue which affects many women at various stages of their lives; it can be a side effect of the contraceptive pill, occur during breastfeeding or after the menopause. Add in chemotherapy which can lead to dry skin all over your body and the vagina and vulva can most definitely be affected. Many patients who have had cancer will also be launched into premature menopause for example, if your ovaries have had to be removed surgically (surgical menopause), or due to medications given to block hormones (medical menopause). Premature menopause is defined as going through the menopause, when your periods stop, before the age of 40.

The drop of hormones, oestrogen, progesterone and testosterone can affect your libido. Sex drive is actually quite complex, as it often involves a mix of physical and psychological factors. After all, if sex hurts on one occasion, you are less inclined to want to have it again! Vaginal dryness after the menopause is often due to the lack of oestrogen, meaning the vagina becomes dryer, less able to produce lubrication during sex and less able to stretch.

There are things you can do to help; firstly, stop any irritants. The vulva, the external genitals, can and should be washed, but again use water, emollient creams or non-perfumed, non-allergenic soap. Wear cotton underwear or at least underwear with a cotton gusset. Try to avoid wearing tight trousers or leggings with knickers and tights or, if you do wear these, then when you get home to take a few layers off. And your mother was right, consider going to bed without knickers!

A good lubricant can make a real difference to sex but most sexual lubricants are not great for the skin of the vulva and vagina. In fact, lubricants containing glycerine and glycols can further irritate the vulva and vagina and those with a high pH can increase the risk of vaginal infections. Water-based lubricants feel silky and similar to natural lubrication, but they don’t last particularly long. Oil-based lubricants are richer and creamier and last longer however, oil-based lubricants are not appropriate if you use condoms as they can affect the integrity of the condom itself – not always ideal! Brands such as Sylk or Yes lubricants fit these criteria and can be helpful without being an irritant. If you don’t need condoms then the double glide effect can be sex life-changing, using the oil-based lube in you and the water-based on your partner, or your sex toy. As water and oil don’t mix one glides over the other!

Vaginal moisturisers are used more regularly to moisturise the genitals. So if you have itching, general burning, soreness or discomfort you may benefit from a vaginal moisturiser. Brands include Yes and Replens. Some come with applicators and some without and they are available on prescription as well as over the counter. Start off by using them daily and then after a week or two you can decrease to using them every three days.

Topical oestrogen is oestrogen which is given straight into the vagina and is a very effective form of treatment for vaginal dryness or painful sex, but also for urinary symptoms. It is technically a form of hormone replacement, but it is not considered as HRT as so little is absorbed into the bloodstream. It has no effects on the rest of the body (no systemic effects) and is considered to be virtually risk-free. Previously, if you have had breast cancer then it was thought that you could not have topical oestrogen, but current evidence is that it is generally safe to do so. The only contraindication for giving vaginal oestrogen is during active treatment for breast cancer, not that you have had a past history of breast cancer. If you are taking tamoxifen after breast cancer treatment your doctor may ask for advice from your oncologist, but unless you are receiving active treatment for breast cancer, it is considered fine and safe!

Other treatments are available for example if you are taking hormone replacement therapy for premature menopause and have a loss of libido, then adding in some testosterone replacement can be helpful. Psychosexual issues can also be addressed.

If you feel your sex life is affected, be it due to vaginal dryness and pain or a loss of sex drive, please don’t be embarrassed. See your doctor, there are lots of treatments which could help!

Watch our Trekstock Talk's on Sex and Cancer for even more information