Does Pelvic Radiation for Cancer Affect Female Sexuality?

Sexuality is a complex synthesis of the physical, psychological, and social interaction. Cancers that develop in the pelvis, such as uterine, cervical, anal or rectal cancer may require surgery, radiation or both. How does radiation affect women and their sexuality? Often, sexuality is neglected after treatment, or considered secondary in terms of importance related to overall survival. But in women who survive, can they resume sexual activity, and how are they affected by radiation to the pelvis? Survival rates for cancers are increasing and as such, more attention is then paid to quality of life.

Ionizing radiation destroys cancer cells due to their more rapid proliferation compared to normal tissue, but radiation can lead to anatomic changes resulting in bowel and bladder symptoms, pelvic pain, loss of hair to irradiated skin, vaginal narrowing, vaginal dryness, higher infection risk and pain with intercourse, vaginal bleeding and premature menopause. At the same time, women will often feel isolated, or develop anxiety and depression from their diagnosis and throughout or after treatment.

A large study recently reviewed the common complaints and changes that women reported as a result of pelvic radiation for uterine, rectal or anal cancer. Women reported more fatigue, lack of strength, vaginal discharge, diarrhea, skin redness and psychological stress. Of all the sexual dysfunctions, sexual desire was affected more than other sexual domains such as arousal, orgasm, etc. The most common reason for avoiding sex was limitation from the cancer diagnosis and treatment itself, reported by 66% of women. Sexual function was not a function of overall radiation dose received.

Interestingly, 25% of the female patients reported that their doctors questioned them about their sexual function, while 17% reported that they were the ones who prompted the doctor with questions about sexuality. These topics may sometimes be perceived as trivial and may be dismissed in light of the overall health concerns.

No less important is the quality of the relationship the woman has with her spouse/partner, who may withdraw for fear of the cancer itself, or fear causing harm to their loved one, or fear of the unknown if sexuality is explored. Overtime, the stress on the body, whether physical or psychological can increase, thereby worsening sexuality with time as well. In the end, intimacy may be avoided in order to avoid anxiety that may be provoked with sexual activity.

Reviewing such a topic with women who are dealing with cancer may be encouraging and inspire hope and strength throughout treatment.