Radiation therapy to the pelvis can be used to treat gastrointestinal cancers, such as anal and rectal cancer.
Because the anal canal and rectum are very close to a woman’s genitals, side effects from pelvic radiation can affect a woman’s sexual health. Here we answer frequently asked questions about the sexual side effects of pelvic radiation for patients with anal and rectal cancer and how women can manage their sexual health after treatment.
How does pelvic radiation affect women’s genitals?
Radiation can damage pelvic tissues and organs. Direct radiation damage to other structures, such as the vagina and clitoris, can affect a woman’s sexual health after treatment. For premenopausal women, radiation damage to the ovaries can also cause hormonal changes that can lead to further sexual health problems.
What are the common vaginal side effects of pelvic radiation?
During and immediately after pelvic radiation, women may experience acute vaginal side effects, including:
- discharge
- pain
- stimulation
- bleeding
Months or years after pelvic radiation, women can experience permanent vaginal damage, which can cause dryness, contractions, pain, and bleeding. In rare cases, a fistula, or abnormal connection, can develop between the intestines and the vagina.
Vaginal intercourse can be difficult or painful during radiation, so many patients choose to refrain from it. When we treat patients with anal or rectal cancer, we do not ask them to avoid sexual activity during radiation therapy. However, cases of gynecological cancer may be different.
What are the common hormonal side effects of pelvic radiation?
During or after pelvic radiation, premenopausal women usually experience changes in their menstrual cycles. Damage to the ovaries from radiation often causes premature menopause and can lead to infertility and infertility, but it can also contribute to vaginal dryness and painful intercourse.
Radiation can cause early menopause and can cause hot flashes, mood swings, and vaginal dryness. Early menopause can also cause infertility.
If you are undergoing pelvic radiation therapy and are thinking of having children in the future, it is important to talk to your doctor about fertility preservation. If you are an MD Anderson patient, you can request a referral to us to determine what options are available to you before starting radiation therapy.
How do you help patients cope with these side effects?
We approach side effect management in two different ways: prevention and treatment.
For prevention, we will take steps to protect your vagina from unintended radiation during treatment.
We often insert vaginal dilators into the vaginal canal during radiation treatment. When treating anal and rectal cancer, the back wall of the vagina is very close to the tumor. However, the vagina can be protected by inserting a vaginal dilator, a cylindrical device that pushes the front wall of the vagina away from the back wall. This reduces the total volume of the vagina damaged by radiation and may improve the patient’s sex life in the future.
After pelvic radiation, patients are advised to continue using vaginal dilators or have penetrative vaginal intercourse at least three times a week to reduce the risk of vaginal stenosis, which is a shortening or narrowing of the vaginal canal. I am giving advice to you.
For women who develop sexual dysfunction after pelvic radiation, we offer several treatment options. These include pelvic floor physical therapy and estrogen replacement.
Pelvic floor physical therapy can be a game-changer for women experiencing painful intercourse after pelvic radiation. An experienced pelvic floor physical therapist can offer many interventions and strategies to help patients’ pelvic floor muscles and improve their sexual health.
I also refer patients to my gynecology colleagues. They will discuss things like vaginal moisturizers, vaginal estrogen, or estrogen replacement therapy to help maintain the vaginal lining, lubricate the vagina, and reduce painful intercourse.
When should patients talk to their doctors about how pelvic radiation can affect their sexual health?
It’s never too early to discuss concerns about your sexual health with your doctor.
After being diagnosed with cancer, patients often focus on their chances of survival. Therefore, it is understandable that their future sex life may not be on their minds. That’s why I bring it up early and often. Active preventive measures to maintain sexual health are much more effective than trying to solve sexual problems after they begin.
What else should women know about pelvic radiation and sexual health?
Sexual health is a complex issue that can’t be explained by vaginal or hormonal measurements alone. Emotional, psychological, and relationship issues also play a large role in overall sexual health after cancer. Sex therapy is an intervention that helps people overcome personal barriers to a satisfying sex life.
Even if your anatomy has changed, there are ways to change the way you think about sex so you can continue to enjoy this part of your life.
I’m learning more about sex aids, things that couples can use to have a satisfying experience. For example, there are silicone cylinder-shaped devices that men can wear on their penis during sex to control the depth of penetration. This is especially helpful for women with vaginal stenosis.
At every appointment, I ask my patients if they have any problems with their sex life. If it exists, look for a solution.
Even if your sex life changes after pelvic radiation, there are still ways to be intimate and enjoy that part of your life. Although this is a common problem after pelvic radiation, we want patients to know that there are things they can do before and after treatment to improve their sexual health. If this is an important aspect of your life, don’t be shy to discuss it with your cancer care team.
Dr. Emma Holliday is a gastrointestinal radiation oncologist.
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