Any type of surgery can affect our sex lives, even if it doesn’t involve the sex organs. However, cancer treatment that affects the genitals and breasts directly may cause quite marked changes.
Once the womb is removed, the surgeon stitches up the top end of the vagina. This makes it slightly shorter than it was before. Sometimes one or both ovaries are also removed, if you have given consent for this. The slightly shorter vagina is usually no problem at all. Early on however, while healing takes place, a woman might prefer her partner to be very gentle, or not to have penetrative sex. Try different positions to find out which are most comfortable. Having the woman on top may be best as she can then control the depth of penetration. A hysterectomy may affect a woman’s experience of orgasm, as some of the nerves leading to the clitoris can be affected by the surgery. Most women find that they are still able to have an orgasm, but the sensation may be different from before the operation. Some surgeons specialise in doing surgery which is less likely to damage the nerves. This is known as nerve-sparing surgery.
Unfortunately, women who have a hysterectomy will be unable to have children. If you wanted to have children, this can be very difficult to cope with. The feelings and emotions you may have are discussed later in this booklet.
Oophorectomy is the name of the operation where an ovary is removed. The ovaries produce most of the oestrogen in the body. If both ovaries are removed, you will go into a menopause and will have menopausal symptoms. Removing both the ovaries is sometimes known as a surgical menopause.
It is likely that you will notice menopausal symptoms occurring more quickly than the gradual onset that occurs with a natural menopause. For many women, hormone replacement therapy (HRT) can return the body’s systems to nearly normal. You may find it helpful to talk all this through with your doctor or specialist nurse.
Mastectomy or lumpectomy
Mastectomy is the removal of a breast. This operation creates a body change that can affect sexual arousal in many ways – particularly if you were previously aroused by having your breasts touched. Some women say that the operation affects their image of themselves and they feel less womanly. Some women may find that they need a lot of time to talk through the feelings and emotions that a mastectomy can cause.
A lumpectomy removes just the breast cancer and an area of surrounding tissue, not the whole breast. It can still affect the way women feel about their bodies and may affect the sensations in the breast.
An abdomino-perineal resection is one of several different operations used to remove tumours of the bowel (colon or rectum). This operation can affect the nerves leading to the womb, vagina and clitoris. Modern surgical procedures are aimed at not damaging the nerves in this part of the body, but even so, women may find that their sensations during sex and orgasm are different after this type of operation.
Vulvectomy is where part or all of the vulva is removed. This is a rare operation, which is sometimes necessary for women who have cancer of the vulva. Removal of the vulva will affect sexual sensations, especially if the clitoris has been removed.
Effects on men
Radical prostatectomy is the removal of the prostate gland. Up to 90% of men who have a prostatectomy will have difficulty getting or keeping an erection after the surgery. This is due to damage to the nerves that control an erection. This can be permanent and starts immediately after the surgery. There are ways of dealing with impotence and these are discussed in our section solutions to sexual problems. Sometimes, surgery that tries to avoid damaging the nerves can reduce the risk of problems.
In men who can still have and maintain erections, it is very common to have dry ejaculations. When this happens you will feel the same sensations of build-up before orgasm, but when you ejaculate, the semen passes into your bladder and not out through your penis. You will still have an orgasm, although some men say it feels slightly different. It does not cause any harm, but can be worrying if you do not expect this to happen. You can tell if it has happened as when you next pass water the urine is cloudy with the semen.
These changes will mean that you are infertile (no longer able to father a child). If you wanted to have a child, this can be very upsetting. Some of the feelings and emotions that you may have are discussed later in this booklet.
An abdomino-perineal resection is one of several different operations used to remove tumours of the bowel (colon or rectum). This operation can affect the nerves that control erection and ejaculation. Modern surgical procedures are aimed at not damaging the nerves in this part of the body but even so, many men will have erection problems.
Orchidectomy is an operation where a testicle is removed.
Removal of one testicle In men with testicular cancer, usually only one testicle is removed. This will not cause infertility and does not usually affect your sexual performance. Initially, after the operation, sexual positions which apply pressure to this area should be avoided. Some men describe orgasm as feeling different, and the normal contractions of the testicular sack (scrotum) at orgasm may feel uncomfortable. The amount of ejaculated fluid is usually less than before.
Removal of both testicles If both testicles are removed, for example as a treatment for prostate cancer, the man will be infertile and may be unable to have an erection.
It is common for a false testicle (prosthesis) to be inserted into the scrotal sac. This gives the appearance and feel of a normal testicle. However, although it looks normal, men may still feel differently about their body. Some men describe feeling less masculine, and need time to talk through this change.
Effects on men and women
Sometimes surgery is used to create an opening on the abdominal wall (a stoma) because of bowel or bladder cancer, or advanced cervical or ovarian cancer. In this situation there is a high chance of permanent damage to the blood supply and the nerves in the genital area. This may cause a man to have problems in getting and maintaining an erection. It is not clear how this type of operation affects arousal and orgasm in women.
A stoma can make some lovemaking positions uncomfortable.
Having to change a stoma bag before lovemaking may reduce spontaneity and people often worry that the stoma will leak. Stoma nurses can give advice and help with all the effects on sexuality that a stoma may cause. Information is also available from the Sexual Dysfunction Association or the Ileostomy and Internal Pouch Association.