Female sexual dysfunction is a common long-term late effect after cancer treatment. It involves physical changes like vaginal dryness, tissue shortening or tightening, pain during intercourse, and lowered libido, alongside emotional and body-image distress.

Common Physical Causes

• Hormonal shifts: Oophorectomy can lead to acute decrease in estrogen, progesterone, and testosterone levels
• Pelvic radiation: Some problems, such as loss of vaginal size and lubrication after radiation to the pelvis, may develop months or even years after cancer treatment is done
• Endocrine/Hormone therapies: Long-term use of medications like tamoxifen or aromatase inhibitors can maintain a low-estrogen environment causing severe dryness and dyspareunia (pain during or after intercourse)
• Surgical damage: Removal of important nerves and blood vessels in the pelvis can alter genital sensitivity or cause numbness

Psychological and Emotional Factors

• Body image distress: Scars, weight changes, surgical alterations (such as mastectomy without reconstruction), or hair loss changes how a woman feels about her physical self
• Mood and energy: Persistent fatigue, anxiety, or depression significantly dampen sexual interest and the body's natural arousal response
• Relational strain: Communication gaps with partners regarding changing physical needs can heighten feelings of isolation

Management and Support Options

• Moisturizers and lubricants: Regular use of non-hormonal vaginal moisturizers and water-based lubricants reduces friction and discomfort
• Pelvic floor therapy: Specialized physical therapy can help stretch and relax tight pelvic floor muscles and improve tissue flexibility
• Medical consultations: GP or gynaecologists can evaluate whether localized, low-dose non-systemic vaginal oestrogen or other treatments are safe and appropriate
• Counselling: Talking therapy or specialized sex therapy can help reframe intimacy and address relational or psychological distress

Please see your GP if you are experiencing female sexual dysfunction