Effects on fertility

Although many cancers are more common in post-menopausal women, some young women will develop a cancer before they have completed their family. The cancer and the treatments may make it difficult, or impossible, to have a baby after completing cancer treatment.  

There are different ways that the cancer may affect your chance of conceiving. Fertility problems may occur because of surgical removal of the uterus and/or ovaries, or because of chemotherapy or radiotherapy. Many women also experience physical changes and body-image concerns after surgery, which may lead to having sexual intercourse less frequently. This affects the chance of conceiving naturally.  

Women commonly feel a sense of loss when they learn that their reproductive organs will be removed or will no longer function. You may feel devastated if you are no longer able to have children and may worry about how this might affect your relationship. 

Even if your family is complete, you may have many mixed emotions. These reactions are natural. As well as talking to your partner, speaking to a counsellor or a gynaecology oncology nurse about your feelings and individual situation can be very beneficial. 

Fertility-sparing options

Chemotherapy or radiotherapy may affect the number of eggs left within your ovaries and, in many cases, accelerate the normal age-related decline in your egg numbers. In some cases, this may lead to early menopause – this means you will need to use another woman’s eggs (egg donation treatment) to become pregnant.  

You can talk to a fertility specialist about your options to have a baby after cancer treatment ends. You should be referred to a respected unit for this advice. The Reproductive Technology Accreditation Committee, under the Fertility Society of Australia and New Zealand, administers a national code of practice and a system for the accreditation of assisted reproductive technology clinics. For a list of accredited clinics in Australia and New Zealand, see the Fertility Society of Australia and New Zealand website. 

Ovarian transposition

Ovarian transposition is a surgical procedure that lifts the ovaries as far from the source of the radiation as possible. This can reduce the harmful effects of the radiation on the ovaries. However, the uterus will still be exposed to radiation. 

Ovarian suppression

An implant containing a drug called a GnRH analogue may be used to suppress the function of the ovaries while you have chemotherapy. There is some evidence that this may help to protect against the effects of chemotherapy, but this procedure is experimental. It will not help protect against the effects of radiation therapy. 

Egg freezing

Egg freezing refers to freezing unfertilised eggs, which can give you the option of using your own eggs to become pregnant at a later stage. This in vitro fertilisation (IVF) procedure takes up to 1 month before starting chemotherapy or radiotherapy. It involves daily injections to stimulate the ovaries and then, after a couple of weeks, a minor surgical procedure to have the eggs collected. These eggs are rapidly frozen until they are needed. 

Embryo freezing

If time permits, you may opt to go through an IVF cycle, but in this case your eggs are fertilised with your partner’s sperm and the resulting embryos are frozen until they are used. 

Ovarian tissue freezing

Ovarian tissue freezing involves freezing tissue from your ovaries. Before treatment begins, a piece of tissue from your ovaries will be surgically removing, frozen, and then reimplanted after treatment. Ovarian tissue freezing is experimental treatment. If there are any cancer cells in the piece of ovarian tissue that is frozen and reimplanted, there is a risk of reintroducing cancer cells to your body if using this procedure. 

‘Wait and see’ 

Many women find these choices too hard to make at this time of great anxiety. It may help to talk to the fertility specialist or a fertility counsellor. 

If you find you are unable to conceive after your cancer treatment and you have retained your uterus, you may consider embryo or egg donation treatment. 

If you have had a hysterectomy, you may consider using a surrogacy arrangement using either your own eggs or a donor’s eggs. 

Sexuality, intimacy and vaginal cancer

Having cancer doesn’t mean you are no longer a sexual person. However, treatment such as surgery, chemotherapy and radiotherapy can affect your sexuality. This includes your interest in sex, your ability to give or receive sexual pleasure, how you see yourself and how you think others see you. Some of these effects are temporary, whereas others are permanent. All can be managed or controlled. 

You don’t need your uterus to have sex, but treatment for vaginal cancer can affect your sex life. Many of these effects can be prevented or treated: 

• Lack of interest or loss of desire for sex. Low libido is common during cancer treatment. Sometimes it can be brought on by anxiety and worry about your diagnosis, rather than the treatment. Libido usually returns after treatment is over. 
• Temporary pain. After a hysterectomy, you will have to wait several weeks before having sex again. In the meantime, kissing, caressing and touching can also be pleasurable. 
• Vaginal tenderness and narrowing. If you receive radiotherapy to the pelvis, it can cause the vagina to become tender, and to shorten and narrow. To keep your vagina open and supple, use a dilator, which is a tube-shaped device made of plastic or rubber. Your healthcare team can show you how to use a dilator. Apply a water-based vaginal lubricant to relieve painful irritation. Avoid Vaseline or other oil-based lubricants because they may cause irritation. If you are ready and able, have regular gentle sex to help widen the vagina. 

If you have a vaginal reconstruction, you may still be able to have intercourse, but it may not be possible to have an orgasm through penile penetration of the vagina. However, as surgery to the vagina does not affect the clitoris, it is still possible to have an orgasm through oral sex and masturbation. 

Tips for maintaining intimacy with your partner: 

• If fatigue is a problem, try different times of the day to be intimate. 
• If you are have a low libido, talk to your partner about how you are feeling. They need to know when you feel ready for sex and ways to help you get in the mood. 
• Although sexual intercourse may not always be possible, closeness and sharing are vital to a healthy relationship. Explore other ways of sharing intimacy and showing affection for each other, such as touching, holding, hugging and massaging. 
• Stimulate and help your partner reach orgasm. 
• Take more time for foreplay to help the vagina relax and become well lubricated. This will make penetration or intercourse less painful. 
• Try different sexual positions if your usual ones are uncomfortable. Use cushions or pillows to support your weight. 
• Suggest a quick lovemaking session rather than a long one. 

Regaining sexual confidence

For many women, sex is more than arousal, intercourse and orgasms. It involves feelings about intimacy and acceptance, as well as being able to give and receive love. 

If we are not comfortable with the way we feel about our bodies, this may affect our confidence and desire for sex. Some women worry about being rejected by a current or future partner because of changes to their body, whether these changes are visible or not. 

It is sometimes difficult to communicate sexual needs, fears or worries with your partner in an intimate relationship. If your vaginal cancer treatment involves treatment to the vulva, you may find it even more difficult. But, you may be surprised and encouraged by the amount of tolerance, trust, tenderness and love that exists between you. 

However, problems can arise because of misunderstandings, differing expectations, and different ways of adapting to changes to your sex life. If this happens, you may find counselling helpful, either with your partner or on your own. You may be able to work through these challenges towards a new closeness and understanding. 

If you are experiencing a sexual problem because of cancer treatment, you may find it helpful to discuss it with your doctor, or you may feel more comfortable talking to a hospital counsellor, social worker or psychologist. 

Cancer Australia has developed a resource on intimacy and sexuality for women with gynaecological cancer, to support women (and their partners) in understanding and addressing issues of intimacy and sexuality following the diagnosis and treatment of gynaecological cancer. It aims to empower women so they can ask questions that they may otherwise avoid asking due to embarrassment or other concerns. 

The Cancer Council Helpline – 13 11 20 – can also put you in touch with a counsellor or a sex therapist and has developed information on Sexuality, intimacy and cancer.