Sexual Impact on Women

While I was prepping to write an article for BladderCancer.net, I came across an article that really opened my eyes to the impact of Bladder Cancer (BC) on female sexuality. It explained how BC is often misdiagnosed as a urinary tract infection (UTI) for months, which gives the cancer time to grow. Because of the later time of diagnosis, BC is finally diagnosed at a later stage, with a worse prognosis. With all cancers, the earlier the diagnosis, the better the outcome. We have to do a better job with initial testing and offer broader screening options that detect the cancer. To get into the main topic of the article, I’d like to explore some of the treatment and surgical options available and mention their effect on female sexuality.

Hormone changes

Before we get into the treatments, we should discuss the impact of hormones on female sexuality, especially if the surgical options include the removal of organs. The big two are estrogen and testosterone. Estrogen is made in the ovaries, helps with vaginal health and is also related to vaginal lubrication. Testosterone is also made by the ovaries (in smaller quantities) and the adrenal gland. Testosterone is related to the formation of estrogen and is also related to libido. One needs to be aware what their treatment or surgical procedure will entail so they will be prepared for the hormone changes to their body, which can include surgical menopause.

Intravesical treatment

In women where the BC was diagnosed early, they are typically good candidates for intravesical treatment. With this type of treatment, the medication is placed into the bladder via catheter, where they hold the treatment in their bladder for a period of time. With this treatment, women report side effects including fever, fatigue and blood in their urine. The sexual side effects include painful intercourse. This leads to the avoidance of sex, the avoidance of intimacy and lower sexual desire.

Chemotherapy

Chemotherapy has a long and well-known list of side effects, including hair loss – including eyelashes and eyebrows. Other side effects include nausea and vomiting. While it's understandably logical not to feel like being sexual, there are additional sexual side effect one needs to be aware of. Chemotherapy can also have an impact on a woman’s natural lubrication, which can also lead to painful intercourse.

Surgery

Depending on the recommended surgical procedure, the ovaries and uterus can be removed. Further, in some cases like a radical cystectomy, the uterus is removed along with a section of the anterior vaginal wall. This leads to vaginal shortening. Another technique allows for the anterior wall to be removed then, the sides are rolled together. This leads to vaginal narrowing.

Following the removal of the ovaries, uterus and fallopian tubes, the effect on the body can be immediate. Besides healing with the surgery, her body was just thrown into menopause. Some of the symptoms will include loss of libido, discomfort and pain, vaginal dryness and pain with intercourse.

Radiation

Radiation is another treatment option. With radiation, women typically report vaginal changes, thickening of the vaginal wall and/ or ulcerations. With this treatment, there can be a lot of pain with intercourse related to these changes.

Keep doctors aware

One of the most important things you can do is to stay in touch with your doctor after your treatment/surgery is over. They will be able to help you manage the effects of your BC treatment/surgery.

To conclude, I’ve always advocated for a sexual counselor or therapist to be a part of the medical team. They have special training and education that would help you navigate the side effects. If a counselor or therapist is not a part of the treatment team, I’d ask your doctor for a referral. With any luck, you’ll find a counselor who has additional education related to Bladder Cancer and has experiences in dealing with these issues. Thank you.