Cancer treatments can cause many changes to the body, including the vagina. Some women have pain with sexual penetration or sexual touching that gets in the way of sexual activity. Other women have vaginal dryness or discomfort that affects their daily activities. This information is about strategies to manage vaginal dryness and discomfort.

Pain with Sexual Activity

Is it normal to have pain with sex?

It’s common for women to have pain with sex if they’ve been through menopause or have had chemotherapy, radiation therapy, or pelvic surgery. This happens partly because of a change in hormones, but also because of changes to the blood flow to vaginal tissues. After menopause, the ovaries stop making an estrogen hormone (estradiol). Without this hormone, the lining of the vagina gets thinner and the walls of the vagina don`t stretch as well. When a woman gets aroused (turned on), the vagina deepens and the lining makes drops of a clear, slippery liquid. These changes make intercourse more comfortable. After menopause, the vagina may be drier and/or tighter, even when a woman feels aroused.

What if I have pain with sex?

If intercourse is painful, it’s best to stop doing things that hurt. Don’t try to push through the pain. If you do, you may start to expect pain with sex, and you may develop a fear of pain with sex. A fear of pain can affect your desire for and interest in sex. If intercourse is painful, you should stop doing it for a while. Take a break and try some of the treatment options in this information before you have intercourse again.

Let your partner know that you’re experiencing changes to your vagina from your cancer treatment. Remember, there are many ways to be sexual other than intercourse. You can continue other kinds of sexual activity if you’d like to. You may find that touching of the genitals or oral sex doesn’t cause the same pain. If intercourse hurts, try genital caressing. Being aroused is a natural way that your body gets ready for sex. If your body has enough time to get aroused, the tissues in the vagina will expand. This process of becoming aroused can take up to 20 minutes for most women, and can take even longer if they’re post-menopausal. When this happens, there’s more room in the vagina for a penis, finger, or sex toy.

Using a vibrator around the clitoris might also help enhance sexual experiences if you’re not having intercourse. Vibrators can also help if you’re feeling tired.

You may need to ease yourself back into sexual activity after your cancer treatment. You don’t have to start with intercourse. Do things that you’ll enjoy, that feel good, and that will arouse you.

Is there anything I can do to help with the pain?

For women with vaginal dryness or very sensitive skin on the vulva, using a lubricant for sexual activity often helps to decrease pain. There are other treatments that you can use daily, not just when you’re being sexual. These treatments work well to help keep the vagina healthy after menopause and to stay comfortable when something is put in the vagina (e.g., intercourse). These treatments include:

• lubricants​ (for sex)
• natural products (e.g., vitamin E, coconut oil)
• vaginal moisturizers - After 12 weeks of regular use of moisturizers, the vagina becomes more moist, less acidic, and has more stretch, much like women taking estrogen
  
• topical local estrogen​​
  
• relaxing tight vaginal muscles (including vaginal dilation)
  

Think about using these treatments even if you aren’t planning on having sex to preserve future sexual function or to help make pelvic exams more comfortable.​