Sex and Cancer: Surgery
Oral surgery
Surgery is often the most effective treatment for oral and mouth cancers. It is possible that this could affect your sex life depending on the type of treatment and surgery you have had.
For some people, this may be related to changes in the amount of saliva they have and their ability to swallow. In others it has been related to their ability to speak affecting their confidence in talking to potential new partners.
If you are struggling to adjust to the effects of your treatment you should speak to your cancer care team who should be able to provide you with specialist support. If your concerns are related to speech, you can request to see a speech and language therapist (SLT). The Mouth Cancer Foundation also gives information and support to people affected by head and neck cancers, including mouth cancers.
Gynaecological surgery
Surgery can occasionally leave people with a narrowing or shortening of the vaginal canal. This may make penetrative sex more difficult. If this has occurred, dilators are prescribed to support the narrowing and there are products like Ohnuts which help to control the depth of the penetrative partner. Alternatively you can explore non-penetrative sex and sex toys.
Some surgeries may remove the vulva, vagina, or both. The amount this may impact you depends on how much tissue has been removed. The outer genitals, especially the clitoris, are important in sexual pleasure and surgery to this area may affect their function. Likewise, some surgeries may remove the part of the vaginal wall where the g-spot is located. If surgery has removed these areas, then orgasms may not be possible and there might be some numbness present.
If you experience any of these problems you can discuss this with your clinical team who may be able to suggest ways to improve things, or may be able to refer you on to a specialist or a psychosexual counsellor. There are also some sex shops that have specialists who can give tailored advice on the best sex toys to use to help with specific problems (see resource section at the end).
Mastectomy
Having surgery that removes your breast(s) may affect how you feel about your body and affect your comfort with sex and intimacy.
Undergoing a mastectomy is a very individual process. For some people it may affect their confidence and self esteem but for others it may not affect them in the same way.
Mastectomy is a procedure that can be very difficult to come to terms with for some people. A common reflection from patients who have had this operation is that they may feel self conscious about their body and may feel unbalanced if only one breast is removed.
Reconstructive surgery is offered to patients who are eligible to create a breast after mastectomy. You can speak to your medical team to find out if this is an option for you.
For some people, this can help them to restore some confidence in their appearance although it will not bring back lost sensation and the breast tissue may feel different than before which some patients struggle to adjust to, particularly in relation to intimacy.
Some people choose not to have reconstructive surgery and are very happy with this choice. Some lesbian and bisexual women describe reconstruction as heteronormative and are happy with not pursuing it as an option. Patients who are transgender or non-binary have reported finding their flat chest after mastectomy gender affirming.
No one should feel pressured to do something just because other people assume it is the best thing for them.
Some people don’t have the option of reconstructive surgery for various reasons including the risk of recurrence and the need for regular scans or other existing medical conditions.
Some people may choose to avoid surgical reconstruction and opt to wear a prosthesis (artificial breast) inside their bra to restore the breast shape. These come in a variety of materials and skin tones.
Whatever people decide, it must be the right decision for them as an individual. Discussing your options and treatment goals with your cancer care team will help them to respect your wishes and provide you with personalised care.Whether you have a long term partner or are contemplating a new relationship, procedures like mastectomy can be difficult to navigate your way through. For further information and support on these specific issues you may find Breast Cancer Now’s resources useful.
Prostatectomy
Removal of the prostate can result in erectile dysfunction and a reduction in pleasurable sensation when receiving anal sex (bottoming). There are new approaches to prostate and pelvic surgery that can, in some circumstances, preserve sensation and the ability to have an erection. You can discuss these nerve sparing procedures with your doctor(s) and surgeon(s).
Orchidectomy
Surgery to remove a testicle (orchidectomy) doesn’t usually affect your sex life. If you were to have both testicles removed, you would be offered testosterone to replace the hormone which is usually made in the testicles. This would help to ensure you could continue to have erections and be able to engage in penetrative sex as the active partner (top). However, because sperm is produced in the testicles it would mean that you would not be able to make someone pregnant through sex.
Surgery to the penis
Having surgery to your penis can be difficult to come to terms with. Your specialist cancer team should be able to provide you with advice and support or alternatively there are organisations such as Orchid who provide support to people affected by penile cancer.
The type of operation you have will depend on the stage of your cancer and how much of the penis it affects. Some types of surgery can affect the way your penis looks and can have an impact on your sex life and fertility.
If the cancer is just on the foreskin you may need to have a circumcision. This is a surgical procedure either done under local or general anaesthetic to remove the foreskin. You would be advised to avoid any sexual activity involving the penis for 4 weeks after the surgery to allow it to heal. After this time it should be possible to continue with your sex life although you may feel a bit of tightness and discomfort at first but this should resolve itself. If it does not resolve, speak to your surgeon or cancer care team.
If you have a small cancer that is low grade and only in the top layers of tissue on the head of the penis (glans) you may need an operation called Glans Resurfacing.
This is where a surgeon removes the outer layers of skin that are affected by the cancer or the cells they are concerned about. They take a small skin graft from another area on your body, usually the upper thigh, to cover the wound on your penis. This is done to help it heal more quickly. The operation is done under general anaesthetic. They will also place a tube called a catheter into your bladder to drain your urine into a bag to make it easier for you to pass urine and to protect the graft from getting urine on it whilst it is healing. The catheter is usually removed after a week.
Your surgeons will try to keep your penis looking as close to normal as possible. There will be no loss of length of the penis, however there is likely to be a change in sensitivity to the tip of the penis which can sometimes be permanent.
A small percentage of people don’t feel like having sex after their operation and there may be a number of reasons for this. Some people find that the glans doesn’t have the same level of sensation as it did prior to the surgery and this may make it difficult to get or keep an erection. Some people find it difficult adjusting to the diagnosis, surgery, and physical changes which can have an impact psychologically. If this is the case please speak to your specialist team as they can find ways to help you.
If the cancer is spread over a larger area you may need to have a wide local excision. This is where the surgeon cuts out the cancer along with some normal tissue around the edge, called a margin. Some people may need a skin graft which is where they take a piece of skin from another part of your body to replace the tissue taken away. Most people can continue to have a normal sex life after this surgery.
If you require a removal of the penis head (glansectomy) it is usually still possible to continue having penetrative sex, although there may be less sensation than before. Getting erections is usually possible after this type of surgery.
If you need to have part of your penis removed (partial penectomy) it is still possible to continue having penetrative sex. Penetration will be possible with the remaining shaft of the penis and you may still be able to have erections and orgasms.
If you need to have removal of the whole penis (penectomy) penetrative sex (as the giver or top) will not be possible but sexual pleasure still is, and there are still ways of being sexually satisfied. It is important to discuss with your partner(s) how you feel about this change to your body and explore together what feels good to you. If the cancer hasn’t spread it may be possible to have reconstructive surgery on the penis. This is major surgery that carries risks of complications and isn’t suitable for everyone but you can talk to your clinical team about if this is the right choice for you. Penis reconstruction is carried out by specialist plastic surgeons and urologists who can use muscle and skin from other parts of your body to form a new penis. A penile implant is usually inserted so that it is possible to have an erection.
For some people this type of surgery to the penis can be a large burden on their mental health. Feeling depressed, anxious or worried is normal when cancer is part of your life. Changes to how your body looks and works can be very difficult to cope with and can directly affect your body image and sexual well being.
Things that may help include asking to speak with your surgeon before the surgery so you can prepare for any potential outcome. Talking and getting help and advice from your specialist nurse, your partner or people who are close to you.
Sometimes it can be helpful to talk to someone who has been through similar surgery. Some people find it helpful to talk to a psychosexual counsellor or an expert in sexual satisfaction who can guide you in appropriate sex toys to use for specific problems and help you explore what else can give you sexual pleasure.
Anal surgery
Surgery can lead to narrowing of the anal canal which may make anal sex (bottoming) difficult or uncomfortable. Anal dilators available via NHS care teams are not designed to support anal sex. For this reason, you may wish to consider using sex toys to gradually dilate. However, always make sure the toy has a flared base or something that prevents the toy being inserted too far or completely into the body. Ensure that you use lube, and that you are careful not to injure yourself. You can speak to your cancer care team or psychosexual therapist about your goals for dilation, how they align to your surgical outcomes, and ask them to help you plan your dilation schedule.
Bowel surgery
Most people have no problem resuming their sex life after bowel surgery. However, surgery to the rectum can affect the nerves and blood supply to the sexual organs, for example there may be difficulty in being able to get or keep an erection and ejaculation may also be affected.
If being the receptive partner (bottom) in anal sex is a part of your sex life, you may experience some difficulty in returning to this after bowel surgery.
If only part of the bowel has been removed and the anus remains open, you can talk to your consultant or CNS about the type of surgery you have had, your projected recovery period, and if it would be safe to return to anal sex.
Being the receptive partner in anal sex after the rectum has been removed (proctectomy) will not be possible. If adjusting to this change becomes difficult, ask to see a psychosexual therapist who will be able to help you navigate this experience.
Stoma
In instances where the anus is completely closed a stoma usually is created on the abdomen. This can remove the option of receiving anal sex, and may also affect a person’s body image. Online retailers have a range of high-waisted underwear specifically for pouches with a sewn-in pocket for comfort. These may be useful for casual encounters if you don’t want to explain your stoma. You might also want to explore other sex-based clothing, outfits or outerwear that covers your midsection.
Emptying or changing the pouch before sex may help boost confidence, and experimenting with different positions may help to keep weight or pressure off the stoma.
You may want to consider talking to your partner(s) about your stoma. You might want to let them look at and feel your stoma or appliance. If they seem uncomfortable, remember not to take this personally or view it as rejection. Give your partner(s) time to adjust to the stoma and continue to create opportunities to discuss the stoma, its impact on your sexual function, and your sexual intimacy together.
Sexual activity directly involving the stoma (e.g. penetration) can cause damage and can allow the transmission of sexually transmitted diseases and is not advised.
Bone surgery
If you have had surgery for bone cancer or muscle cancer it can sometimes be more difficult to get into a comfortable position to have sex. If you are in pain, this can make enjoying sex more difficult.
It is also important to ensure that any sexual activity during recovery is not too vigorous as it could risk causing further damage to any surgical wounds or healing bones. Speak to your CNS or someone you feel comfortable talking to so that we can advise you on ways to manage any problems or difficulties you may experience.