| Tara Langdale
5 Reasons Why Sex is Painful after Radiation
Radiation therapy focuses on one area of the body, but although it brings fewer side effects than chemotherapy, it does affect healthy cells. Is pain after radiation normal? Unfortunately, it is. Post-radiation pain is common, regardless of the type and location of cancer. Unfortunately, in some cases it can cause neuropathic pain, chronic post-radiation pain or soft tissue damage.
Radiotherapy in the pelvic area most often causes inflammation, soreness and changes to tissues, so it makes sense that sex can be painful after radiation. This article examines the reasons why sex is painful after radiation. It also answers some of the most pertinent questions about the sexual side effects of pelvic radiotherapy, and sex after cancer.
Why is sex painful after pelvic radiation?
Sexual problems after cancer are all too common, whether the treatment was radiotherapy or chemotherapy. The fact is that pelvic radiation targets one of the most sensitive and delicate areas of a woman’s body. It is no surprise that there are many sexual effects of radiation, both during and after treatment.
Below you can find 5 reasons why sex is painful after radiation:
Inflammation and swelling of the skin and tissues
Radiation therapy to the pelvis can irritate the sensitive and tender vaginal tissues, which may swell up and become red or pink (with the appearance of sun burn). This swelling and tissue irritation may last for several weeks after treatment, during which time sex can be painful. It may still be possible to have sex, although it might help to soothe inflamed tissues with a cooling lubricant – and of course to make sure your partner takes it easy until you are feeling better.
Damage to the vaginal lining
Radiation to the vagina or surrounding areas may cause damage to the vaginal lining. Your vaginal walls might thin out and become more fragile, leaving the skin prone to tears during sex. Many women who have had pelvic radiation treatment notice light bleeding during or after sex. It is possible to bleed without pain, but in some instances radiation can create vaginal ulcers or open sores. These can cause a lot of pain during sex, and can take many months to heal once treatment is finished.
Fibrosis and scarring inside the vagina
After your radiotherapy course is done, inflammation will start to heal. However, there can be further problems at this point. Radiation therapy can cause scarring on the vaginal walls, which may thicken and become leathery in texture.
Vaginal fibrosis is another common side effect of high dose pelvic or vaginal radiation therapy, affecting up to 80% of women who received it. Fibrosis is the name for fibrous connective tissue that forms as a reparative response to injury or damage – in this instance, from radiation damage. Fibrous tissue can lead to tightening and shortening of the birth canal (called vaginal stenosis), which in turn can make sex painful or difficult. Due to the proximity of the anus to the vagina, vaginal fibrosis can also occur after anal radiation therapy.
Early menopause and hormonal changes
If you are given a high dose of radiation to the ovaries, they may no longer be able to function. Whether you recover from this can depend on your age and the dosage given, but it’s possible that you’ll become infertile. The ovaries are responsible for making hormones that naturally decline as you go into the menopause. However, radiation treatment can start this process earlier than it would naturally occur.
As a result, you can go through the menopause and all the symptoms this brings, such as:
- The end of the menstrual cycles
- Hot flashes
- Mood changes
- Vaginal dryness
- Lack of libido
Lack of libido and vaginal dryness can lead to painful sex after radiation. If you’re not in the mood, it will not feel natural, and if there is no lubrication, thrusting can hurt. A water-based personal lubricant may help with this issue, and it might be necessary to make extra efforts to become aroused.
Radiation enteritis and bladder and bowel damage
Radiation enteritis is the name for inflammation of the intestines caused by radiation therapy. Although it is not a direct cause of painful sex, its symptoms can certainly impact your sex life, and inflammation and soreness can be felt during sex. Enteritis can cause nausea and vomiting, diarrhea, and stomach cramps in people who had pelvic radiation. Although in most instances it is temporary, it is possible that symptoms can linger for months or years.
It is also possible that radiation might damage the bowel or bladder, which might have a similar negative impact on your sex life.
What can I do about the effects of pelvic radiation?
Depending on the post-radiation sexual symptoms you are experiencing, there are various therapies, treatments and tools to choose from. Some of the ways to make sex easier after radiation include:
- Exercises to stretch and soften scar tissue
- Pelvic floor physical therapy
- Vaginal dilator therapy
It’s a good idea to discuss your concerns and expectations with your health care provider – especially around your sex life. This isn’t something they will necessarily bring up if they don’t know that you are having problems with sex after radiotherapy. They may be able to suggest techniques or treatments to assist your particular situation, and answer any questions you have about sex during and after radiation.
Can vaginal dilators help painful sex after radiation?
Vaginal dilator therapy is the number one therapy for all kinds of vaginal issues. Women’s sexual health professionals all around the world often recommend it. Here is what Lauren Streicher, Clinical Professor of Obstetrics and Gynecology at The Feinberg School of Medicine, has to say about them:
“Vaginal dilators have two purposes. One is to get the vagina used to having something inside of it. Even if the size of your vagina is normal, painful sex initiates a cycle of pain–fear–muscle spasm–more pain that results in the vagina constricting at any attempt to have intercourse. Dilators are often needed after the initial cause of the pain has been eliminated to erase muscle memory that has kept your pelvic floor in protective mode. Vaginal dilators are also a way to gently and gradually stretch tissues that are tight and have lost their elasticity, which is often the case if a woman has vaginal dryness and thinning from hormonal changes, skin conditions (such as lichen sclerosis) or her vagina has been altered by radiation or surgery. Scarring and shrinkage of the vaginal opening is almost always reversible! The other important advantage to using a dilator is that you will know when you are ready for intercourse.”
Whatever your sexual problems after radiation, know that the chances are they will improve, but you might need to help your body to recover. Know that the side effects are often at their worst toward the end of the course of radiation, and for a couple of weeks afterwards. Once your healthy cells start to recover (usually within a few weeks), your sex life is likely to improve too.
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