Follow-Up Examinations More ‘Tolerable’ With Sexual Activity After Cervical Cancer

For individuals who have had cervical cancer, it’s important to know how sexual activity and vaginal dilation could offer benefits, especially during follow-up examinations, an expert told CURE®.

“Directly after radiotherapy, the vagina could still be inflamed and patients sometimes say, ‘Yeah, it feels a bit itchy, it feels a bit sore and I don't dare to touch it.’ And this inflammation causes the vaginal walls to stick together. (It) becomes a problem if those growing adhesions are not separated regularly,” said Kathrin Kirchheiner, clinical psychologist from the department of radiation oncology at the Medical University of Vienna in Austria and author of “Loss of Libido After Cancer.”

Through research presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, Kirchheiner and co-authors of a recent study determined that sexual activity and vaginal dilation may prevent long-term side effects in survivors of cervical cancer.

Kirchheiner explained what long-term side effects could look like and how survivors can navigate discussions about sexual health with their doctors.

Q: Your study noted that engaging in sexual activity could reduce long-term side effects. What do these long-term side effects include?

A: The epithelial lining, or the vaginal lining, is also fragile after radiation treatment, so it’s quite easy to irritate. And it tends to bleed easily. So, if you can imagine, small capillaries and small blood vessels emerge to the surface of the vagina because the epithelial lining is thinning out, and then the tissue becomes very vulnerable. Patients tend to bleed easily, especially during intercourse and vaginal dilation. This is not really dangerous to patients, it’s just minor bleeding. But it can be really irritating to patients because they’re scared of injuring themselves somehow, or that sexual intercourse is somehow dangerous for them now.

In worst cases, they are also afraid to cause cancer recurrence because in many cases where cervical cancer was diagnosed, it started with the symptom of vaginal bleeding. This is a symptom that makes many patients very insecure. And that sometimes leads to patients stopping any sexual activity and saying, “Oh, no, this is too dangerous for me now, I don't want to injure myself. I don't want any recurrence,” and so on.

For me, clinically, the most important symptom or endpoint is always “Do my patients have pain during intercourse?” It’s the most important question because as you can imagine, all of those radiation-induced changes can be painful.

Q: Why is it important for patients with cervical cancer to engage in sexual activity and vaginal dilation?

A: There is quite an easy and pragmatic answer: to make sure your follow-up examinations are as tolerable and pain free as possible. It’s also recommended to take care of vaginal health somehow.

The second thing is also to make things in daily life more comfortable. It can be quite uncomfortable to have the itchiness and the soreness of the vagina, and any signs of inflammation, so it’s wise to take care of vaginal health.

Do patients need to be sexually active? No, of course not. They quite often asked that because they have some decrease in sexual interest — libido — after treatment, which is totally normal. So, this is not a requirement in in any way.

I also know from long-term survivors, some months or years after treatment, their sexual interest might come back. The majority of patients early after treatment, the first month, they say, “Oh no, this chapter is over. I don't want to have anything to do with (sex). I'm done.”

Sometimes, it takes months or years before the sexual interest returns and then it’s important to start any prevention and vaginal care quite early after treatment, just to literally keep the door open for the future. If there is pronounced vaginal stenosis or fibrosis, and the patients have shortening of the vagina after a few years because they never dilated, it might become extremely difficult, if not impossible, to restart sexual intercourse.

So, it’s like an investment in the future to take care, despite the majority of patients not being very motivated after treatment.

Q: What advice would you give a survivor of cervical cancer who might be hesitant about the benefits of sexual activity and vaginal dilation?

A: I would ask about their hesitancy: What are you afraid of? How can I reassure you? How can I help you?

There are many tips and tricks in sexual counseling to help patients, first to overcome their fears. Second, if they are uncomfortable during intercourse, there are ways to relieve pain; it starts with pelvic floor training and the relaxation of the pelvic floor muscles.

If patients are afraid, they tense up and then they also clench their pelvic floor muscles. This also makes the vaginal canal even narrower and this may cause even more pain. So, with some exercises for the pelvic floor, sometimes this helps for patients.

Q: What advice would you give patients who are nervous discussing this topic with their doctor?

A: I completely understand that this must be so awful for patients (and) how difficult this might be to bring up proactively. And I think more of the medical health care team should bring it up proactively. It should be their responsibility to ask about sexual health and sexual dysfunctions regularly and if there is any way they can support their patients.

But on the other hand, it’s completely fine for the patients to bring it up. And the medical doctors should be able to handle those questions. So, they should not be scared. It’s much better to share problems than just to suffer alone because there’s really plenty of help available. There are plenty of things for patients to do and to try out that work effectively.

But if we always keep this as a taboo topic and never dare to talk openly about it, then everyone is suffering quietly.

This transcription has been edited for clarity and conciseness.

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