Surgeries used to manage cancer change anatomy and have the potential to compromise the blood vessels, arteries and nerves to genital pelvic organs that are vital to the sexual response cycle. Some research has demonstrated that the incidence of sexual complaints after gynecologic cancer treatments can range from 40 to 100%. Extensive pelvic surgeries can cause women to experience changes in the perception of their feminine identity and body image and may lead to difficulty with self-esteem. Other issues that can affect sexual functioning include: hormonal disruption, loss of the ability to reproduce and sexual changes related to bowel and bladder changes. All these facets can promote emotional and relationship alterations Significant loss in sexual capacity commonly occurs after pelvic surgery leading to complaints of lowered libido, decreased sexual interest and overall poor sexual dissatisfaction.
Other procedures that affect the vaginal vault may cause narrowing or vaginal stenosis, decreased or absent lubrication and significant discomfort because of fibrosis and scarring. Discussions regarding sexuality prior to surgical procedures are paramount. Some female patients are not knowledgeable about their sexual anatomy and providing education about the physiology of female sexual response can help improve functioning.
During the gynecological examination, women should be encouraged to examine their vagina and vulva as well as other pelvic structures with the aid of handheld mirrors while the healthcare provider identifies important structures such as the clitoris, prepuce and labia and can help address misconceptions and fears concerning changes in appearance and sexual function.