Intimacy when you’ve had pelvic pain problems

Clinical trials? What’s the big deal?
14 January 2024
Clinical trials? What’s the big deal?
14 January 2024

Having been a sex therapist for decades, I have worked with more women that I can count who have been diagnosed with all sorts of pelvic problems, including vaginal dryness, menopause, cancers and other conditions. 

The women I see are:

  • struggling to negotiate an intimate and sexual relationship with their partner
  • experiencing sexual pain, reduced sexual interest and/or problematic arousal and orgasm
  • undergoing medical treatment and worried about whether they will ever feel sexual again

I can tell you that it is possible to restore satisfying sexual relations.

Women who have needed medical interventions for a range of conditions often describe feeling abandoned by the medical profession once they’ve had their treatment. They feel left alone to deal with sensitive personal issues that can emerge after the initial problem has been addressed (if not cured).

It’s common to find that it’s difficult or embarrassing to talk about this with their significant other. 

It can feel strange that something which was once so easy and natural becomes the ‘elephant in the room’ with both of you becoming unsure how to approach any sort of intimacy. 

Or if you’re single, you may wonder whether you will ever be able to have a ‘normal’ sexual relationship again. 

So, let’s talk about it how to go about this…

Your sex life probably isn’t the first thing on your mind when you receive a diagnosis or are having treatment. It still might not be, but there may be some worries lurking in the background.

At some point, many women (and their partners) need help adjusting to individual changes they experience, and in getting their sex life back on track.

It doesn’t matter if you’re in your 20s or your 70s, single, in a long-term or casual relationship or whether you’re attracted to men or women. How you feel and express yourself sexually may have changed over time.

When you have medical professionals repeatedly examining your intimate parts, even if they are kind and caring, you can become a little distanced from the pleasure aspect and begin to see these areas only as problems.

Keep your lover in the loop

The first thing is, please don’t put your intimate relationship on hold until you feel fully recovered. There’s a lot more to intimacy than sexual pleasure.

Your mantra should be ‘little and often’. What do I mean by this? Well, keep talking and touching. That’s what intimacy is really all about, and maintaining intimacy keeps the structure of your relationship strong, in emotional and sexual terms.

Holding each other is comforting and helps you both to feel close. More importantly, it means there is a good foundation in place for when you feel ready for something more sexual.

Take a good look

Worries about pain and discomfort or concerns about damaging the area that was treated can make you both feel anxious and, depending on what treatment you had, you may look a bit different ‘down there’.

You won’t know until you have a look. Take a deep breath and get the mirror out.

When women have been prodded, poked, treated and examined by numerous medical professionals, they can find it hard to connect with their genitals in a sexual way. It’s no longer the secret and private place they once shared with their partner.

It can take time for this feeling to go, and becoming comfortable with how you look will help. As you become more comfortable and confident, the sense of connection to your genitals and sexual pleasure can be restored.

Menopause: it’s complicated

With some treatments, including hysterectomy, you may go into an early menopause which can cause both physical and emotional changes.

Common physical side effects are hot flushes, changes in mood and sleep disturbance.

A drop in oestrogen levels after the menopause can also lead to your vagina becoming dry and less stretchy.

As well as using lubricant for intercourse or sexual stimulation, a good moisturiser such as Hyalofemme will help rehydrate your vaginal tissue.

A non-hormonal moisturiser is best. Whether hormonal treatment is an option if you’ve had cancer would need to be discussed with your oncologist.

Side effects of hormonal changes can also affect your sexual desire, arousal and orgasm.

A healthy vagina is a well-used one!

I love this quote by Professor Alan Riley. It emphasises in no uncertain terms the importance of using your vagina, which is especially important if you’re menopausal or have had radiotherapy treatment on your pelvic area.

Bear in mind, it doesn’t necessarily mean frequent sexual intercourse.

Using a vibrator on the genital area for a few minutes every day can encourage blood flow to the vulva and vagina and stimulate nerve endings, which can help some women achieve better arousal and more reliable orgasms.

If you have never used one before and find this suggestion a bit alarming, please be reassured that vibrators now come in some lovely materials in non-phallic looking shapes and sizes that can bought on the internet and delivered to your door in discreet packaging.

Your partner may not be used to vibrators either, so if you can both have a laugh about it, that helps with your relationship intimacy too. Get playful with it!

There are different types of trainers available. Even so, some women might find them too clinical to be enjoyable. You could use your own finger, or your partner’s.

Using a dilator or vibrator can be useful for women who are nervous about having intercourse or anxious about discomfort.

Using one will help your confidence, by getting you used to the sensation of something going in your vagina again. This helps to stop your pelvic floor muscles tensing, or help to retrain them to relax if they’re already tense.
There’s are some tips about using dilators at the end of this article.

If you’ve been scarred…

With radiation treatments for cancer, there is a risk of scar tissue forming in the vagina and decreased blood supply to the radiated areas. This shrinks or slows down the growth of the cancer, but it can also lead to a tender, less elastic and dry vagina.

This side effect can be lessened in two ways: by regular sexual intercourse (three times a week is recommended) or by using a vaginal dilator or vibrator.

This helps to keep the vagina open (dilated) and the tissue more elastic. Both of these things are important for future examinations and easier sexual penetration.

Hopefully you have been encouraged to do this by your medical team and given a printed instruction sheet about dilators (sometimes called trainers).

If you feel unsure or nervous, ask one of the medical staff to show you how you how best to insert it.

Ready for intercourse?

You are going to have to tell your partner when and what you are ready for. Don’t expect them to guess or use telepathy: spell it out, but ideally not in the in the middle of intimate touching as this will really kill the mood.

Choose a time outside the bedroom. Perhaps go for a walk, have a chat in the car or over dinner. If you find it difficult to find the right words you could write them a note.

Accept that you both may be nervous the first time you have intercourse especially if it has been a while, or it’s the first time since your treatment.

Think about which sexual position you would prefer. Talk to them about taking things really slowly at first, perhaps even just getting used to them being inside you for a minute or so and then use other ways to stimulate them to orgasm. This will help you relax and build your confidence.

As your confidence improves, you can let them move gently when they’re inside you.

On the other hand, if you don’t feel nervous but you are struggling with fatigue, then you could take a nap earlier in the day, and opt for quickie until you get your energy back.

Plan ahead

The idea of making a plan can be really helpful if you haven’t been sexual or intimate for some time.

Some couples believe that sex should be spontaneous and can find this suggestion difficult to get their heads around.

But if the days have turned into weeks, the weeks into months or even years then basically spontaneity isn’t working.

Bear in mind that you might feel a little self-conscious at first but that’s normal because you are creating new habits.

As planning in time for sexual intimacy becomes more frequent, what you do together will begin feel more ‘natural’.

And remember…if you want things to be different, you need to do things differently!

Can’t be bothered? Tips for getting in the mood

  • Make a date night once a week and have an evening where laptops, tablets other electronics are banned.
  • What did you enjoy doing together before your diagnosis? Perhaps it was taking a shower together, or having a Sunday morning lie-in. Well, make sure you are doing those things again.
  • Decide on what you would like to do intimately with your partner and establish clear boundaries so that you can relax and enjoy it, without background worry about it going further than you want it to. Be sure to ask in advance if they are ok with things going no further than where you have said you’d like to. It becomes harder for you both if you leave it until your partner is hot and bothered, and you say stop.
  • You could, for instance, ask them for a sensual massage then agree to do something sexual for them.
  • If your partner isn’t great at massage, you could research together some techniques on YouTube so that you can each say what you think you might and might not enjoy, and then you can try them out.
  • Temperature matters. Separate duvets and a fan or heater in the bedroom can help if you often feel ‘overheated’ or one of you is prone to feeling cold.

Is it worth the effort?

Getting a diagnosis, having treatment, living with a health condition or moving along on the road to recovery can be a difficult and stressful journey which can have a devastating impact on intimate and sexual relationships.

It has the potential to rob women of their sexual self-confidence, their femininity and the most intimate part of their relationship.

Therefore, helping women to maintain and restore their sexual relationship is not a lifestyle issue but a quality of life issue and healthcare professionals have a major role in providing an opportunity for early discussion and help and support.

So don’t suffer and worry in silence. Ask for help.

Suggestions to help you use the dilator (trainer)

  • If you have been given a whole set of dilators (trainers) in different sizes and the larger ones cause you distress, put them away in a drawer and concentrate on using the smaller ones until you feel more confident.
  • Plan in time when you have some privacy. If you have small children, ask your partner to look after them for half an hour while you explore the dilator pack.
  • Aim to use the dilator daily if you can.
  • Get comfortable on the bed or floor, put a pillow under the small of your back to tilt your pelvis into a good position.
  • If you are feeling scared, perhaps get a mirror to look at yourself before using the dilator. You could just practice putting the tip at the entrance of your vagina – or even use an earbud. It’s taking the first step that’s important.
  • Put on some relaxing music or distract yourself by watching TV.
  • Diaphragm breathing is really helpful as it is often easier to insert the dilator on a long slow out-breath.
  • Don’t forget to lube up, preferably with a silicone or oil-based lubricant that doesn’t dry up quickly.
  • Practice rotating the dilator once it is inside, and move it in and out.
  • Don’t move onto the next size until the one you’re using feels okay.
  • When moving onto the next size, first use the one that’s already comfortable.
  • When you are using the trainer on your own, you have control so it is important for some women to use the dilator with their partner. For this I would recommend that they choose a trainer that they find really comfortable and easy to use. Alternatively, your partner could insert their finger very gently with lubricant or if you have a vibrator you could use this together. 

Want more help? Here are some resources

  • International Guidelines on Vaginal Dilation after Pelvic Radiotherapy (available online)
  • Website specifically for people recovering from cancer which provides online information, telephone support and intimate products 
  • Information and National Directory of Psychosexual Therapists 
  • Booklet ‘Intimacy & Sexuality for cancer patients and their partners’
  • Macmillan Cancer Support tel: 0808 808 00 00. Booklet ‘Relationships, Sex and Fertility for Young People Affected by Cancer’
  • Relationship Counselling & Psychosexual Therapy 
  • Charity that supports women with cervical cancer

This article was written by Angela Gregory – BA (Hons), PST Dip, CH Dip,COSRT acc.

Angela is the Lead for Pschosexual Therapy at the Chandos Clinic, a sexual dysfunction service for men and women with a wide range of sexual difficulties based at Nottingham University Hospital Trust. She works as a full-time Sexual and Relationship Psychotherapist and provides in-house training for both medical and nursing staff and regularly lectures at a national level.

She is currently the secretary of the British Society of Sexual Medicine. In 2013 she had work published in the International Journal of Gynaecology on ‘Sexual Problems in Older Women’ and a further two articles were published in 2014, one in the International Journal of Urological Nursing on ‘The Impact of Trauma on Sexual Functioning’ and the other entitled ‘Tales of the Un-erected’ in the Endocrinologist.

In 2015 she was involved in primary research looking at ‘Women’s experience of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus’ published online here.

Featured photo: iStock

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Intimacy when you’ve had pelvic pain problems
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