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Sex is an important part of being in a relationship, but certain types of radiation therapy can cause sexual problems to develop. These problems often happen to women getting radiation to the pelvic area (lower abdomen). Managing these issues might involve several different therapies, treatments, or devices, or a combination of them. Counseling can also be helpful.

This information describes common sexual problems an adult female getting radiation to the pelvis may experience. If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

It’s very important to talk about what to expect, and continue to talk about what's changing or has changed in your sexual life as you go through procedures, treatments, and follow-up care. Don't assume your doctor or nurse will ask about any concerns you have about sexuality. Remember, if they don't know about a problem you're having, they can't help you manage it.

How pelvic radiation can affect sex

Radiation to the pelvic area can affect a woman's sex life during and after treatment. This is because the radiation beams damage the delicate tissue in and around female genitals. Here are some examples of sexual effects that radiation can have. You can find more about the effects of radiation on specific types of cancers in Cancer A to Z.

• During treatment, tissues in the treatment area can get irritated. They may become pink and swollen and may look sunburned. A woman’s vagina may feel tender during radiation treatment and for a few weeks afterward.
• Radiation to the vagina can also damage its lining, making it thin and fragile. Many women notice some light bleeding after sex, even though they felt no pain at the time. In rare cases vaginal ulcers or open sores may develop, which may take several months to heal after radiation therapy ends.
• When treatment ends and the irritation heals, there might be scarring. The walls of the vagina may become leathery and tough. Treatment can also shorten or narrow the vagina. This means the walls might not stretch out as much during sex, which can cause pain.
• In some cases, the bladder and bowel are damaged by radiation to the pelvis, and these changes can also impact sexual health.
• If the ovaries get a large dose of radiation, they may stop working. Sometimes this is just for a short time, but often it’s permanent. If a woman has already gone through menopause, she may notice little or no change because her ovaries had already stopped making hormones. But if she hasn’t, radiation may cause sudden menopause, meaning menstruation (having periods) may stop and women may have menopausal symptoms, such as hot flashes and vaginal dryness. Young women who get smaller doses of pelvic radiation may start to menstruate again as their ovaries heal. But with larger doses of radiation therapy, the damage could be permanent.
• Women who get radiation to the pelvis often become infertile. But no matter what the radiation dose, women younger than 50 should talk with their team before stopping birth control since it may still be possible to become pregnant.

Is it safe to have sex while getting pelvic radiation?

It's very important to talk to your cancer care team to know if you have any limitations or should take any precautions related to sex while you're getting radiation therapy.

In general, as long as a female is not bleeding heavily from a tumor in her bladder, rectum, uterus, cervix, or vagina, it's usually OK to have sex during pelvic radiation therapy. But since everyone is different, be sure to check with your cancer care team. Depending on any surgery you may have had before radiation therapy, the outer genitals and vagina might be just as sensitive as before. Reaching orgasm should be possible, too, although stress and sexual position might affect this.

Certain types of cancer are treated with a radiation implant. An implant is a radiation source put inside the bladder, uterus, or vagina for a certain number of days. Sex likely will not be allowed while the implant is in place.

Radiation therapy from a machine outside the body does not leave any radiation in the body, so your partner will not come in contact with it. Women treated with a radiation implant transmit radiation while the implant is in place, but not after it is removed. See Radiation Therapy for information about the different types of radiation and the precautions you may need to take.

What can help with the effects of pelvic radiation?

There are some therapies and exercises that might help limit or soften scar tissue. Talk to your cancer care team to find out if any might be helpful for your situation. Sometimes stretching the walls of the vagina is suggested. This can be done with vaginal penetration during sex or using a vaginal dilator on a regular basis.

To learn more about physical problems related to cancer surgery and sexuality and how to talk to your cancer care team about them, see in Managing Female Sexual Problems Related to Cancer.