Medically reviewed by Dr. Andrea Apolo
After bladder most cancers remedy, a girl is usually left struggling. She appears to be like within the mirror at her new physique, possibly with a urostomy bag hooked up, and worries that she’s not attractive and her intercourse life won’t ever be the identical.
But there’s hope for her — and all bladder cancer sufferers. It is feasible to have a wholesome, satisfying intercourse life after bladder most cancers remedy.
Stages and remedy
Non-muscle invasive bladder cancer (NMIBC) happens within the lining of the bladder and is the most typical stage of bladder most cancers within the United States. The remedy of NMIBC typically includes scraping the tumor from the bladder wall and, in some circumstances, inserting drugs straight into the bladder. In uncommon conditions, the bladder might have to be eliminated in a cystectomy. “We may remove the patient’s bladder if the type of the tumor is of an extremely aggressive subtype or if they fail the conservative approaches,” Dr. Armine Smith, a urologic oncologist at Johns Hopkins Medicine in Baltimore, wrote in an e mail.
Later stage bladder most cancers, muscle invasive bladder cancer (MIBC), happens when the most cancers has unfold into the muscular tissues of the bladder wall. The conventional remedy for MIBC is chemotherapy adopted by a radical cystectomy, which is the removing of the bladder and the close by organs, together with the uterus, fallopian tubes, ovaries and a part of the vagina. After surgical procedure, medical doctors create a brand new means for urine to depart the physique. This might end in a stoma — a gap within the stomach. A affected person might also have a urostomy bag — a pouch outdoors the physique that collects urine.
A brand new physique
With each NMIBC and MIBC, sufferers might experiences bodily modifications that have an effect on their intercourse lives. “Bladder treatments of any kind … may affect urinary function and cause pelvic pain, which in turn can affect the sex life of a woman,” wrote Smith. “These changes can be temporary or permanent.” Patients might also expertise side effects like vaginal dryness, lowered intercourse drive and worry of contaminating companions with medicines, and having a radical cystectcomy will result in menopause if the lady isn’t already postmenopausal.
“The removal of the sexual organs can cause menopausal symptoms because you’re removing the organs that produce hormones that help with a lot of sexual functions, such as lubrication,” stated Dr. Andrea Apolo, a medical oncologist on the National Cancer Institute in Bethesda, Maryland. Women can combat this lack of pure lubrication with store-bought lubricants or vaginal hormones when acceptable.
“After surgery like this, we want to get the vagina feeling happy again. Vaginal hormones can help the vagina feel more supple and stretchy,” stated Dr. Heather Bartos, an OB-GYN and member of HealthyWomen’s Women’s Health Advisory Council.
A radical cystectomy might also shorten the vagina, which may trigger painful intercourse and penetration. Solutions embrace vaginal dilators — plastic, cone-shaped objects used to stretch the vagina — and vaginal reconstruction, a surgical process that lengthens the vagina.
Pelvic workout routines, like kegels, can be useful after a cystectomy. Working with a bodily therapist might assist as nicely. “A pelvic floor physical therapist can help release muscle tension down there and release any kind of scar tissue,” Bartos stated.
Nerve damage may also happen throughout a cystectomy. Nerve bundles contained in the vagina may be broken, and if the top of the urethra is eliminated, the clitoris might lose sensitivity. Patients ought to discuss to their medical doctors earlier than surgical procedure about probably sparing these areas.
Emotional affect
“Any time there’s cancer in the pelvic organs and a woman needs to have all of those organs removed, there’s a lot of emotional trauma,” stated Bartos. Apolo defined it as sufferers needing to regulate to what she calls “a new state of being.” According to Smith, girls face many points when they’re recognized with bladder most cancers. These points can embrace despair and anxiousness, which may translate into decreased sexual need or satisfaction. Some of those points could also be attributable to the emotional toll of the analysis or the remedy, and others could also be attributable to the bodily modifications ensuing from the remedy.
Addressing the emotional aftermath of bladder most cancers, probably with a psychological well being skilled, is necessary for sexual well being. “Talking to a therapist, in either individual [or] couples therapy or both, can really help get those emotions out,” Bartos stated.
Many girls additionally expertise a insecurity about their post-cystectomy our bodies. “Patients that have an external apparatus may be embarrassed and worry that their partner isn’t going to find them attractive,” Apolo stated. Intimacy attire for ladies with stomas is on the market and may make them really feel sexier. But Apolo believes a very powerful approach to really feel snug after surgical procedure is to speak overtly to medical doctors, companions and different sufferers. There are communities on the web, such because the Bladder Cancer Advocacy Network, the place sufferers help each other and share data.
“It’s important that stories like this are written. I think the best way to empower people is with knowledge and resources because bladder cancer can feel very lonely after diagnosis,” Apolo stated.
Finding a means again to pleasure
For most sufferers, the clitoris is unaffected by surgical procedure and clitoral orgasms are nonetheless doable. However, even for these sufferers who lose clitoral sensitivity or those that battle with vaginal intercouse, orgasm and pleasure are nonetheless achievable.
“Having this surgery doesn’t mean the end of the sex life. There’s a lot that women can do to continue a healthy sex life,” Apolo stated. The most necessary a part of that, she defined, is to speak along with your companion about what does and doesn’t really feel good.
Bartos famous that sexual pleasure after a cystectomy might merely look completely different from earlier than. “There’s still a great deal of pleasure to be had. If vaginal intercourse is uncomfortable, some patients will try anal intercourse or oral sex. It’s about what works for that woman. It just may not be what she’s always assumed sex to be like,” she stated.
Bartos stated that single girls might have a better time attaining pleasure after bladder most cancers in comparison with these in dedicated relationships. “Single women progress through their new sexuality faster because they can pleasure themselves without pressure to satisfy someone else or feelings of self-esteem from a partner seeing them,” she wrote in an e mail.
Of course, a caring companion might be an awesome supply of help, however Apolo finds {that a} girl’s character performs extra of an element than her relationship standing. “It really depends on the person and how sexually active she was before the surgery,” she stated.
Speaking up earlier than remedy
One of one of the best methods to face bladder most cancers and its affect is to be ready. Women ought to communicate overtly to their urologists, oncologists and gynecologists about what to anticipate after surgical procedure. “If you’re kind of prepared that this is going to be a different way of life, you’ll be more ready for the outcome after treatment,” Apolo stated.
Another necessary problem sufferers might need to talk about with their medical doctors is having kids. Although most ladies recognized with bladder most cancers are over 55, it’s doable for ladies who’re nonetheless of child-bearing age to develop the illness. Since remedy might contain removing of intercourse organs, youthful girls might need to talk about reproductive choices, resembling freezing their eggs, with their medical doctors earlier than remedy begins.
People with bladder most cancers must also ask their medical doctors about different remedy choices, resembling radiation and chemotherapy. Right now, essentially the most accepted remedy for MIBC is aggressive surgical procedure, however different choices are beneath investigation and chemoradiation could also be an possibility for sure sufferers. Doctors are additionally shifting towards surgical strategies that protect sexual organs and nerves wanted for sexual pleasure. According to Smith, the Johns Hopkins Women’s Bladder Cancer program has moved away from routinely eradicating pelvic organs throughout cystectomy and is advocating for procedures that go away organs and nerves in place, which could cut back sexual issues.
Sex might not look the identical after remedy. Pleasure might come from a brand new place, and a girl’s physique might really feel completely different from earlier than. But none of that implies that she will’t take pleasure in intercourse after bladder most cancers. She can discover her means again to a full, satisfying intercourse life.
This useful resource was created with joint help from Astellas and Seagen.