Anal Cancer and Sexual Health for Women

Sex after Chemoradiation for Anal Cancer 

Most women notice that chemoradiation for anal cancer creates new sexual problems. One common change is that radiation causes a tight band of scar tissue (stenosis) at some point along the length of the vagina. A woman may not be able to have penis-in-vagina intercourse with full penetration if stenosis is severe, or at the least, intercourse will be very painful. As many as 40% of women end up with this problem. Vaginal dryness, pain with penetration of the vagina or the anus, and leaking stool during sex are all common problems after treatment for anal cancer. See the list of Iris handouts at the end of this summary for strategies to prevent and overcome pain, including use of vaginal moisturizers and lubricants, vaginal estrogen replacement, and pelvic floor muscle exercises. 

 Anal Caressing and Intercourse 

Women who have had treatment for an anal tumor may have changes in the shape of their anal canal and a tendency to leak stool at times. For women who have had pelvic surgery, radiation, or a combination of chemotherapy plus radiation, anal intercourse may become more painful, just like vaginal intercourse. If anal intercourse was a major source of pleasure in their sex lives before cancer, they may need to explore other kinds of sexual caressing to take its place.  Hand or oral caressing inside or just around the entrance to the anus is an even more common way of giving sexual pleasure as well as anal caressing or penetration with vibrators or penis-shaped sex toys. Teens may engage in anal intercourse to avoid the risk of pregnancy.  

It is easy to get sexually transmitted infections during anal intercourse because the lining of the anal canal is thinner and more fragile than the vaginal lining. The anal lining can easily get small tears during sex that allow viruses or bacteria to get into the bloodstream. Persistent infections with HPV are a major factor in the increased risk of anal cancer seen in recent years. A woman's risk of getting the human immunodeficiency virus (HIV) is also higher with anal intercourse than with vaginal intercourse. 

Many women find anal penetration uncomfortable even if they have not had any cancer treatment. It is always important to use an extra lubricant before putting anything in the anus. Some of the thicker, water or silicone-based lubricants work best. Bacteria that are normal in the anus can cause vaginal infections, so it is important not to have anal penetration with a penis or sex toy and then directly have vaginal penetration. The couple should stop and use a new condom or sex toy.  

 Fertility in Women with Anal Cancer 

 The best option is to preserve fertility before cancer treatment by having an ovarian stimulation cycle and freezing eggs or embryos. Some women may benefit from having their ovaries moved upward, out of the field of radiation (ovarian transposition). The chemotherapy drugs used for localized disease are not considered highly damaging to the ovaries.