Treatment for bladder cancer can result in side effects that can affect both urination and sexual health function. 

Cystoscopy Considerations 

Women may have soreness in the bladder and urethra (urinary tube) for days after each cystoscopy. The side effects may be worse if chemotherapy is put into the bladder. When the bladder lining is irritated, a woman feels the need to urinate urgently and frequently. Urination can often burn. Unfortunately, these treatment side effects also can cause pain during sex. The vagina is right behind the urethra, and having intercourse often sets off painful bladder spasms or urethral burning. Tenderness around the urinary opening can also be distracting during caressing on the vulva. 

Radical Cystectomy, Sexuality, and Fertility 

In radical cystectomy, the surgeon may or may not need to remove a portion of the front vaginal wall. The vagina is made into a whole tube again, either by using a skin graft or flap to replace the tissue that was lost, or just by sewing the vaginal edges together again. Depending on the procedure, the vagina may be more narrow or shallow. 

Some surveys have shown that many women are unable or uninterested in sex following cystectomy, with the referenced issues being loss of vaginal lubrication, decreased libido, and inability to achieve orgasm. Some women find that the use of vaginal dilators help them increase their vaginal size and relieve some pain. If you are interested in this option, read through our resource and plan to discuss with your doctor to see if this option is right for you. Most women can eventually have pain-free sexual intercourse if they get the information they need to cope with the physical changes. 

Here are some strategies to cope with sex during treatment for noninvasive bladder cancer: 

Avoid penetrative sex during the days of the worst irritation. 

• Avoid hard thrusting during penetration.

• Use a good lubricant or moisturizer for all sexual activity.  

• Substitute hand caressing or oral sex for vaginal intercourse. 

• Avoid using a diaphragm for birth control, since the pressure of the ring may add to pain in the urethra. 

Sex After Urinary Diversion  

Depending on the type of urinary diversion, it is common to experience fear that you will leak urine during sex from an ostomy appliance or from a neobladder (new bladder built inside the body), or that a partner will be turned off by the need to be hooked up to a drainage device to collect urine during sleep. Having an open conversation about this with your partner is important. Counseling with a trained mental health professional may help couples cope with these issues in their sex lives. 

The need for troubleshooting during sex can depend on how self-regulated your urinary diversion type is. Some individuals can control when they urinate while others cannot.  

• Consider learning how to self-manage care of your urostomy, this can help you regain a sense of health and independence. 

• Consider wearing a smaller pouch during sexual activity. These small pouch covers need to be emptied more often, however are more discrete for short term situations where this is preferred. 

• To lessen the chance of a leak or odor during sex, it may help to empty urine from the pouch before initiating sex. If you think you will have sex later, avoid eating foods like asparagus or some processed meats that give urine a strong odor. 

Although having a continent ostomy sounds much more convenient than having to wear a pouch and faceplate, many continent ostomies leak at times. If you have a continent ostomy, you do not have an appliance that can move around, leak, or even fall off during sex. On the other hand, continent ostomies do sometimes still leak. if you have leaks during sex, you may want to put a pad over the stoma and wear a wrap belt around it.