Pain during sexual activity is one of the most common sexual problem women experience after a cancer diagnosis. The pain can be the result of changes to vaginal tissue from menopause or cancer/cancer treatments.

Understanding the potential causes of vaginal dryness and painful sex can help you decide on next steps to take to promote vaginal health. 

What Causes Vaginal Dryness and Pain During Intercourse?

• After menopause, the lining of the vagina thins and can lose some ability to stretch due to decrease in estrogen. Even if an individual is sexually aroused, their vagina may remain dry and tight. The vagina’s pH (acidity) can increase making it more likely to get vaginal and bladder infections. These changes are called genitourinary syndrome of menopause, or GSM. These changes can cause the genital tissues to become sore during sexual caressing or intercourse. 

• Because cancer treatments can cause sudden menopause in women under 50, GSM can be more common in this patient population. 

• Certain chemotherapy drugs can cause temporary vaginal lining irritation. Radiation therapy of the pelvis and vagina can cause irritation, ulcers, and possible long-term vaginal shrinkage and loss of stretch. Bone marrow or stem cell transplants from a donor can cause graft versus host disease in the vagina. This can lead to severe scarring if not caught and treated early. 

• Fear of sexual activity causing pain may result in the muscles around the vaginal entrance to tense up. This muscle tension can cause vaginal irritation with penetration. 

What Can You Do to Help? 

• Talk openly with your partner about any pain or discomfort you are feeling. If possible, work together to find alternatives for sexual intimacy. 

• Talk with your doctor about whether you are a candidate for vaginal estrogen. If you have had breast cancer or another type of cancer sensitive to estrogen, ask your oncologist’s opinion. 

• Consider using vaginal moisturizers (over-the-counter products you put inside the vagina) and lubricants (over-the-counter products you use when engaging in sexual activity). 

• Reach out to a gynecologist and/or physical therapist who specializes in pelvic pain and sexual problems to get expert treatment.  

Vaginal Lubricants 

Vaginal Moisturizers 

Kegels and Cancer: How and Why You Should Be Doing Them