Vaginal Dryness After Cancer Treatment

This page is for women who have vaginal dryness or painful sex after cancer treatment. It explains why it happens, the usual treatment steps, and when to call your care team.

NCI says cancer treatment can lower estrogen levels. Low estrogen can cause vaginal dryness. That can make sex difficult or painful. Some treatments can also cause other changes in vaginal tissue. NCI lists vaginal stenosis, which means a vagina that is narrower, shorter and less elastic. It also lists vaginal atrophy, which means a thin vaginal wall and weak muscles, plus itching, burning and inflammation.

Naming your route helps the team pick the right fix.

Chemotherapy. NCI says chemotherapy can lower estrogen levels and cause primary ovarian insufficiency. This means the ovaries are not making hormones. Periods may become irregular or stop, and vaginal dryness can follow. Chemotherapy can also cause sores in vaginal tissue.

Pelvic radiation. NCI says radiation to the pelvis can cause low estrogen levels and vaginal dryness.

Endocrine therapy. Aromatase inhibitors block estrogen production. The three named by NCI are anastrozole, letrozole, and exemestane. Tamoxifen and toremifene block estrogen's effects instead. NCI lists hot flashes, night sweats, loss of interest in sex, and disrupted periods in women before menopause. NCI says hormone therapy is often taken for 5 years or more.

Surgery and transplant. Surgery for gynecologic cancers may affect your sexual life. After a stem cell transplant, graft-versus-host disease can affect the vagina. NCI names both radiation and graft-versus-host disease as reasons a dilator may be advised.

NCI says your team can help with medicines and exercises to make sex more comfortable. These include vaginal gels or creams, lubricants or moisturizers, vaginal estrogen cream for some types of cancer, dilators, and exercises for pelvic muscles.

Lubricants. ACS advises a water-based or silicone gel with no perfumes, coloring, spermicide, herbal remedies or flavors. ACS warns against petroleum jelly and oil-based products, which can cause yeast infections or other vaginal problems. ACS also says you might want to avoid products with nonoxynol-9, a spermicide that can irritate the vagina.

Moisturizers are a separate product. ACS says to use them several times a week, and that bedtime works best. They do not make things slippery enough for sex on their own.

Dilators and pelvic floor therapy. A vaginal dilator is a smooth tube used to keep the vagina from getting tight. NCI says a dilator can help prevent or reverse scarring after radiation or graft-versus-host disease. ACS advises using one several times a week and moving up a size as the tissue becomes more flexible. Pelvic floor physical therapy teaches you to relax those muscles, which can lower pain.

Vaginal estrogen. NCI says vaginal estrogen cream may be appropriate for some types of cancer, not all. Ask your oncologist before you use any estrogen product.

This part needs a real conversation with your oncologist, not a web search. Whether a hormone product is safe depends on your cancer type, your receptor status, and which drug you take now. Bring the drug name to the visit. "I take letrozole for ER-positive breast cancer" starts a useful conversation. "I had breast cancer" does not.

Laser and radiofrequency devices are marketed for these symptoms. The FDA has warned that these energy-based devices may be linked to serious harm, such as vaginal burns, scarring and pain with sex. The FDA says it has not cleared or approved them for menopause symptoms or sexual function. If a clinic offers this, ask your oncologist first.

• Call 911 or go to the nearest emergency department if you have heavy vaginal bleeding that will not stop, or you feel faint. Do not drive yourself.
• Call your care team right away if you have any bleeding or spotting after menopause. MedlinePlus lists bleeding after menopause as abnormal. Do not assume it is only dryness.
• Call 911 or go to the nearest emergency department if you have sudden confusion, or you are hard to wake, or fever comes with shaking chills and breathlessness. Do not drive yourself.
• If you are on chemotherapy, a stem cell transplant, CAR T, or have low white blood cells, call your care team right away, day or night, for a temperature of 100.4 degrees F (38 degrees C) or higher, chills, a sore throat, mouth sores, burning or pain when you urinate, cloudy or bloody urine, redness where a catheter enters your body, or any other sign of infection. CDC says to call your doctor immediately at 100.4 degrees F, because fever may be the only sign of infection. A normal temperature is not permission to wait. If you cannot reach your team quickly, go to an emergency department and say you are on chemotherapy. NCI says to talk with your doctor or nurse before taking any medicine for a fever.
• Call your care team right away if it hurts when you urinate, or your urine is cloudy or bloody. NCI lists both as infection signs during treatment.
• Call your care team right away if a dilator session causes tearing or bleeding. Stop and report it.
• Call your care team within a day or two if the stepwise plan above is not helping after a few weeks of steady use, or sex is still too painful to attempt. Ask for the referral by name rather than waiting for the next scheduled visit.

Say it plainly early in the visit, not with your hand on the door. "Sex has been painful since I started letrozole, and lubricant alone is not enough." That one sentence names the drug, the symptom, and what you already tried.

If your oncologist does not manage this, ask who does. Depending on the problem, that may be a gynecologist, a sexual medicine clinician, or a pelvic floor physical therapist. Ask for that referral by name and by specialty.

For related reading, see Sexual Health and Cancer, Cancer and Fertility, and Fertility Preservation Before Cancer Treatment.

• National Cancer Institute — Sexual Health Issues in Women and Cancer Treatment
• FDA — Energy-Based Devices for Vaginal Rejuvenation: Safety Communication
• American Cancer Society — Managing Sexual Side Effects as a Woman with Cancer
• National Cancer Institute — Hormone Therapy for Breast Cancer
• National Cancer Institute — Infection and Neutropenia during Cancer Treatment
• MedlinePlus — Vaginal or Uterine Bleeding
• CDC — Watch Out for Fever