Impact of Cancer Treatments on Sexuality & Fertility

Treatment	Vaginal, sex and fertility outcomes
Abdominoperineal (AP) resection	This can cause a dry vagina (unless on HRT/oestrogen), sometimes result in reduced vaginal size and painful sex, and rarely is associated with low sex drive, trouble reaching orgasm, and infertility.
Aromatase inhibitor therapy for breast cancer	Sometimes low sexual desire, a dry vagina, reduced vaginal size and painful sex, which may extend to issues with orgasm (due to pain). This is only given to women after menopause, so does not affect fertility.
Chemotherapy	Sometimes low sexual desire, but often a dry vagina, painful sex, and causes infertility. Reduced vaginal size may occur rarely with menopause. Orgasm is not usually affected.
Conization of the cervix	This never affects sexual drive, vaginal moisture, vaginal size, orgasm, and hardly ever affects sexual sensation (unless scar tissue exists), and very rarely causes infertility.
Mastectomy or radiation to the breast	This hardly ever affects sexual desire, doesn't affect the vagina at all, but rarely can affect the ability to reach orgasm.
Oophorectomy (removal of both tubes & ovaries)	This procedure rarely causes low sexual drive, but often (unless on oestrogen therapy) causes a dry vagina, reduced vaginal size, and painful sex, and always causes infertility. Rarely it can cause issues with orgasm.
Oophorectomy (removal of one tube & ovary)	This rarely causes issues with libido, and is never associated with a dry vagina, reduced vaginal size, painful sex (unless linked with menopause), or trouble reaching orgasm. It can rarely cause infertility. Oestrogen therapy helps circumvent issues.
Pelvic radiation therapy	If sex is linked with pain, low libido can result. Radiation causes a dry vagina, reduced vaginal size, painful sex, and infertility. It rarely causes issues with orgasm.
Radical cystectomy	This surgery rarely causes issues with libido, often reduces vaginal moisture, always reduces vaginal size, sometimes causes painful sex and trouble reaching orgasm, and always results in infertility. HRT can help.
Radical hysterectomy	This procedure rarely causes low sex drive, but does result in a dry vagina, reduced vaginal size, and results in permanent infertility. It rarely causes painful sex or trouble reaching orgasm.
Radical wide local excision vulvectomy (or partial vulvectomy	A vulvectomy rarely causes issues with sexual drive, never affects vaginal moisture, sometimes reduces vaginal size, sometimes causes painful sex and trouble reaching orgasm, but fertility stays intact.
Tamoxifen therapy for breast or uterine cancer	This procedure sometimes causes issues with libido, causes a dry vagina, sometimes impacts vaginal size (smaller) and causes painful sex. Orgasms are rarely affected. Birth control is required.
Total pelvic exenteration with vaginal reconstruction	This procudure can reduce sexual drive in some women, causes low vaginal moisture, sometimes reduces vaginal size and causes painful sex, and can interfere with orgasm. It is always associated with infertility.