More attention has been focused on the effects of surgery on male sexual dysfunction than has been focused on female sexual dysfunction. Surprisingly, it is only in recent years that any attention has been focused here.
In women, a radical cystectomy typically includes removal of the uterus (hysterectomy), ovaries, and fallopian tubes (salpingooophorectomy), and a small portion of the vagina. The nerves that go to the clitoris and vagina are similar to those that go to the penis in men.
Therefore, we can expect that a radical cystectomy may affect a woman’s sexual function as well as a man’s. If you are sexually active, it is important to discuss these issues with your urologist before surgery. Nerve-sparing surgery may be an option to help limit sexual dysfunction after surgery.
In addition to producing eggs, ovaries also produce estrogen and testosterone. Testosterone is the dominant sex hormone in men, but is also produced in small amounts in women. It is known to be a driving force for a woman’s libido (interest in sex).
After removal of the ovaries, the levels of both of these hormones fall dramatically. Estrogen replacement after removal of the ovaries is common, although the risks and benefits are not entirely clear; thus, replacement therapy should be discussed with your urologist, primary care provider, or gynecologist. Testosterone replacement is also easily achieved with medications, but is still not well studied.
If your libido is decreased after surgery, testosterone therapy may help it to return to how it was before surgery. Again, the risks and benefits of these therapies remain unclear, and thus each case needs to be addressed individually.
Some women may have difficulty with intercourse after surgery because of narrowing or shortening of the vagina. If you are sexually active before surgery and wish to remain active or even maintain the potential to be sexually active, it is important to discuss this with your doctor. During surgery, techniques to minimize the narrowing or shortening of the vagina can be employed to help preserve function and avoid potential pain with intercourse.
The nerves that supply the vagina, much like those that supply the penis in men, act to increase blood flow to the vagina when stimulated. The increased blood flow in turn stimulates vaginal lubrication.
Therefore, any injury to these nerves during surgery can lead to vaginal dryness during sexual activity. For many women, this can be easily treated with the use of lubricants that are available at most pharmacies and supermarkets.