Adjustment to surgical scars takes time. Because the surgery often requires extensive removal of major organs, the scar can be long and invasive. Depending on how quickly you heal, the redness and swelling can take some time to reduce. Women with surgical scars often feel a need to hide their body in intimate settings for fear that their partner will be ‘turned off. Many start wanting to have sex in the dark or be covered prior to sex. They fear that their nakedness will expose the scarring and reduce their partner’s impression of them as sexual. It takes a very sensitive and understanding partner to help the woman acknowledge her feelings and sense of ‘loss’ and to accept the scar as irrelevant to their femininity and sexuality. Think of the scar as your life saving device. Show your partner the scar straightaway in hospital. Applying creams or other oils to the scar on a daily basis can feel like a positive step to healing. Discuss the best approach with your nurse. The alternative (a cancer-ridden body and no scar) is not a welcome outcome. If love and intimacy was based purely on body shape and image there would be millions of ‘loveless’ people in the world – both men and women!!
Women with vulva cancer often have the greatest readjustment to make because of the radical extent of the surgery and radiation therapy. Because surgery requires the removal of the external genitals that provide much of the stimulation during sexual intercourse, traditional and former ways of sexual expression are often no longer possible. The vulva is the visible outward sign of female sexuality as the penis is for men. Many women with vulva cancer experience acute pain, inability to have satisfactory penetrating sex, inability to orgasm due to psychological trauma, lack of feeling in the genital area and lymphoedoema in the groin, and in some cases radiation burns on the upper thighs. For some women, especially those in heterosexual relationships the fact that their external genitalia have been removed creates an intense and obsessive desire for its return, and a profound sense of loss of a balanced sexual life. In cases of radical vulvectomy, the external appearance is radically altered with some women describing it as ‘gaping holes’ … in fact this is the removal of the exterior padding of the genitalia. These feelings are quite normal, but often slow down the process of acceptance that the surgery was necessary to preserve their life and realization that a satisfying (but different) sex life can still be achieved – including the ability to still experience orgasm. It is the one gynecological cancer where professional sexual counseling, contact with vulva cancer survivors and extreme sensitivity and understanding on the partner’s part are essential.