Sexual dysfunction is common among adults with cancer,1 and women with gynaecological cancer are no exception.^2,3 Much of this is easily explained, given that most patients with cancer experience anxiety or depression after diagnosis and during treatment. To this may be added other aspects of their condition or treatment that make sex difficult - chronic fatigue, nausea, diarrhoea, altered genital appearance or loss of the vagina, tender scars, pain, malodour, alopecia, nervousness about breakdown of the wound, embarrassment about stomas, or advanced disease. What is less clear is why, after “successful” treatment, some women continue to have sexual difficulties.

Most of the organic causes of this problem relate to treatments that alter the genital area. Radical vulvectomy removes the clitoris (although orgasm may still occur4), renders the tissues tight and devoid of fat “cushioning,” and may result in prolapse of the posterior vaginal wall or vaginal stenosis. Radical hysterectomy shortens the vagina, and pelvic exenteration removes it entirely. Radiotherapy renders the vaginal mucosa dry, easily traumatised, stenosed, and less distensible; to this is added the effect of ovarian failure, which in itself causes substantial sexual dysfunction.5 Both surgery and …