AP Resection: Impact on Vaginal Health & Sex

A typical colon surgery used to remove colon cancer is called an abdominoperineal (AP) resection. This surgery involves the removal of the lower colon and rectum.¹

The lower part of the bowel is removed, plus the area of rectum faeces exits the body from. This part of the surgery can include removal of parts of the vaginal canal.^2,3

The AP resection process involves the creation of a colostomy so that stool can leave the body safely, with a colostomy bag.⁴

The AP resection and colon surgery in younger women

Just the colon or rectum may be removed, however sometimes the uterus, ovaries and sometimes the back wall of the vagina must also be removed (hysterectomy). A vaginoplasty may then be performed to repair the vaginal canal with skin grafts or skin and muscle.^5,6

Sex after colon surgery

The nerves are not damaged in the vagina or vulva during an AP resection, so sexual feeling is retained and orgasm is entirely possible. Vaginal dryness can be a problem after colon surgery, particularly when the ovaries have been removed, since oestrogen is responsible for a large portion of vaginal moisture.^7–9

Lube and vaginal moisturisers can really help, as can oestrogen cream. Talk to your doctor. Some sexual positions can be really uncomfortable or cause pain on penetration after colon surgery.

There is scarring down to the tailbone, on the vaginal canal tissue, which can cause discomfort, so positions for each couple will need to be experimented with.¹⁰

Ostomy bags during sex need to be managed, and this may involve certain positions being most comfortable, keeping the bag out of sight with clothing, and being careful, at least at first.

Learn more about sex with an ostomy

Confidence

The anatomy may not function like it used to, but an AP resection doesn’t mean no sex, interruptions to sexual function, and besides the ostomy and possibly some discomfort, nothing untoward should occur.

There is often a loss of sexual confidence after pelvic surgery since our most intimate parts are cut out, irradiated, poisoned and reshaped. It takes some getting used to the new you, and the interim can be emotionally very difficult. Your intimacy may be affected in negative ways.¹¹

Join a support group – people have great ideas, coping strategies and laughs.

References

1.
Marwan K, Staples MP, Thursfield V, Bell SW. The Rate of Abdominoperineal Resections for Rectal Cancer in the State of Victoria, Australia: A Population-Based Study. Diseases of the Colon & Rectum. Published online December 2010:1645-1651. doi:10.1007/dcr.0b013e3181f46485
2.
Smedh K, Khani MH, Kraaz W, Raab Y, Strand E. Abdominoperineal Excision With Partial Anterior En Bloc Resection in Multimodal Management of Low Rectal Cancer: A Strategy to Reduce Local Recurrence. Diseases of the Colon & Rectum. Published online June 2006:833-840. doi:10.1007/s10350-006-0539-9
3.
Garcia-Henriquez N, Galante DJ, Monson JRT. Selection and Outcomes in Abdominoperineal Resection. Front Oncol. Published online August 18, 2020. doi:10.3389/fonc.2020.01339
4.
Seow-En I, Chen WTL. Laparoscopic Abdominoperineal Resection. Mastering Endo-Laparoscopic and Thoracoscopic Surgery. Published online November 17, 2022:525-536. doi:10.1007/978-981-19-3755-2_72
5.
D’Souza DN. Vaginal Reconstruction Following Resection of Primary Locally Advanced and Recurrent Colorectal Malignancies. Arch Surg. Published online December 1, 2003:1340. doi:10.1001/archsurg.138.12.1340
6.
van der Sluis WB, de Boer NKH, Buncamper ME, van Bodegraven AA, Tuynman JB, Bouman MB. Neovaginal cancer after sigmoid vaginoplasty: Implications for postoperative cancer surveillance. JPRAS Open. Published online June 2024:170-174. doi:10.1016/j.jpra.2024.03.002
7.
Sharabiany S, Kreisel SI, Strijk GJ, et al. Exploring the impact of urogenital organ displacement after abdominoperineal resection on urinary and sexual function. Int J Colorectal Dis. Published online August 31, 2022:2125-2136. doi:10.1007/s00384-022-04234-3
8.
Thyø A, Elfeki H, Laurberg S, Emmertsen KJ. Female sexual problems after treatment for colorectal cancer – a population‐based study. Colorectal Disease. Published online June 27, 2019:1130-1139. doi:10.1111/codi.14710
9.
Paszyńska W, Zborowska K, Czajkowska M, Skrzypulec-Plinta V. Quality of Sex Life in Intestinal Stoma Patients—A Literature Review. IJERPH. Published online February 1, 2023:2660. doi:10.3390/ijerph20032660
10.
Levine RA, Qu Z, Wasvary H. Retrorectal Teratoma: A Rare Cause of Pain in the Tailbone. Indian J Surg. Published online March 22, 2012:147-148. doi:10.1007/s12262-012-0457-0
11.
Savoie MB, Paciorek A, Van Loon K, et al. Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma. The Journal of Sexual Medicine. Published online February 17, 2023:439-446. doi:10.1093/jsxmed/qdac047