A radical cystectomy is the removal of the bladder, uterus, ovaries, fallopian tubes, cervix, the front wall of the vagina, and the urethra due to bladder cancer.
Most women who have this type of surgery are postmenopausal. Some women report that they are less orgasmic after a radical cystectomy, with less lubrication, desire, and some pain during penetration.
The partial removal of the vagina
Part of the vagina is removed during this type of surgery, but it can be rebuilt using skin grafts, including skin from the back wall of the vagina.
Vaginal reconstruction techniques evolve all the time, so speak to your surgeon about what will be appropriate for you. Because the cervix is removed (the top of the vagina), the vagina will be somewhat shorter.
The narrowed vagina
The surgery may result in a narrowed vagina, which can cause problems and pain with penetration. This will be particularly true if radiation therapy was applied, causing thickening of the vaginal walls as scar tissue develops. A lack of depth may cause issues.
Making sex easier and better with tools
You may be asked to use vaginal dilators to help expand your vaginal tissue so it can fit a regular-sized penis or sex toy in it. These dilators are different sizes and you ‘graduate’ up as you go.
You can also use a variety of vaginal moisturisers and lubricants, plus possibly oestrogen creams to improve vaginal cell function and performance.
A short vagina (unreconstructed)
You will need to adjust yourselves to accommodate this shortened vagina, but it’s possible to have a fulfilling sex life. The angle will be important, plus different adjuncts to the penetration including holding the thighs together to give the illusion of a longer vagina, without causing pain.
When penetration is painful
The clitoris typically still works, so using other ways to get each other off will be required, and talk to your doctor to see if anything can be done to locate the source of the pain and alter it. Painful sex is called dyspareunia.
Orgasms
Orgasms are completely possible – and often unchanged – after a radical cystectomy, but some women do encounter nerve damage that causes a loss of orgasm.
This outcome will depend on the skill of your surgeon, so talk it over with them first and make sure you are happy with their experience and expertise in retaining sexual function, if possible.
Removal of the urethra
This can cause the blood supply to the clitoris to be cut off, so talk to your surgeon about the possibility of keeping the urethral meatus (end). The clitoris is erectile tissue too, and requires blood to become engorged.
You will have an ostomy (or stoma) for urine
Once your bladder is removed, you will have an opening made for you to remove urine from your body at regular intervals. Sex with a urostomy needs special attention, since it will be present.
Empty the pouch before sex, and think about some outfits that can hide the pouch, like crotchless panties, a slinky nightie, or a top. You can also have a midsection pouch cover – there are many available online.
There are also continent ostomies that are emptied with a catheter. Read more about sex with an ostomy
Specially formulated probiotic for vaginal application to promote a healthy vaginal microbiome.
Unique, comprehensive BV, AV and 'mystery bad vag' treatment guide, one-of-a-kind system, with effective, innovative treatments.
