Cancer can also strike a woman’s vagina, uterus, cervix or ovaries.

Women with these cancers experience negative changes in all stages of the sexual response cycle and with their sex lives in general (Gamel et al.,

2000) . Some women who have been diagnosed with cervical cancer ini­tiate sexual intercourse as a way to “say goodbye” to their sex lives be­cause they believe they will never have a sex life after cancer treatment (Zegwaard et al., 2000). A woman’s feelings about her cancer treatment and her social support network are both important in sexual recovery from these treatments.

Подпись: oophorectomy The surgical removal of the ovaries. Cancer of the reproductive organs may result in a hysterectomy. In a total hysterectomy, the uterus and cervix (which is part of the uterus) are removed; in a radical hysterectomy, the ovaries are also removed (oophorectomy; oh-uh-for-RECT-toe-mee), along with the Fallopian tubes and surrounding tissue. Hysterectomies are also performed for conditions other than cancer. In fact, they are done so often that hysterectomy is the most common medical procedure performed in the United States today (Kuppermann et al., 2004). Many critics began to claim that American surgeons were much too quick to remove a woman’s uterus; in France, for example, doctors performed fewer than one-fifth the number of hysterectomies as in the United States. Because of this criticism, the num­ber of hysterectomies performed in the United States has been dropping.

Physicians may neglect to discuss the sexual implications of losing a uterus with their patients because they know that the uterus does not directly influence sexuality and they assume that the woman feels the same way. Yet many women believe that their uterus is needed for normal sexual functioning and worry that removal will affect their sexual desire or their ability to have normal relations. Research has found that women who undergo hysterectomies often have low blood flow responses to the vagina, which suggests possible nerve damage (Maas et al., 2004). Other studies have found that sex­ual functioning improved after hysterectomy (Rhodes et al., 1999).

A hysterectomy can affect sexual functioning and pleasure in a number of different ways. The ovaries produce most of a woman’s estrogen and progesterone; so, when they are removed, hormonal imbalances follow. Even with hormone replacement therapy, re­duced vaginal lubrication, mood swings, and other bodily changes can occur. Also, many women find the uterine contractions of orgasm very pleasurable, and when the uterus is removed, they lose that aspect of orgasm. In some cases, part of the woman’s upper vagina may be removed, and the vagina may then be shorter, making intercourse un­comfortable or painful.

Some women experience depression and the disruption of intimate relationships af­ter a hysterectomy. In part, how a woman feels about her hysterectomy reflects other needs in her life. Older women who are through with childbearing may find it less dis­turbing; in fact, some women are happy to be free of menstrual periods and the need for contraception (especially if the hysterectomy was for reasons other than cancer). Other women may feel a profound sense of loss because they may have wanted to bear children

or because they are mourning the loss of a cherished part of their body and female iden­tity. Sexual partners must be sensitive to how the woman tries to work out her new re­lationship to her sexuality. Over time, the adjustment to these changes often improves.