Ask the Doctors: Vulva Cancer, the Clitoris, and Pleasure

Do you still have feeling and sexual sensations if you do not have a clitoris? If I would put a vibrator there could it give me a orgasm? I lost mine to vulva cancer. Haven’t had intercourse in 4 years. I heard that it is painful. Before my cancer I would play with my clitoris and bring myself to orgasm. What can I do or use to get that back? I am willing to try anything! Thanks.
–Survivor

The clitoris is very important to most women’s sexual response, but that isn’t the whole story. It is very possible that you can explore your newly-configured body so as to experience erotic sensations and even orgasm. Let me start with some information about genital anatomy and arousal, then go on to some suggestions for you.

In case it’s useful, here’s a link to an illustrated image of female genitals (that have not had surgery to alter them, as you have had). There’s one change I’d make to this, which otherwise is very good and clear;  it does not show the legs of the clitoris, which is a much larger organ than many people think it is. The part that you can see and touch (or that you could, before your surgery) is just the tip of the iceberg, so to speak; the legs extend 3-plus inches into the body, like the legs of a wishbone.

I don’t know the details of your surgery, so I don’t know whether your clitoral legs were spared. Hopefully this is something you can find out from your doctor; the information should be in your surgical report. It has some implications for your continuing ability to get erotic pleasure from your clit — that is, any part of it that remains, since it is tissue that can engorge and assist in arousal via the legs as well as the external part that in your case is now gone. Unless it was removed in its entirety (possible particularly if that’s where your cancer was situated), or was damaged too much by the surgery, those legs might be part of a revived ability to get aroused and come.

Also important might be vaginal sensations, particularly G-spot stimulation.  The G-spot, situated between the clitoris and the front wall of the vagina, might be more intact than any part of the clitoral body (if the surgery spared your urethra, that’s even more likely). Pressure and stroking it from within the vagina is highly sexually satisfying to many women, and can result in orgasm. The first picture I linked to above actually gives you a look at the nerves that connect your genitals to your spine and from there to your brain, and it also matters how much nerve damage was (or wasn’t) part of the effects of your surgery. Some sexologists now believe that there are two separate genital nerve pathways that can transmit orgasmic sensations: one serving the clitoris (or penis), the other the G-spot (or prostate).

As to intercourse (or vaginal insertion in general) being painful: Let’s separate this out into three things to consider, because there are in fact at least that many relevant issues in your case. First, scarring (from the surgery itself, and also from radiation, if you had any to control the cancer) may affect how it feels to have anything, from a finger to a toy to a penis, put into your vagina. This is often the source of pain after a surgery of this kind, and of course there is also the possibility that nerve damage has occurred. But if you are not feeling pain in your genital area on a regular basis post-surgery, let’s assume (and hope) that nerve damage isn’t part of the problem.

Second, the fact that you have not had intercourse for four years means that — and I do not mean this to sound minimizing or disrespectful at all — you’re “out of practice.” A common experience for adults, especially as they get older, who do not maintain sexual contact (either solo or with a partner) is that it becomes more difficult to get back to it when their libido returns, they find a partner, etc. Don’t panic, because I said “more difficult” — but by no means impossible! And the fact that you have desire for erotic experience is a big, big plus.

So the third issue is, in fact, closely related to desire: it’s physical arousal. For any woman, much less you in a post-surgical cancer survivor’s body, arousal is a very important component of erotic experience. I don’t just mean the mental interest or desire for such experience, although this is a component of it. Arousal is a physiological process that involves blood flow to the genitals, nerves responding, and the changes in sensation that accompany these things. There are hormonal changes in the body that go with it too, but a very important element is blood flow. Starting genital stimulation too fast, especially insertion, can be a mistake, since pain is more likely to result in an unaroused state — among other wonderful things about the state of arousal, it helps mediate pain.

So when I suggest to you possibilities like G-spot exploration and trying a vibrator (more about this in a second), I want to emphasize that arousal is a key element in your process of re-making friends with your body on an erotic basis. If you can’t get aroused — via physical stimulation, fantasy, reading erotica, etc. — these other strategies may not work. The might be painful or uncomfortable, or they might simply not get you into your sexual response, certainly not to orgasm. And suggestions may not work the first time you try them — it may take some practice. Please don’t give up, because touch and erotic feeling can be part of your life again.

Changing types of stimulation: First, for many people in positions similar to yours (that is, who are forced into changing the way they experience sexual arousal and the specific things they do to get aroused and get off), the hardest thing is actually adapting to a new pattern. You actually have a little advantage here, in a way, because it sounds like sex hasn’t been part of your life for a few years. While no one ever starts completely anew in a situation like this — you will remember what you did to experience sexual pleasure before, I am sure — at least you can start afresh in learning about your “new” body and how it responds to your touch, to vibration, to insertion, etc. Again, really take your time, and be creative. There are people who have very strong sexual responses who never experience genital stimulation — your sexuality is full-body, and maybe your new sexuality will be very different from the way it used to be. Just try to keep as open a mind as possible about this, because that will allow you many more possibilities for pleasure.

Now then, here are some things to consider and perhaps try.

If some part of your clitoral legs remain, you might be able to stimulate them through the use of a vibrator. The Hitachi Magic Wand is the premier choice for this — it’s stronger than battery vibes, plus its large, cushiony head spreads the stimulation out more. Many women do not use this vibrator directly on the clitoris anyway — some position it to the side, pressing in toward the clitoral leg, which is a placement that might work for you. Vibration gives stronger and more consistent stimulation, and it’s very good for circulation — remember, that’s a key part of physical arousal. You can also get a cap for this vibrator, the G-Spotter Deluxe, that will allow you to give yourself insertive, G-spot-focused vibration. You might find you like other G-spot vibes even better — there are many of them.

Lots of women love anal play, too — this is a type of stimulation that, because it stimulates nerves farther for your surgical site, will perhaps give you a new area for erotic exploration, if this was not part of your experience before. And don’t leave out any other part of your body that has erotic feelings — when you explore, stimulate yourself everywhere you can reach, as long as it feels good. Add in anything that heightens your erotic focus and arousal, like erotica.

Regardless of whether you explore anal or vaginal insertion, if you do use toys (or find a partner you want to have intercourse with), make sure you start smaller and then explore larger sized items only if you want to, taking plenty of time — and use lubricant. A good-quality lube and good attention to toy hygiene are important because you don’t want to irritate any areas the surgery impacted.

You might also be interested in the Vaginal Renewal program at the FeMani Intimates website. That site has lots of great information about vaginal and sexual health at menopause — you didn’t tell me how old you are, but much vulvar cancer in pre-menopausal women is associated with HPV infection, while older women are, other than that, more at risk. Also, some of the cancer treatments, particularly radiation, may cause menopause-like symptoms or even hasten menopause. In short, you might find this site and these products worthwhile.

By the way, for other readers: this really brings home the issue of HPV (human papillomavirus, which also causes genital warts) and its dangers — it isn’t just a sexually transmitted condition, it is increasingly implicated in genital (and some rectal) cancers. Gardasil and certain other vaccines are being used to prevent HPV but must, for best effect, be administered before a person becomes sexually active, and the issue of vaccinating very young teens has become intensely controversial and politicized. The more you read about vulvar cancer, though, the more you might think it’d be good to do what we can to prevent this impactful and disfiguring disease. Another risk factor, according to some researchers, is persistent vulvar itching and scratching — women who have recurring problems with itching would do well to seek help before their skin is damaged by constant scratching.

OK, back to our letter: Many women experiencing post-cancer-treatment impact on their sexuality have a partner with whom they need to share new information about their changed body and responses; sometimes that relationship (and each partner’s feelings about getting back into a sexual space with the other, and about the cancer) complicates learning and exploration. I don’t get the impression that you have a partner currently, which simplifies your ability to explore, in a way — you can focus specifically on yourself, take as long as you like, try anything you want. Take advantage of this now, and if you do have a partner, or if someone comes into your life, you will have much more information about how you respond now and what you need to become aroused and, hopefully, satisfied.

Here are a few resources I found while researching;  you may or may not have seen them. Interestingly, British sites on vulvar cancer seem more likely to address sexuality than US medical sites — the medical profession in the US could be a lot better than it is when it comes to sex education and comfort about discussing sexual issues.

Mayo Clinic info: http://www.mayoclinic.com/health/cancer-treatment/SA00071/METHOD=print

A good British site: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Livingwithvulvalcancer/Sexlife.aspx

Anne’s cancer journal: http://annescancer.tripod.com/Article2002/part2.html

Finally, here are three books that you might find to be useful. Good Vibes carries the first one (I’ll link to it); the others will have to be sought elsewhere.

Cory Silverberg wrote The Ultimate Guide to Sex and Disability with Fran Odette — Cory writes the sexuality column for About.com and is a terrific resource. Woman Cancer Sex is by Anne Katz, who works as the sexuality specialist at CancerCare Manitoba. (The book is published by Hygeia Media, an imprint of the Oncology Nursing Society, copyright 2009). And the American Cancer Society publishes a book called Sexuality for the Woman with Cancer, which I’m sure you can access through their site cancer.org — and it’s a free book, to boot. Now, I do not wish to label you as disabled, or even as having cancer; you are a cancer survivor — but some of the information and insights in these books might be more useful to you than information in books written with women in mind who have never had surgery affecting their genitals.

I’m going to write a second, separate answer with thoughts about ways to explore and eroticize your whole body and not seek all sexual sensation between your legs — it will be coming soon. I consider that a big piece of the puzzle, so with luck you will find both of these elements useful. I wish you all the luck in the world with your explorations!


We’re dedicated to getting you the information you need about sex, pleasure and your health. If you have any questions, please email our staff experts, Dr. Carol Queen and Dr. Charlie Glickman, at education@goodvibes.com! For product-related questions, please email or call our customer service staff at customerservice@goodvibes.com.

Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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