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If you’re facing a diagnosis of bladder cancer or a similar health concern, sex may be the last thing on your mind.

However, your sex life after a cystectomy (bladder removal surgery) should be a major consideration for any doctor who recommends it.

Sadly, research shows that’s much more likely to be true for men than it is for women. In fact – although sexual function after bladder removal is ‘routinely considered’ for male patients – surgeons in one study discussed complications that could affect pelvic health and sexual function with just 13% of female patients. Worse, the medical counseling those women got after surgery ignored the topic of sex altogether.

A group of urologists from Wake Forest Baptist Medical Center in North Carolina is fighting to close that gender gap. Their recommendations – based on a review of more than 70 sources of scientific data – were recently published in the Sexual Medicine Reviews.

One of their findings is cause for celebration; survival rates after a cystectomy are rising. But women who beat the odds still discover that, when it comes to post-surgical quality of life, sex can be difficult and painful for a number of reasons (medically termed dyspareunia). Pelvic Organ Prolapse is a common complication; and a radical cystectomy often involves a section of the vagina. Ovaries may also be removed, leading to a sudden loss of estrogen. The bladder removal itself requires a medical decision about the best way to permanently divert the flow of urine.

Needless to say, cystectomy has a profound effect on a woman’s sex life. Patient complaints range from problems with lubrication and orgasm to painful sex. Across various studies, 30-60% of female patients report a decrease in sexual satisfaction after surgery; and many of them stop having sex altogether.

With the right intervention, it’s possible for women and their partners to adjust and return to a pleasurable sex life. But the researchers say that intervention should start before surgery, with doctors prioritizing sexual satisfaction equally for men and women as part of the bigger picture of post-surgical quality of life.

If your doctor has recommended a cystectomy, make sure the surgical checklist includes these three important things:

Pre-surgical discussion of all the risks and side effects. You need to know what you’re facing, and your doctor needs to know your goals for sexual function before you decide together on the best treatment plan.

Full consideration of alternative surgeries. In some cases, robotic surgery or a simple cystectomy may be just as effective as a radical cystectomy while significantly lowering the risk of complications.

Comprehensive follow up, including evaluation and treatment of sexual or urinary complications that affect quality of life. That may include pelvic floor physical therapy.

Every cystectomy case is different; and the best chance of survival is always the top priority. But there is more to life than survival; make sure your medical team supports your entire quality of life, including your sex life.

References:

Citation – Voight M., Hemal K., Matthews C. 2019. Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature. Sexual Medicine Reviews 7:3 408-15.

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Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

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