Women’s cancer treatment and the clitoral erectile tissue we neglect

Women’s cancer treatment and the clitoral erectile tissue we neglect

When a woman undergoes cancer treatment, if she is lucky, someone may talk to her about the effect of treatment and subsequent hormone deprivation on the vagina: dryness, soreness, elasticity and moisturisers.

Even when this conversation happens, it often goes no further. We still tend to focus on the space we penetrate, rather than the erectile tissue that belongs to her.

Compare this with how we talk about men. After cancer treatment, we understand that changes to erectile tissue, blood flow and nerve function can affect sexual function. We have language for erectile dysfunction, ways to investigate it and research into treatment.

In women, we often reduce an extraordinarily complex change in sexual function to ‘vaginal dryness’.

The clitoris is erectile tissue

The clitoris is highly innervated, hormonally responsive and not dissimilar in size and shape to the equivalent erectile tissues within the penis. Reduced oestrogen exposure, a common consequence of cancer treatment, can affect vulvovaginal tissues, vascular response, clitoral erectile response and the structures around the clitoris.

Yet the clitoris is usually absent from the language we use to discuss this issue. If we only talk about dryness, there is a temptation to think moisturising treatments may be enough. They can lubricate and improve tissue quality to a degree, but they will not meaningfully slow the atrophy of these vital sexual tissues.

Many existing guidelines on genitourinary syndrome of menopause in the context of cancer share this blind spot. They frame emollients, moisturisers and lubricants as first-line options for aromatase inhibitor users, with local hormone use reserved for those for whom this is not enough.

Information and choice matter

Some oncologists remain cautious about the safety of local genital hormones for people using aromatase inhibitors. In helping women decide what they want to do about this uncertainty, it is important to say that moisturisers can treat dry vaginas but will not preserve clitoral erections.

Women deserve information and choice about their future sex lives after cancer. While the conversation is framed only around dryness rather than preserving erectile tissues, we are not being properly honest about the choices often being made for them.