Thousands of women with bladder cancer are having life-changing surgery without realising it will end their sex lives, a Mail on Sunday investigation has found.
The operation, which involves removing the bladder and part of the vagina to ensure that cancer is eradicated, leaves most women unable to have sex again.
Even for those who can, sexual pleasure may be impossible because the procedure often causes permanent nerve damage.
The Mail on Sunday has learned that scores of women, some as young as 40, who undergo the operation are in the dark about the results. Patients say their doctors severely under-played the effects, using vague explanations such as 'things not quite being the same down there', 'your sex life might not be the same' and 'bits and pieces might be missing'.
Bladder cancer mainly affects the over-65s, and surgeons, speaking to this newspaper, said that 'at that age, sex isn't such a priority'.
Yet one 57-year-old described her shock when, months after the procedure, she attempted to insert a pessary, only to discover she had essentially been left with no vagina. Another told of 'excruciating agony' when she tried to have sex for the first time after surgery.
Now, experts are calling for doctors to give official guidance to patients, with detailed explanations of the procedure's consequences.
The consultants, from Guy's and St Thomas' NHS Foundation Trust in London, have launched a campaign urging doctors to speak candidly about the effects on women's sex lives – something they say rarely happens due to bladder cancer being seen as a male disease.
The Mail on Sunday has learned that scores of women who undergo the operation are in the dark about the results. Patients say their doctors severely under-played the effects (stock)
Led by urologist Raj Nair, the initiative involves a document compiled by women's health experts, including physiotherapists and gynaecologists, that gives a comprehensive explanation to patients.
Professor Mieke Van Hemelrijck, a cancer researcher, says: 'We want medical teams to have clear discussions with patients. Currently, sexual consequences of bladder cancer treatment are not addressed, because it's not an easy conversation.'
More than 10,000 Britons are diagnosed with bladder cancer every year. About a third of cases are the most aggressive type, often requiring chemotherapy followed by extensive surgery to destroy all cancer cells, known as a cystectomy. In men – who are twice as likely as women to suffer the disease – this usually involves the removal of the prostate, leaving more than half suffering from erectile dysfunction.
Medication and other treatments can often remedy the problem to some extent, but women rarely have these options. Their surgery involves the removal of the bladder, as well as the cervix – the opening of the womb – and the front, or anterior, vaginal wall, where the cancer typically first spreads. Sometimes doctors must remove the uterus, ovaries and Fallopian tubes, too, resulting in infertility.
Only a handful of specialist hospitals offer vaginal reconstruction, and it is rarely provided on the NHS. Experts also argue that far more women than necessary are undergoing the procedure because they are diagnosed at a late stage.
More than 10,000 Britons are diagnosed with bladder cancer every year. About a third of cases are the most aggressive type, often requiring chemotherapy followed by extensive surgery to destroy all cancer cells, known as a cystectomy (stock image of bladder anatomy)
Symptoms of bladder cancer, including blood in the urine and pelvic pain, are often mistaken for urinary tract infections, which are common in women.
A 2013 study published in the British Medical Journal found nearly a third of female bladder cancer patients visited the GP at least three times before being referred to a cancer expert, compared with one in ten men. As a result, one woman in three with the disease is diagnosed at a late stage, requiring the most intensive treatment, compared with just over a fifth of men, according to NHS figures.
Speaking to The Mail on Sunday, NHS urologists reported seeing at least one case of delayed diagnosis every month – usually a woman in her 40s or 50s. Professor John Kelly, consultant urological surgeon at University College London Hospital, says that at late stages the cancer has often spread to the vaginal wall, as well as to the glands in the pelvis. He explains: 'Sometimes the upper portion of the vagina, along with the urethra and lymph nodes, must be removed to clear the cancer. This means the vagina becomes smaller and narrowed so patients cannot have intercourse.
'We try to preserve as much as possible, but getting cancer clearance is life-saving. Women need to be warned about how their sex life will be affected because, depending on how much their disease has spread, they may choose to have radiotherapy instead.'
Tim Dudderidge, consultant urologist at Southampton University NHS Trust, adds: 'Women who have this operation are often left with practically no vagina. It is wrong that this can happen without discussion.'
Some experts say the effect on sexual function is overshadowed by another life-changing repercussion of bladder removal: the need for a urinary stoma bag, to clear urine from the body in the absence of a bladder. Prof Kelly says: 'Sexual function may also be low on the priority list, so perhaps