Table 2.

Summary of results

Main theme	Subtheme/s	Quotes
Complexity and nuance in sexual functioning experiences	Material changes in sexual functioning	“The sexual relationship, I couldn’t, there was no sex involved the next year or so, even now it’s still a bit, not sore, but two months ago I was very uncomfortable, because I had a yeast infection. It’s your whole bottom body is on fire all the time, constipated, I have been constipated since the chemo started, feeling constipated all the time. So, your sexual being, it doesn’t exist.” —Ivy “They said the radiation caused scar tissue that is why I think I’m too tight. The dryness is also from the treatment they said, and sometimes he has to do stuff to make me wet, and that is uncomfortable, that is an uncomfortable feeling, when I’m too tight and too dry I’m very uncomfortable. And after sex I’m always tired, I feel so weak, like I have no energy left in my body.” —Fiona
	Impact of prediagnosis symptoms	“I actually had this uncomfortable feeling and itchiness all the time for years. Yes, it was about three to four years that I had it, I went to the doctor and then I had a Pap smear, and then she said that it’s just fine, I must just use the ointment. And then, because I think I went twice to different doctors, and because it’s a gynae problem and you don’t want just any doctor to just look into you, you don’t feel comfortable.” —Sam “Before, I don’t even want to talk about before, before I also didn’t want to have sex, because you know I told you that when we were having intercourse I would start to bleed, that was really messy and that is why we never bothered having sex that much.” —Fiona “Before I received the treatment, I didn’t have a desire to have sex with my husband, because that desire to have sex was not there. So, after the operation that feeling of being a woman came back, that feeling of being woman…So, after the treatment I felt different. I am the one that wants it most of the time, I feel that I am always ready for my husband, there isn’t a time where I feel tired or worried about the pain.” —Wendy
	Intimate partnership dynamics	“I don’t know why but sometimes we won’t have sex for two weeks and we sleep in the same bed. For instance, I touch him and then he will, but if I don’t touch…It’s like that, so I can’t say from his side what’s the problem there, maybe he doesn’t feel like it, maybe he is too tired or whatever.” —Roxy “I will be honest with you, it’s been down [their sex life]. Most of the time, it’s not all the time…After the treatment and before because he is a diabetic. So, I had to compromise with his sickness as well, and be patient and tolerant. So, I think that is where the understanding comes from on both sides.” —Ivory “Yes, it’s after the treatment, so I think the operation hasn’t healed on the inside, yes. And unsatisfied on his side, I would say he might also have a problem because I don’t feel him the way I used to. I think that the problem is with him. He thinks about going to the doctor.” —Busiswa
	Coexistence of pleasure and discomfort	“I don’t like it as often as I used to, so not often, so that is how I would like to describe it. I’m very well lubricated, not dry at all but I don’t like it that often. I’m quite comfortable, there is no discomfort. I mean it’s still as pleasurable, it’s as still pleasurable but I still don’t like it as often, and I’m very well lubricated and very comfortable.” —Jane “There’s always a desire, I make myself available after I finish my work, and I wash myself and I make myself sexy but I’m tired [laughs] that is the problem. I’m tired and he would force me and then we would argue and then I become angry; because sometimes when I’m tired I don’t feel like it.” —Priscilla
The influence of heteronormative gender role expectations on sexuality	‘Failing’ at femininity	“You doubt your femininity, because now your life has changed – you are sick now. There’s always anger in the household because you are sick, everything is going backwards. It seems like there is no mother in the home because mom is sick. So, everything is unpleasant, and so you start to doubt whether you are a real woman. So, all of that makes me feel empty when I am not take care of at home. And also, you aren’t desirable because you are sick, and you are always lying in bed, so you lose your desirability and your husband loses interest in you, he doesn’t see anything in you because you are also not fixing yourself up because of your health.” —Grace
	Sexual violence	“What caused it is if we were intimate I would bleed, it wasn’t nice and blood clots would come out. And when all is done I would get an itchy discharge which is constant and that is not treatable, so I ended up going to check myself out to see what is going on. That is how I felt but he was also persistent. I would bleed when I’m intimate with a man, it wasn’t nice, and I would be in pain, the pain caused me to act. So, what he would do is he would force me, but I would tell him that the discharge would come out while I’m standing. So, he was forcing things, so I ended up calling the police to chase him out of the house.” —Cebisa “Let me put it like this he is a man and he wants sex, right but you can’t give it to him. You can’t give it to him, so he is going to become angry, or he will hit me, and he will fight with me because I don’t want to give it to him. Look I must avoid him because why do I have to do that, look he wants to sleep with me, and now my wound has not healed. It’s still raw on the inside, now that is why I’m avoiding him.” —Maggie
Re-embodiment of the sexual self	N/A	“I’m still a woman no matter what has been done to my body, I’m still a woman, it happened and it’s done. The operation has been done and I have to live with that.” —Edith “I would say that I still find myself attractive, confident, feminine. I’m still whole and I’m comfortable because that is who I was before. And I’m still that person, it doesn’t matter what operation I had, what was removed from me, that is from the inside. But I’m a person, my heart is whole, so I still feel attractive and I still feel confident.” —Fiona
Psychosexual support during the cancer journey	Information received from healthcare professionals	“They just call you into the boardroom to tell you what the procedure is going to be, what they will be doing here in the treatment; but not on a sexual, not telling you about how or you know.” —Gia “No, the doctor said I am quite old age, he doesn’t think that I am somebody that is a young girl that likes to have a lot of sex and things like that.” —Bonnita “They did tell me yes, they explained to me I’m not going to get the feelings because every, they told me that not every woman is the same, every woman has a different body.” —Fatiema
	The need for comprehensive support	“I would say that they should explain it to a person in more detail, just like myself I don’t have much information on what sex would do to me…Even if you give us pamphlets, yes to read, a person to read on their own and see whether sex has an effect or not, and for us not to be worried, or to be too anxious.” —Xoliswa “I think that when you come for your visit, doctors don’t need to wait for you to say, “Doctor, I’m getting sore when I have intercourse,” or “Doctor if I bend too low having sex, I’m getting sore.” I think they need to, when you come, they must sit with you and must have a chat with you about that part; because that part is the most, that is the part where you find it most difficult.” —Roxy “And to have a support group would be nice, I mean I know about cancer, cancer is expensive to go through and even some of the other support groups it’s very difficult, but to have something as part of the hospital that’s here.” —Ivy

N/A, not applicable.