Sex and closeness while you are on chemotherapy

Sex is the topic most likely to be skipped in a busy clinic. It is also the one many people worry about quietly at home. NCI publishes guidance on it for a reason. It is a real part of treatment, not an extra.

Two things are worth saying up front. The changes below are physical effects of medicine. They are not a sign that something has gone wrong between you and a partner.

NCI also notes that the impact varies. It depends on the type of cancer and the type of treatment. It depends on the dose and how long treatment lasts. It depends on your age and your general health. So nothing here is a prediction about you.

NCI says chemotherapy can lower oestrogen. It can also cause primary ovarian insufficiency, which means the ovaries stop working as they should. The listed effects include hot flushes, irregular periods, and vaginal dryness. NCI notes that dryness can make sexual intercourse difficult or painful.

Hormone therapy can cause a similar pattern. That includes low oestrogen, hot flushes, irregular periods, and dryness.

Radiation to the pelvis can cause low oestrogen and vaginal dryness too. It can also cause vaginal stenosis, which is narrowing. It can cause vaginal atrophy, which means weaker muscles and thinner walls. And it can cause inflammation that makes sex painful.

Surgery adds another layer. NCI notes that gynaecological procedures cause physical changes. So do other operations, such as a mastectomy or an ostomy. Those changes affect body image as well as function.

NCI says chemotherapy may lower testosterone and sexual interest during treatment.

Radiation to the pelvic area can damage blood vessels and nerves. That can make it hard to get or keep an erection. Doctors call this erectile dysfunction. Damage to the prostate may lead to dry orgasms.

Hormone therapy lowers testosterone and reduces sexual drive. Erections become harder to get and to keep. Surgery in the pelvic area may damage the nerves involved in erections. NCI notes that nerve-sparing surgery can be used to prevent these problems.

NCI also names two kinds of drugs that can affect sexual drive. They are pain medicines and antidepressants. That is worth remembering, since both are common during treatment.

Two pieces of NCI guidance are practical rather than emotional. Both need a talk with your team.

Condoms. NCI says condoms may be advised. They protect your partner from exposure to some types of chemotherapy. NCI's guidance for men explains why. Semen may hold traces of chemotherapy for a period of time after treatment. Ask your oncologist how long that period is for your regimen.

Contraception. NCI says contraceptives are recommended during and after treatment for women of childbearing age. Do not assume that irregular or missing periods mean you cannot get pregnant.

These are not optional details. Ask about both before you need the answer.

NCI lists many things care teams can offer women. They include vaginal gels, creams, lubricants, and moisturisers. They include oestrogen cream where it fits. They include vaginal dilators to prevent scarring, and pelvic muscle exercises. Teams can also help with related side effects such as pain, fatigue, and hair loss. Contraceptive counselling is on the list. So are support groups and counselling.

For men, NCI lists medicines that raise blood flow to the penis. It lists penile implants. It lists advice on condoms and contraception. Teams can help with related problems such as fatigue, pain, and emotional concerns. They can also refer you to support groups or counsellors.

NCI notes that most men can stay sexually active during treatment. Timing and precautions depend on your own situation.

If you cannot say it out loud, write it down. Then hand the note over. Clinicians read such notes without flinching. Once the subject is open, it usually gets much easier.

Intimacy is also wider than intercourse. Closeness, touch, and honesty with a partner are still there on days when little else is. And both partners are allowed to find this hard.