Sexual Health & Fertility During Cancer Care

Cancer treatment commonly affects sex and fertility. Both are among the least discussed subjects in the exam room. Clinicians run short on time, and worry about intruding. Patients assume it is trivial next to survival, or wait to be asked. So people learn about permanent changes after the fact, when some could have been planned for. Both subjects belong in the conversation before treatment starts. And both stay relevant long after it ends.

Several things are at work here, and each calls for a different response. Hormonal shifts are the largest. Chemotherapy, ovarian suppression, and removal of ovaries or testicles can all cause them. So can endocrine therapies, such as aromatase inhibitors or androgen deprivation. The result can be abrupt menopause, low testosterone, hot flashes, vaginal dryness, loss of desire and erectile difficulty. When this happens over weeks rather than years, the effect is sharper than a natural change.

Structural changes come from surgery and radiation. Pelvic radiation can narrow or dry vaginal tissue. Prostate and pelvic surgery can affect the nerves involved in erection and continence. Stomas, scars, mastectomy and reconstruction change how a body feels to its owner.

Then there is everything else. Fatigue, pain, neuropathy (nerve damage), steroids and antidepressants all play a part. So does the plain fact that fear and exhaustion do not make room for desire. Partners often withdraw, wishing not to pressure anyone, and that is easily read as rejection. Naming it out loud usually helps more than any medical treatment.

Many cancer treatments reduce or end fertility. Almost all the options are time-sensitive. Most need to happen before the first dose.

The American Society of Clinical Oncology updated its fertility preservation guideline in 2025. It recommends that fertility be discussed with people with cancer at diagnosis. It should also be addressed as part of survivorship care after treatment. In that update, ASCO recommended in vitro maturation of eggs as an emerging method. It concluded that this is no longer experimental.

Here are the main approaches, in general terms.

• Sperm banking is fast, straightforward and widely available, including for adolescents.
• Egg or embryo freezing needs ovarian stimulation over roughly two weeks. That has to be scheduled against the treatment timeline.
• Ovarian tissue freezing involves a small surgery and no stimulation. So it can be used when treatment cannot wait, and for girls who have not reached puberty.
• Testicular tissue freezing is offered in some centers for boys who have not reached puberty, generally through a research protocol.
• Ovarian transposition means moving the ovaries surgically out of a radiation field. It is sometimes an option before pelvic radiation.

Cost and coverage vary widely by state and plan. That is a common reason people do not pursue options they were eligible for. Ask the fertility clinic for a written estimate. Ask your center's financial navigator about help with the cost. Our page on fertility preservation before treatment begins covers the process in more detail.

Contraception is the other half of this conversation. Reduced fertility is not the same as no fertility. Teams generally want to avoid pregnancy during treatment.

• Put it on the written list you bring to the appointment. Then it does not depend on your nerve in the moment.
• Say it plainly. "How will this affect sex, and what can be done?" is enough.
• Ask for a referral rather than a conversation. Reproductive endocrinologists, sexual health clinics, pelvic floor physical therapists and sex therapists all exist for this.
• Ask whether the effects described are expected to be temporary or permanent, and over what timeframe.
• Ask which of your other medications may be adding to the problem.
• If a clinician brushes it off, ask another member of the team. Oncology nurses are often the most willing to engage.

Treatable causes are more common than people expect. Vaginal dryness, pelvic floor tightness, erectile difficulty and painful sex all have specific approaches. Pelvic floor physical therapy in particular is underused. Whether hormone-based treatments suit you depends on your cancer type. That is a discussion with your oncologist, not a general rule.

Recovery of sexual function is often slow, and it rarely follows a straight line. For some people the change is permanent. That is worth saying honestly. Being told everything will return to normal, and then finding it has not, is its own kind of injury. Many people rebuild a sex life that is different, rather than identical to the one before.

If a relationship is strained, ask for couples counseling with someone who works in cancer care. That is a reasonable request. Our support page has starting points. The questions to ask before treatment begins list is a good place to add your own.

One decision cannot be made later, and that is fertility preservation. Everything else can be revisited. This one has a deadline, usually the day treatment starts.

• National Cancer Institute — Sexual Health Issues in Women with Cancer
• National Cancer Institute — Sexual Health Issues in Men with Cancer
• National Cancer Institute — Female Fertility and Cancer Treatment
• National Cancer Institute — Male Fertility and Cancer Treatment