Sexual Health & Fertility During Cancer Care

This page is for people facing cancer treatment who want to understand how it can affect sex and fertility, and how to raise both with their team.

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 a major one. Chemotherapy, hormone therapy, and removal of ovaries or testicles can all cause them. The result can include:

• Abrupt menopause
• Low testosterone
• Hot flashes
• Vaginal dryness
• Loss of desire
• Erectile difficulty

Structural changes come from surgery and radiation. Pelvic radiation can narrow or dry vaginal tissue. Pelvic surgery and radiation can affect the nerves and blood vessels involved in erection. NCI notes that nerve-sparing surgery can be used to prevent some of these problems. Surgery can also change body image.

Then there is everything else. Fatigue, pain and some medicines, such as opioids, all play a part. Worry and exhaustion can lower desire too. Talking about it openly with your partner and your team can help.

Many cancer treatments can reduce or end fertility. NCI advises seeing a fertility specialist before treatment starts. Research it cites found that survivors had fewer regrets when they did, whatever they decided.

Here are the main approaches, in general terms.

• Sperm banking is the most common method for males who have gone through puberty. Samples are frozen for later use.
• Egg or embryo freezing is the most common method for women.
• Ovarian tissue freezing may suit people who are advised not to delay cancer treatment.
• Testicular tissue freezing for boys who have not reached puberty is still in clinical trials.
• Ovarian transposition means moving the ovaries surgically away from a radiation field.

Cost can be a barrier. Ask the fertility clinic for a written estimate. NCI points to the Oncofertility Consortium for guidance and financial help. 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. Some treatments may harm a pregnancy, so doctors may advise birth control 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.

Many of these problems can be helped. NCI lists vaginal gels, creams and moisturizers, pelvic exercises, vaginal dilators after radiation, and medicines or devices for erection problems. Whether a treatment suits you depends on your cancer type. That is a discussion with your oncologist.

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, which is usually before 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