The short answer
Cancer treatment can bring changes that affect your sexual life during — and sometimes after — treatment. Some changes are temporary; others last longer. Most people can stay sexually active during treatment, but it's worth confirming with your doctor. Care teams have helped many people with these concerns and can offer practical options and support.
Changes that affect sexual life are a recognized side effect of cancer treatment for both women and men.
Some problems are temporary and improve after treatment ends; others can be long term or start after treatment.
In women, treatments can lower estrogen and cause symptoms like vaginal dryness that make sex uncomfortable.
In men, some treatments can affect nerves and blood vessels, making erections difficult, or lower testosterone and sex drive.
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The full explanation.
The simple version
People being treated for cancer may experience changes that affect their sexual life during — and sometimes after — treatment. You may not have the energy or interest you had before, but feeling close to your partner is probably still important. These changes are a real, recognized side effect of treatment, and your care team has helped many people work through them.
Your doctor or nurse may bring this up, or you may need to be the one to ask. That's normal — and worth doing.
What affects whether changes happen
Whether your sexual health is affected depends on factors such as:
- the type of cancer and the type of treatment(s)
- the dose and length of treatment
- your age at the time of treatment
- how much time has passed since treatment
- other personal health factors
Some problems are temporary and improve once treatment ends. Others may be long term, or may start after treatment.
How treatment can affect women
- Chemotherapy can lower estrogen levels and cause primary ovarian insufficiency — the ovaries stop producing hormones and releasing eggs. Symptoms may include hot flashes, irregular or no periods, and vaginal dryness, which can make intercourse difficult or painful.
- Hormone therapy can also lower estrogen and cause similar symptoms.
- Radiation therapy to the pelvis can cause low estrogen and vaginal dryness, and can lead to vaginal changes — such as a narrower, less elastic vagina, thinning of the vaginal wall, or itching and burning — that cause pain or discomfort during sex.
- Surgery for gynecologic cancers may affect your sexual life, and treatment for other cancers (such as a mastectomy or an ostomy) can bring physical changes that affect the way you view your body.
- Some medicines, such as opioids and some drugs used to treat depression, may lower interest in sex.
How treatment can affect men
- Radiation therapy to the pelvis can affect sexual function. If blood vessels or nerves are damaged, it may be difficult to get or keep an erection (erectile dysfunction). If the prostate is damaged, a man may have a dry orgasm.
- Hormone therapy can lower testosterone levels and decrease sex drive, and it may make erections difficult.
- Surgery for prostate, penile, testicular, rectal, and other pelvic cancers may affect the nerves needed for erections. Sometimes nerve-sparing surgery can help prevent these problems.
- Chemotherapy may lower testosterone levels and libido during treatment, though it does not usually affect the ability to have an erection.
- Pain medicines and some depression medicines may also affect sex drive.
Things people discuss with their care team
Most women and men can be sexually active during treatment — but confirm this with your doctor, because there may be times (such as periods of increased infection or bleeding risk) when abstaining is advised.
Depending on your situation, your team can help you:
- Learn about options that make sex more comfortable. For women, these may include vaginal gels, lubricants or moisturizers, a dilator if radiation has affected the vagina, or pelvic floor exercises. For men, a doctor or urologist can explain medicines and devices used once a sexual health problem has been diagnosed.
- Manage related side effects. Pain, fatigue, hair loss, sadness, or trouble sleeping can all spill over into your sex life. Speaking up helps you get treatment and support.
- Understand condoms and contraception. Condoms may be advised because traces of chemotherapy can remain in semen or vaginal secretions for a time. Contraception may be advised to prevent pregnancy during and after treatment.
- Find support. Sharing concerns with people close to you, a professionally led support group, or a counselor can help. Your nurse or social worker can recommend options in your area.
The takeaway
Sexual health is part of health. These changes are common, they are not your fault, and many can be managed — but your care team can only help with what they know about. A short list of questions at your next visit is a good place to start.
Words to know
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Common questions
▸Can I be sexually active during cancer treatment?
Most people can, but NCI advises confirming with your doctor. There may be times during treatment — for example, when you are at increased risk of infection or bleeding — when you may be advised to abstain. Depending on the treatment, condom use may also be advised.
▸How can treatment affect a woman's sexual health?
Chemotherapy, hormone therapy, and pelvic radiation can lower estrogen levels, causing symptoms such as hot flashes, irregular or no periods, and vaginal dryness, which can make intercourse uncomfortable or painful. Pelvic radiation can also cause vaginal changes, and surgery for gynecologic and other cancers can bring physical changes that affect body image.
▸How can treatment affect a man's sexual health?
Radiation to the pelvis and surgery for pelvic cancers can affect nerves and blood vessels, making it difficult to get or keep an erection. Hormone therapy can lower testosterone and decrease sex drive. Chemotherapy may lower testosterone and libido during treatment, though it does not usually affect the ability to have an erection.
▸Why might condoms be advised during treatment?
Condoms may be advised to prevent a partner's exposure to traces of chemotherapy that may remain in semen or vaginal secretions for a period of time. Contraception may also be advised to prevent pregnancy during and for a time after treatment.
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