Sexual Health and Cancer Treatment

Cancer treatment can change your sexual life. The changes can happen during treatment, and sometimes after it. You may not have the energy or interest you had before. Feeling close to your partner is probably still important. These changes are a real, recognized side effect of treatment. 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.

Several things shape whether your sexual health is affected:

• 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 last a long time. Some do not start until after treatment.

• Chemotherapy can lower estrogen levels. It can cause primary ovarian insufficiency, in which the ovaries stop producing hormones and releasing eggs. Symptoms may include hot flashes, irregular or absent periods, and vaginal dryness. The dryness 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. It can also change the vagina itself. It may become narrower and less elastic, the vaginal wall may thin, and there may be itching and burning. Those changes can cause pain or discomfort during sex.
• Surgery for gynecologic cancers may affect your sexual life. So can treatment for other cancers. A mastectomy or an ostomy brings physical changes that can affect the way you view your body.
• Some medicines may lower interest in sex. These include opioids and some drugs used to treat depression.

• 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. It may also 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. It does not usually affect the ability to have an erection.
• Pain medicines and some depression medicines may also affect sex drive.

Most women and men can be sexually active during treatment. Still, confirm this with your doctor. There may be times when abstaining is advised, such as periods of increased infection or bleeding risk.

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 can help if radiation has affected the vagina, and pelvic floor exercises may help too. For men, a doctor or urologist can explain the 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. It can help to share concerns with people close to you, a professionally led support group, or a counselor. Your nurse or social worker can recommend options in your area.

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.

• Call your care team the same day if bleeding after sex will not settle after a few minutes, or a period is far heavier or longer than usual for you. NCI counts these among the bleeding signs to report.
• Reach your team straight away, at any hour, or go to an emergency department if you feel shivery or your temperature hits 100.4°F (38°C) or higher during a stretch when your counts are low. A fever during chemotherapy is a medical emergency, so it should not wait for office hours. Infection can move fast when counts are low.
• Call your care team within a day or two if intercourse hurts every time, or dryness and burning do not improve with the lubricant or moisturizer you were given.