Treatment Affected Intimacy

This page is for anyone whose sex life has changed because of cancer treatment. It covers dryness and pain, erection changes, low desire, and what help to ask for.

Sex can change after cancer treatment. The reasons include hormones, nerves and tissue. It is not a failure of desire, and you do not have to wait it out quietly. Chemotherapy, pelvic radiation, hormone therapy and surgery can all affect sexual function. NCI says opioids and some antidepressants may also lower interest in sex.

Most of what follows can be treated, or at least improved. Almost none of it gets raised unless you raise it.

NCI says chemotherapy and pelvic radiation can lower estrogen and cause vaginal dryness. Pelvic radiation can cause vaginal stenosis. That means a shorter, narrower, less elastic vagina. Scarring can make both sex and internal examinations painful.

Here is what can be offered.

• Lubricants and moisturizers. NCI recommends both for comfort. Ask your team which to use, how often, and which products to avoid if you are sore.
• Dilators. NCI says a dilator can help prevent or reverse scarring after pelvic radiation. Ask when to start, how often, and for how long. Ask what to do if it hurts.
• Vaginal estrogen may be appropriate for some types of cancer (NCI). If your cancer is hormone-sensitive, your oncologist decides whether it suits you. Do not start hormonal products without asking, including ones you can buy over the counter.
• Pelvic muscle exercises. NCI mentions exercises for the pelvic muscles to lower pain. Ask about pelvic floor physical therapy.
• Menopause symptoms. Treatment that lowers estrogen can bring on menopause symptoms such as hot flashes and dryness. Ask what options exist for you.

Erectile difficulty after prostate or pelvic surgery can come from nerve damage. NCI says surgery may affect the nerves, and radiation can affect sexual function if blood vessels or nerves are damaged. Hormone therapy and chemotherapy can lower testosterone.

Medicines for erection problems exist, and a urology or sexual medicine clinic can explain which suit you. NCI also mentions penile implants, a firm rod or inflatable device, for men who need them. Testosterone may be checked if desire has gone flat. It is not appropriate in every cancer.

Dry orgasm (orgasm without ejaculation) can happen when the prostate is damaged. Ask your team what to expect. NCI advises using a condom during chemotherapy, because semen may contain traces of the drugs.

Fatigue can make sex harder. Practical changes can help. Plan for the part of the day when you have energy. Time your pain medicine so it is actually working. Choose positions that do not put weight on a painful area. Treat touch without sex as a real option, not a consolation prize. Neuropathy (nerve damage from treatment) changes what touch feels like. Ports, lines, stomas and scars change what you want seen, and when.

Say it plainly at your next appointment. "Sex is painful." "I cannot get an erection." "I have no desire at all." Then ask for one of these: a sexual health or sexual medicine clinic, gynecology or urology, pelvic floor physical therapy, or a certified sex therapist. Fertility questions go to a fertility specialist. Ask before treatment starts if you can, but ask even if treatment has finished.

Clinicians often do not raise this. Partly it is time, and partly it is awkwardness. So the question usually has to come from you. It is a completely ordinary thing to bring to a follow-up.

• Call 911 or go to an emergency department if an erection is painful or lasts longer than 4 hours. MedlinePlus lists this as a reason to call your doctor immediately when taking sildenafil, and the same urgency is sensible for any erection treatment. Trapped blood damages tissue, so this is a same-hour problem, not an embarrassing one to sit out. Do not drive yourself.
• Call 911 or go to an emergency department if chest pain starts during sex, or you feel faint or sick with it. MedlinePlus says to call a doctor immediately and avoid sexual activity until you are told otherwise. Chest pain is treated as a possible heart problem until someone rules that out. Tell the emergency team what you have taken and when. Do not drive yourself.
• Call your care team right away, at any hour, if a line site becomes sore, red or inflamed (CDC).
• Call your care team within a day or two if intercourse or a dilator hurts every time, if there is bleeding afterwards, or if a scar or stoma becomes sore or inflamed. Pain that keeps recurring is a referral question, usually to pelvic floor physical therapy or a sexual medicine clinic.

• MedlinePlus — Sildenafil
• NCI — Sexual Health Issues in Men and Cancer Treatment
• NCI — Sexual Health Issues in Women with Cancer
• NCI — Fatigue and Cancer Treatment