Cancer, its treatments and their associated side effects, can affect you both physically and emotionally, impacting your identity, body image, self-esteem and relationships. A woman may be concerned about her attractiveness, appearance and her sexuality whilst adjusting to the diagnosis and treatment, and coming to terms with mortality and feelings of grief.
Treatment for some types of cancer can directly affect your physical ability to have or enjoy sexual intercourse, and can also affect your desire to have intercourse or be sexually intimate.
A cancer diagnosis and the treatment that follows can also influence your confidence and body image, which can affect how you feel about sex and intimacy.
For some people, these changes are temporary, while for others they can be long-term. If you have a partner, it’s important to communicate with them – you may both need to learn different ways to express your sexuality and intimacy. Remember, intimacy doesn’t have to include sexual penetration or intercourse, it can include other types of sexual stimulation and pleasure ‘outercourse’.
It’s normal to feel nervous about resuming sexual activity after or during cancer treatment but be assured, you can still have a fulfilling sex life after a cancer diagnosis. Sexual intimacy including intercourse will not make the cancer worse or make it come back and it may help both you and your partner emotionally.
It’s also important to remember that sexuality and sexual needs can vary greatly from woman to woman, just as every experience of cancer can vary greatly, so go at your own pace and take the time to work out what’s right for you.
Cancer treatments and side effects
Common sexual side effects and how to deal with them
Tips to help you adjust
The most common cancer treatments are chemotherapy, radiation therapy, surgery, hormone therapy, immunotherapy and targeted therapy. They can all affect your desire or ability to be sexually intimate.
Chemotherapy is a treatment that uses powerful drugs to kill or slow the growth of cancer cells. There are different groups of chemotherapy drugs available and they can be used alone or in combination with other treatments. Cancer cells grow and multiply more quickly than other cells, so chemotherapy drugs target fast-growing cells. This means they can also damage other healthy cells that grow quickly, such as those responsible for hair growth.
The chemotherapy side effects that you experience will depend on the type and dose of drugs you’ve been given. Most side effects are short-term and usually improve once your treatment ends but sometimes chemotherapy can have lasting effects.
As well as hair loss, common side effects of chemotherapy can include fatigue, nausea, vomiting, diarrhoea, constipation, brain fog and mouth ulcers. These can affect your body image and energy levels and will usually make you less inclined to be sexually intimate.
Chemotherapy can also affect the hormones connected to libido (sex-drive), so you may experience less desire to have sex. This usually improves after treatment ends.
Thrush is another common side effect of chemotherapy, especially if you are also taking steroids or antibiotics. Thrush can cause vaginal dryness, pain, itching and discharge but will usually resolve once treatment is over. However, antifungal treatment may still be needed.
Chemotherapy can also affect the amount of oestrogen your ovaries produce. This can lead to menopausal symptoms such as irregular periods, hot flushes, sweating and vaginal dryness. These symptoms may be temporary but for some women, chemotherapy can bring on menopause early, which means your monthly periods will stop and you will no longer be able to have children with your own eggs.
If you are having sexual intercourse during chemotherapy treatment, it’s important to use male or female condoms as the drugs may be released into your bodily fluids. Your healthcare team can give you more information on this.
Radiation therapy, or radiotherapy, uses a controlled, high dose of radiation to kill or damage cancer cells. The radiation can be placed inside or outside your body. Side effects may include fatigue, skin sensitivity and redness, and loss of hair (only if therapy is targeted in areas where hair grows) and loss of appetite.
If you are having internal radiation therapy and you are having sexual intercourse, you’ll need to use male or female condoms until your treatment is finished. Your healthcare team can give you more information.
The side effects depend on which part of your body the radiation therapy is targeting. If it is targeting your pelvic area, it may affect your ovaries and cause menopausal symptoms like those experienced with chemotherapy. Again, your periods may return after treatment but sometimes radiation therapy causes menopause and therefore infertility.
Pelvic radiation therapy can also irritate and inflame the lining in the vagina or vulva. While this is usually temporary, as the lining heals, scar tissue can sometimes make the vagina shorter and narrower. This is called vaginal stenosis and it can make sexual intercourse painful.
Surgical treatment of cancer involves the cancerous body part or tissues being removed. The side effects from your surgery will depend on what type of cancer you have and what parts of your body are removed.
If your uterus and/or both ovaries are removed, you will no longer have periods or be able to conceive children. Hormonal changes can also cause vaginal dryness.
Some surgeries can change the look and feel of your body parts, for example having a whole breast removed (mastectomy). This can affect sexual arousal as well as your self-esteem, body image and sexual identity.
Hormone therapy, also called endocrine or androgen deprivation therapy, aims to block certain hormones that the cancer is sensitive to. This can help to reduce the size of the tumour, slow the spread, and reduce the risk of the cancer coming back.
For example, some types of breast cancer are sensitive to the hormone oestrogen, so women with this type of cancer are often treated with medicines that block this hormone. Potential side effects from these treatments may be similar to menopausal symptoms: vaginal dryness and discharge, pain during sex, hot flushes and a lower sex-drive.
The side effects usually improve once you stop taking the medicine but it’s commonly recommended to continue this treatment for five years or more, so the side effects can be long-term.
Immunotherapy is a treatment that works by activating or suppressing your immune system. It fights the cancer by boosting your body’s natural defenses. Targeted therapy attacks certain molecules of cancer cells to stop them growing.
The potential side effects depend on the drugs used, and commonly include fatigue, pain, swelling and depression. All these can affect your desire or ability to have sex.
There are many side effects of cancer treatments that can affect your desire and/or your ability to have sex. Here we include some of the most common issues. With all these issues, if you feel you need more support, you may want to talk to a counsellor, sexual health physician or sex therapist. Talking to other women who have had a similar experience may also help you adjust.
A drop in your libido or sex-drive is one of the most common issues experienced during cancer treatment. Side effects such as fatigue, nausea and changes in hormone levels, as well as the general anxiety associated with diagnosis and treatment, can all affect your desire for sex.
Adjusting to a low libido can be challenging. If you have a partner, discuss these changes with them. Try to spend time together doing something you both enjoy. You can also maintain intimacy by making time for physical contact that doesn’t include sexual intercourse. Try massaging each other or bathing together.
Most people find their desire for sex returns when their treatment ends.
Some women may have difficulty reaching orgasm (climaxing) during and after cancer treatment. Emotions can play a big part in your ability to achieve an orgasm. Try to take things slowly and don’t put too much pressure on yourself.
If you’ve had your uterus, ovaries or cervix removed, this can also change how you physically experience orgasm. If your uterus was removed it will no longer contract during orgasm, which can affect some women’s sexual pleasure.
It can be particularly difficult to reach orgasm as you used to if your clitoris or other parts of your vulva have had to be removed. You may need to be creative and find other ways to stimulate yourself and reach orgasm without intercourse. Experiment and explore through touch or use sex toys such as electric vibrators.
Surgery and/or pelvic radiation therapy may cause your vagina to shorten and narrow. This can make sexual intercourse painful and uncomfortable. Your doctor may recommend using a vaginal dilator to gradually stretch it. You can ask your healthcare team for a referral to a pelvic health physiotherapist for help with this.
Vaginismus, where the muscles around the vagina involuntarily tighten before sex, is another common issue. Your healthcare team can refer you to a pelvic health physiotherapist, who can teach you how to relax the muscles before and during sexual intercourse.
As well as these recommendations, you can also try applying water- or silicone-based vaginal lubricants just before intercourse. Avoid products containing perfumes, oils or glycerine. A vaginal moisturiser, used several times a week, may also be helpful. These can be bought without a prescription and should be applied at night when they are more easily absorbed.
You can also try a vibrator and experiment with different sexual positions to see what is most comfortable for you.
The moisture in the vagina often decreases with age and this can be accelerated by many cancer treatments that cause oestrogen levels to drop. Vaginal dryness can make sexual intercourse painful.
As outlined in the ‘Vaginal changes’ section above, you can use vaginal lubricants (which you apply just before having sex) and vaginal moisturisers (which you apply a few nights a week just before going to bed) to help with vaginal dryness.
Depending on the type of cancer you have, you can also talk to your doctor about whether oestrogen creams or pessaries are an option for you. But make sure you avoid using soap, bubble bath and other creams on your vulva and vagina, as these can cause skin irritation.
For more information visit our webpage ‘Vulva & vaginal irritation’.
Sex can be painful after pelvic surgery or radiation therapy. Hormonal changes can also make your vulva and vagina dry and cause pain. If your vagina is irritated during sex, there is a risk of contracting urinary tract infections (UTIs).
If intercourse is painful, you can try using water- or silicone-based lubricants, choosing positions where you can control the depth of penetration, or trying to be as close to orgasm as possible before penetration (so as to minimise intercourse duration and pain).
If you’re experiencing pain in other parts of your body because of your cancer or your treatments, it might also make it harder to relax and enjoy sexual intimacy, intercourse or outercourse. If you’re taking any medication to manage pain, take it about an hour before you have sex so it will be at its most effective. Use props such as pillows to take the pressure off any body parts that are sore and try different positions to make sure you’re as comfortable as possible.
If sex is still painful, talk to a doctor, sex therapist or pelvic health physiotherapist. An occupational therapist can suggest products to help with positioning.
Read more about painful sex here.
If the tissue in your vagina is inflamed or your vagina has become dry due to a lack of oestrogen brought on by cancer treatments, this can cause bleeding after sexual intercourse. Again, applying vaginal moisturisers and lubricants can help. If there is bleeding during or after sex, please see your GP to check what is causing it.
Doing simple things like being kind to yourself and giving yourself time to adjust to physical changes can help with sexual intimacy. You can also:
For some women, talking to your doctor about sexual side effects can be embarrassing and not all doctors are comfortable with it. You can ask to be referred to a specialist or talk to other members of your healthcare team who you feel more comfortable with. It may also be easier to write down your questions and bring them to your appointment.
Remember, it’s never too late to ask questions. While the best time to discuss sexual side effects with your healthcare team is before you start your treatment, you can ask questions and seek advice at any time.
If you don’t have a partner, it’s still important to discuss any sexual issues or ask for referrals if you need to, at any stage of your treatment.
If you have a partner, you may need to give them some ‘time-out’ to share their worries with another person such as a counsellor or friend. They may also need time to adjust to the changes.
Try to keep communicating openly with one another. You may both benefit from seeing a counsellor, psychologist or sex therapist.
You can also bring your partner along to appointments with your healthcare team so they are included in all the discussions you have.
Make time to do things together that you both enjoy, preferably out of the house. This will help you reconnect as a couple and relieve some of the pressure and anxiety you may both be feeling.
Even if you are not ready for sexual intimacy, physical contact such as hugging or holding hands is important to maintain closeness. You may also need to be reassured by your partner that they still find you attractive.
Physical contact that isn’t sexual intercourse can help you to feel close with your partner and can take the pressure off both you and your partner. Even if intercourse is not possible, most women can still feel pleasure and reach orgasm through touching.
When you are being sexually intimate, you could try applying vaginal lubricant as an exciting part of foreplay. While you may have to be less spontaneous and plan sexual activities for the times of day when you have the most energy and are not in pain, exploring new ways of being intimate and stimulating one another can bring new excitement to your sex life. In some cases, some people find that because they were encouraged to try new things, once their cancer treatment is over, their sex life actually improves.
If you don’t have a partner, you can still ask for a referral to a sex therapist and you may find self-stimulation and using sex aids helpful in adjusting to your sexual life after cancer.
It can help to connect with other cancer survivors, either in face-to-face groups or online. An online environment can be good if there are issues you are too embarrassed to talk about in person.
For more information on sex and intimacy after cancer visit Cancer Council Australia.
