Sexual Health After Cancer Treatment

Sex and sexuality are important and rewarding parts of life. Cancer and its treatment — including surgery, chemotherapy and radiation — can cause emotional and physical changes that affect how you feel about yourself and your relationships.

Concerns about sex are quite common — in a study of over 3,000 cancer survivors, 66 percent reported worrying about sexual function including:
 
It’s important to talk with your doctor about questions and concerns, and even more important to talk with your partner.

Your provider can also refer you to City of Hope’s Clinical Social Work or Occupational Therapy programs.

Intimacy

People often equate sex with intimacy. While sex is an important part of being intimate, it’s only part of the picture.

Intimacy is about how you and your partner stay physically and emotionally connected, which can be difficult during and after cancer treatment.

Physical changes, fears, anxiety or changes in a survivor's self-image can impact intimate relationships. Even when facing a serious illness, there are ways couples can grow closer. Kindness, affection and respect go a long way toward staying connected.
 
Set aside your best time for your partner (when you have the most energy) to talk about changes in your intimate relationship, and what steps you can take to reconnect. Talk about things you have done together in the past that brought joy, as well as your hopes, dreams and goals for the future.
 
Be open-minded, playful and curious and see this as an opportunity to discover new things about your partner.
 
Sharing what you have gone through, your feelings and fears can be an important part of improving or keeping your intimacy. Your partner may have his or her own fears, like being afraid of hurting you, feeling guilty or selfish for wanting to be intimate with you, or not knowing how to voice feelings.

Tips for reconnecting

  • Take a warm shower or bath together
  • Take a nap together
  • Write love notes or an email to remind your partner of your love and appreciation
 
You might also want to discuss seeking help from a professional, in a couple’s program or couples counselor. You can always consult with your doctor or nurse about any your questions and concerns. 
 
Since sexuality is an important part of life, it’s also important to talk about the physical changes you’re experiencing as a survivor.

Loss of Sexual Desire

When treatment is over, you might feel like having sex again, but it may take time. Loss of libido after cancer treatment is common — between 40 and 65 percent of female cancer survivors report loss of sexual desire. And sexual changes can last longer than other treatment side effects.

Sexual desire can decrease after treatment for several reasons, including anxiety, depression, fatigue, pain, hormonal changes, body image issues related to physical changes and relationship issues. Loss of libido can also be a side effect of medications or cancer treatment itself.

If you are experiencing low sexual desire, speak with your health care team about it. It’s also important to share your feelings and concerns with your partner, and to find new ways to show how you feel, including touching, holding, hugging and cuddling.

fertility

Chemo, radiation and surgery can all affect fertility. For men, treatments can disrupt hormone production and ejaculation, as well as the ability to make healthy sperm. For women, treatment can cause early menopause or cause damage to eggs.

It’s difficult to predict what impact treatment will have on a patient’s fertility. The outcome often depends on several factors, including the type and stage of cancer, drugs and dosages given, radiation field, extent of surgery, age and genetics.

If you’re considering having children in the future, talk to your cancer team or doctor about family building alternatives and ways to preserve fertility.

Established fertility preservation options include:

  • Sperm cryopreservation (sperm freezing)
  • Oocyte cryopreservation (egg freezing)
  • Embryo cryopreservation (embryo freezing)


Common family-building alternatives include:

  • Embryo donation
  • Egg donation
  • Sperm donation
  • Surrogacy
  • Adoption

Body Image

Cancer treatment impacts how you feel about yourself or your sense of your own attractiveness, as well as how you look, including hair loss, weight changes or scars.

Every person changes in different ways — some will be noticeable to others, while other changes only you can see. It's OK to feel sad, angry and frustrated, and it’s important to take time to grieve your losses.

Dealing with changes in your body and self-image can be difficult, but over time, most people learn to adjust and move forward.

What you can do:

  • Boost your body image by focusing on what you love about yourself.
  • Focus on the ways that coping with cancer has made you stronger.
  • Eat right and exercise.
  • Practice relaxation techniques.
  • Look for new ways to enhance your appearance, including a new hairstyle, makeup or clothing.
  • Try new hobbies or volunteer work to improve your self-esteem.

Pain during sex

Pain during sex (dyspareunia) is the most common sexual complaint among female cancer survivors, particularly gynecologic cancer survivors because it can shorten or narrow the vagina.

As many as 50 percent of gynecologic cancer survivors and 60 percent of rectal cancer survivors report pain during sex.

Surgery, radiation or hormone treatments for cancer can cause vaginal dryness and pain during sex. Treatment can also cause menopause symptoms, including hot flashes, dryness or tightness in the vagina and other problems that can affect the desire and ability to have sex.

What you can do:

  • Use an unscented, uncolored, water-based lubricant during sex. Avoid contraceptive gels, films or foams, containing chemicals that can irritate the vagina.
  • Before you try sex with your partner, check your genital area for any soreness.
  • Strengthen muscles in your genital area by doing Kegel exercises.
  • Talk to your provider about using vaginal dilators during treatment or after surgery, as well as taking hormones or using a hormone cream.
  • Talk to your partner about ways to touch and position that make you feel comfortable.
  • Talk to a mental health professional who specializes in sexual issues.
 

erectile dysfunction

Erectile dysfunction, or difficulty getting or maintaining an erection, is the most common sexual complaint among male cancer survivors.  

About 50 percent of men report having trouble getting erections after treatment, including those treated for testicular, prostate, bladder and colorectal cancer, as well as head and neck cancers.

Surgery and radiation can impact nerves and blood flow, affecting erections. Most men undergoing chemotherapy will still have normal erections, but chemo can still affect erections and sexual desire.

Many men report disappointment, fear and distress when they have problems with erections. Medication, assistive devices, counseling, surgery or other approaches can help.

What you can do:

  • Talk to your doctor about penile or erectile rehabilitation, which uses medication, injections or vacuum devices to promote erections and help recover sexual function.
  • Talk to a mental health professional who specializes in sexual issues.
  • Talk to your partner about feelings of anxiety and stress.
 
 
Sources: National Cancer Institute and American Cancer Society