Sexual Complications

Cancer and cancer treatments can cause a variety of side effects, including changes in your sexual life. While we can’t answer every question, we hope to provide you with enough information that will help you feel confident in talking with your partner and your cancer care team about intimacy and sex.

During and after cancer treatment, you may experience physical and emotional changes. These may affect your desire and ability to have sex. Whether you’ll have problems that affect your sexual health depends on factors such as the type of cancer, the type of cancer treatment, the dosage and duration of treatment, your age, and your overall health.

Sexual complications in women with cancer

Some problems that affect a woman’s sexual health during cancer treatment are temporary and improve once treatment has ended. There are times, however, that side effects may be long-term or may start after treatment. Your doctor will talk with you about how different types of treatment affect your body in different ways, such as:

• Chemotherapy can lower estrogen levels and cause early menopause (primary ovarian insufficiency). This means the ovaries aren’t producing hormones and releasing eggs. It is important to note for a woman to discuss birth control options with her oncologist as pregnancy should be avoided while on chemotherapy. This is not always a temporary condition and should also be discussed with a woman’s oncologist. Women may experience symptoms such as hot flashes, irregular or no periods, and vaginal dryness. Chemotherapy can also affect vaginal tissue, which may cause sores.
• Hormone therapy (also called endocrine therapy) may cause early menopause by reducing estrogen levels, which can lead to symptoms such as hot flashes, irregular or no periods, and vaginal dryness.
• Radiation therapy to the pelvic area (bladder, cervix, colon, ovaries, rectum, uterus, or vagina) can lower estrogen levels, which results in vaginal dryness. Vaginal stenosis (less elastic, narrow, shorter vagina), vaginal atrophy (weak vaginal muscles and thin vaginal wall), and vaginal itching burning, and inflammation can also cause pain and discomfort during sex.
• Surgery for cancers may affect your sexual life. Sometimes, cancer surgeries (e.g., breast cancer surgeries), can also bring about physical changes that may affect how you view your body.
• Medicines such as opioids and other drugs used to treat depression could lower your sex drive.

Sexual complications in men with cancer

For many men, sexual problems during cancer are temporary and will improve once treatment has ended. In some cases, however, side effects may be long-term or may start after treatment. Your doctor will talk with you about how different types of treatment affect your body in different ways, such as:

• Chemotherapy may lower your testosterone levels and libido (sexual desire or energy) during the treatment period. Chemotherapy does not usually affect your ability to have an erection. It is important to note that a man should use precautions to avoid causing pregnancy while he is undergoing chemotherapy treatments.
• External-beam radiation therapy to the pelvic area (anus, bladder, penis, or prostate) and brachytherapy (internal radiation therapy) can affect a man’s sexual function. This may include erectile dysfunction (difficulty to get and keep an erection) due to damaged blood vessels or nerves and/or dry orgasm (climax without ejaculation) due to a damaged prostate.
• Hormone therapy can lower testosterone levels and decrease sexual drive. It may also cause erectile dysfunction.
• Surgery for penile cancer, rectal cancer, prostate cancer, testicular cancer, and other pelvic cancers may affect the nerves, causing erectile dysfunction.
• Medicines used to treat pain, some drugs used for depression, as well as medicines that affect the nerves and blood vessels may all affect your sex drive.

Managing cancer-related sexual complications

Managing sexual side effects is an important part of cancer care. Your health care team can recommend ways to manage symptoms. You may also want to talk with a sexual health expert who can address any questions or concerns you may have.

Typically, men and women can be sexually active during cancer treatment. It is a good idea, however, to confirm this with your oncologist in case there are certain times during treatment you should abstain from sexual activity. When you are able to be sexually active, you should take the necessary precautions to prevent pregnancy if you are still undergoing chemotherapy treatments.

Your cancer care team can help you:

• Learn about treatments: Based on symptoms you are experiencing, your oncologist will advise you on treatment options.
  • For men, these may include oral medications, penile injections, penile implants, vacuum constriction devices (a pump to encourage blood flow and erection), and complementary therapies, such as acupuncture and relaxation techniques.
  • For women, medicines such as vaginal gels or creams, vaginal lubricants or moisturizers, and vaginal estrogen cream may be suggested. Your doctor may also recommend exercises for pelvic muscles to reduce pain, improve bladder retention, improve bowel function, and increase blood flow to the area, which can improve your sexual health. If radiation therapy or graft-versus-host disease has affected your vagina, your doctor may recommend using a dilator (a device used to stretch or enlarge an opening), which can help prevent or reverse scarring.
• Learn about condoms: Condoms may be advised to prevent your partner’s exposure to chemotherapy drugs that may remain in semen or in vaginal secretions.
• Manage related side effects: Talk with your doctor or nurse about problems such as pain, fatigue, hair loss, loss of interest in activities, sadness, or trouble sleeping, as these may affect your sex life.
• Get support and counseling: During this time, it will help to share your feelings and concerns with people you are close to. You may also benefit from participating in a professionally-moderated or led support group. Your oncology nurse or other members of your cancer care team can recommend support groups and counselors in your area.

Talking with your health care team about sexual complications

As you think about the changes that cancer treatment has brought into your life, it is a good idea to make a list of any questions you would like to discuss with your cancer care team. Some questions you might consider asking could include:

• What sexual complications are common among men and women receiving this treatment?
• What sexual side effects am I likely to experience during cancer treatment?
• When might these changes start?
• How long will these sexual complications last? Are any of these complications permanent?
• What advice do you have regarding prevention, treatment, or management of sexual complications?
• Do you have a list of recommended support groups who can help?
• Are there specific times during treatment that I should refrain from sex or that a condom should be used? 

As you deal with cancer and learn more about the sexual side effects you may experience, it is important to remember that you have a team of health care professionals behind you to help answer your questions every step of the way.