Sexuality includes holding hands, special looks, hugging, kissing, etc. It’s not just the sex act. This section addresses side effects of different treatments that affect your sex life and ways to relieve some common problems. It’s important that you talk about any questions or concerns with your cancer team, and even more important that you talk with your partner. Remember that warmth, caring, and physical and emotional closeness are as necessary and rewarding as anything else in your relationship.
Chemo, radiation, and some surgery for cancer can affect the fertility of men and women – some people won’t be able to have children. In women, treatment may cause early menopause. Men might not be able to make normal sperm. It’s hard to predict the outcome for any one person. Some people are still fertile after treatment; others are not.
Chemo and radiation can also cause birth defects if a child is conceived during treatment or within a few weeks of ending treatment. Avoid pregnancy during chemo or radiation. Find out how long you should wait after your specific type of treatment before trying to conceive. Ask what you should expect and talk about any plans to have children. If you want children later, do this before treatment begins.
What the patient can do
- Realize that your sexual desire may decrease for a lot of reasons. The fear of having cancer, worries about treatment, and the effects of treatment itself are just a few. Chemo can sometimes make you very tired or sick. Radiation therapy to the pelvis or genital area can cause pain during sex. Hormone treatments and the removal of the ovaries or testicles will change your body’s hormone levels. All of these things can affect desire or make you less able to have sex.
- Talk with your partner about your feelings and concerns.
- Wait until you feel ready for sexual activity. Don’t push yourself.
- Tell your partner you’re ready to try sexual contact when you feel able to. Don’t wait for your partner to ask.
- Avoid sex if your white blood counts are dangerously low to reduce your chance of infection. Check with your cancer team to see if this is an issue for you.
- Enjoy other forms of closeness, such as touching, caressing, and holding each other.
- Know that you cannot give your partner cancer.
- Try other things such as using your hands or mouth, stroking, fondling, or kissing if your usual sexual activity is uncomfortable. You can also try different positions (for instance, lying on your sides either facing or spooning, or switching who is on top). New positions can allow you to control thrusting, avoid pressure on tender areas, or avoid getting too tired.
Men
- Before you get chemo or radiation to the genital area, ask about saving sperm in a sperm bank if you think you might want to father children later.
- Around half (40% to 60%) of men have some trouble getting an erection after radiation to the genital area. Impotence (inability to get a strong enough erection) usually does not happen right after radiation treatment, but can develop slowly over time.
- Men who have been treated for testicular, prostate, bladder, colorectal, and even head and neck cancers often report having trouble getting erections after treatment.
- Ask about getting your serum testosterone levels checked to see if hormone replacement therapy might help you (although not every man with cancer can take testosterone). Ask about other medicines or treatments that might help you, too.
- Radiation treatment to the genital area can cause pain during ejaculation for a short time. It can also reduce the amount of semen and cause skin irritation.
- Men who have testicular cancer and have lymph nodes removed often have little or no semen at orgasm. (This is called “dry ejaculation.”) The return of semen may take months or years, or may not happen at all. Keep in mind that semen is not needed for your or your partner’s satisfaction.
- For men who have prostate cancer, blood in the semen is not unusual during diagnosis or treatment, especially after a needle biopsy. This isn’t harmful or worrisome, but should be reported to your cancer team.
- Sometimes, you may accidentally pass a little urine (pee) during sex. There’s no need for concern about this. Urine is normally sterile and won’t harm your partner.
- Use romantic dinners, erotic stimulation, and prolonged foreplay.
- Shower together and use sexual play.
Women
- Pain during sex is very common after surgery for many gynecologic cancers because it can shorten or narrow the vagina. Ask your surgeon about the exact extent of your surgery and what to expect during sex. To help with this:
- Keep the vagina from getting smaller and tighter during radiation therapy to the pelvis or vagina. You’ll need to insert fingers, your partner’s penis, or special vaginal dilators (enlargers) 3 to 4 times a week while you get radiation treatment and afterward.
- If surgery that involves the vagina is planned, ask about vaginal dilators to use after surgery. Be sure to find out when to start using them and how.
- Use an unscented, uncolored, water-based lubricant such as K-Y®or Astroglide® if the vagina is too dry during sex. Surgery, radiation, or hormone treatments for cancer can cause dryness.
- Show your partner ways of touching or positioning that are comfortable to you.
- Before you try sex with your partner, check to see if there’s any soreness in your genital area.
- Chemo can thin the vaginal wall. Slight bleeding after sex is not a major concern, but it might help to use extra water-based lubricant. Don’t use contraceptive gels, films, or foams, which contain chemicals that can irritate the vagina.
- Chemo can also reduce sexual desire and make it harder to reach orgasm. This usually gets better after treatment is over.
- Burning during sex may suggest a yeast infection. Talk to your cancer team if this happens.
- Chemo may cause you to stop menstruating (having your monthly periods) for some time, but may not entirely stop the ovaries from working. It may still be possible to get pregnant even if you haven’t menstruated for several months. Ask about birth control, since chemo drugs can hurt a growing fetus.
- Chemo, radiation, or surgery that removes the ovaries may cause early menopause. Ask about your chances of this happening.
- If you are likely to become infertile, ask about the possibility of freezing ovarian tissue or embryos. This requires special surgery and can be very expensive, but it can be an option for some women.
What partners can do
- Find out how cancer and the cancer treatment are likely to affect sex with your partner. For instance, chemo can cause side effects such as fatigue. Surgery and radiation in the genital area might permanently change how the genitals look or work.
- Learn what changes to expect if the patient is taking hormones, which may affect sexual function or desire.
- Be patient during chemo or radiation. Wait until your partner feels ready for sexual activity.
- Offer physical closeness and touching when the patient’s energy is low. Intimacy can be achieved without sex, erections, or orgasms. Kindness, affection, and respect go a long way toward reaching this goal.
- Find out how the patient feels about their body and about sexual activity. Sometimes, people feel unattractive after cancer treatment.
- Changes to your partner’s body affect how they see themselves. This affects both of you, and it’s normal to grieve about these losses and changes. It may help to ask to be referred to a mental health professional if you’ve had changes in your relationship.
- When your partner is ready, be willing to try more gentle activities and new positions that feel good to both of you. Plan for private time when you won’t be interrupted.
- Use unscented, uncolored water-based lubricant (such as K-Y or Astroglide) if dryness makes either of you uncomfortable.
- If you are afraid of hurting your partner, talk about it with them and with the cancer team.
Call the cancer team if the patient:
- Notices new or more pain
- Notices bleeding
- Has an unexpected change in erectile function or in the amount of semen
- Has any sexual problems or questions about sexual activity
