Many female cancer survivors experience sexual dysfunction or changes in their sex lives after a cancer diagnosis. These changes can be physical or mental. Many women are not comfortable discussing these issues with their healthcare team or with their partners, but being able to speak openly is important.

Each type of cancer treatment—chemotherapy, radiation, surgery, and hormonal therapy—can cause possible sexual side effects. Side effects may vary depending on the type of cancer, the specific mode of treatment, and the individual’s response to treatment. Talk to your healthcare team about what you should expect from treatment.

Managing Side Effects

Below are some of the most common sexual side effects and tips for managing each.

Lack of Desire

During and after cancer treatment, many women report a lack of sexual desire. Lack of desire may come from hormonal changes such as early menopause or other side effects, making sex unenjoyable.

  • Rethink what sex and intimacy mean.
    • Do not expect sex after cancer to be exactly the same as sex before cancer. Your body has been through a lot of changes.
    • Be patient. It may take some time to discover what is comfortable and pleasurable for you.
  • Ask your doctor about estrogen therapies to increase estrogen and if they are safe for you to use.
    • Low levels of estrogen can cause female sexual dysfunction.
    • Estrogen therapies can help with lack of desire and dryness.
    • Estrogen therapies come in pills, creams, patches, and vaginal rings.
    • If your cancer is hormone driven, estrogen therapy may not be safe for you.
  • If you are taking anti-depressants or pain medication, talk to your doctor about adjusting your dosage.
    • Both these medications can cause lack of desire.
  • Manage other side effects such as dryness, pain, nausea, or fatigue that may be causing your lack of desire.

Dryness

Early menopause, triggered by chemotherapy, adjuvant therapies, or surgery, can cause vaginal dryness. Radiation to the pelvic region can also cause dryness.

  • Use a water-based lubricant during sex.
    • Stay away from scented and warming lubricants. These can irritate the vagina, actually making dryness worse.
    • Do not use petroleum jelly based lubricants.
  • Try vaginal moisturizers to improve overall dryness.
    • Vaginal moisturizers are different from lubricants. You do not use them only during sex. If used regularly, they improve overall dryness and vaginal health.
  • As mentioned above, ask your doctor about estrogen therapies and if they are safe for you to use.

Pain

Pain during intercourse may occur for a few reasons such as dryness or scar tissue. Radiation to the pelvic region may cause minor burns as well as scarring that causes the vaginal canal to shrink. Gynecological surgery can damage or result in the removal of sex organs.

  • After surgery, ask your doctor if and when it is safe to have sex.
  • If the shape of the vagina has changed from treatment, you may need to adjust the way you have sex by trying new positions or new activities.
  • After gynecological surgeries that affect the vagina, reconstructive surgery may be an option.
  • A vaginal dilator can be used to stretch the vaginal canal. Vaginal dilators are smooth plastic cylinders of different widths. By beginning with the smaller ones and inserting them into the vaginal canal regularly, the vagina begins to stretch, making intercourse less painful. Vaginal dilators also make medical pelvic exams more comfortable.
  • Pain may come from dryness. If you are also experiencing dryness, try the tips above.

General pain in other parts of the body can also make sex uncomfortable and decrease your desire to be intimate. To learn more about pain management unrelated to sex, read Cancer Side Effects: Tips for Managing Pain.

Difficulty Reaching Climax or Orgasm

Surgery and other treatments that directly affect the pelvic region can result in loss of sensation if nerves are damaged. This can make achieving an orgasm difficult for some women. Actions that worked before treatment may no longer feel the same. Other side effects mentioned in this article such as pain, lack of desire, and emotional issues can also make achieving orgasm difficult.

  • Work on managing all of the side effects that may be affecting your sex life.
  • For most women, vaginal penetration does not provide enough stimulation for orgasm. Extended clitoral stimulation may be needed.
  • Use your mind. Make sure you are comfortable and in the right mindset for sexual activity. Try imaging sexual fantasies to get in the mood.
  • Try using a vibrator to increase stimulation. Vibrators can be purchased at a drug store or discreetly online.

Managing Non-Sexual Side Effects

Other treatment side effects, such as nausea and fatigue, may interfere with your sex life. Visit Managing Cancer Side Effects to learn how to minimize and control these side effects.

Self-Esteem and Body Image

How you feel about yourself can affect your sex life. Cancer and cancer treatment can cause significant changes to your body. You may have hair loss, weight loss, weight gain, or scars. With these changes, you may not feel the same way about your body. This is all normal. Do not be critical of yourself. Your body battled cancer.

Below are tips for managing issues related to self-esteem and body image.

Hair Loss

  • Hair usually grows back after treatment ends.
  • In the meantime, try wigs, hats, and scarves.
  • When your hair does begin to grow back, use a gentle shampoo such as baby shampoo.

Weight Changes

  • Talk to your healthcare team about reaching and maintaining a healthy weight.
  • Read Survivorship Nutrition for tips on how to eat healthy.
  • Ask your healthcare team if it is safe for you to start an exercise program.
    • The endorphins released during exercise can also make you feel better emotionally.

Surgical Scars

  • Most surgeries leave some scars. Try using over-the-counter lotions and gels to help minimize incision scars. Moisturizers made with cocoa butter also minimize scars.
  • After surgery for breast cancer, some women choose to wear a breast prosthesis.
    • Insurance companies often cover a prosthesis.
  • After surgery for breast cancer, some women choose to have breast reconstruction surgery.
    • Talk to your healthcare team about your options.
    • Visit Susan G. Komen to learn more about surgical options.
  • After surgery for colorectal, anal, or bladder cancer, some women need temporary or permanent ostomies.

Emotional Support

You have to care for your mental health as well as your physical health. If you are struggling with anxiety or sadness, you probably don’t feel like having sex. Some options for emotional support include: peer partnering programs, support groups, and one-on-one counseling. Visit Emotional Support Programs to learn more.

Fertility

Cancer treatments can lead to infertility. Gynecological surgery can cause infertility. Chemotherapy and adjuvant therapies can trigger early menopause in women. Even though this process sometimes reverses in young women, it can still make conceiving difficult. Radiation to the pelvic area can damage reproductive organs.

Women do have options to preserve their fertility. However, it is important to talk to your healthcare team about fertility and your options before you begin treatment. Many fertility-preserving options must be done before the damage caused by treatment occurs.

Before beginning treatment, some women freeze and bank eggs and embryos. Fertility-preservation can be a long process so you will need to factor this into your timeframe for treatment.

Some steps can be taken to protect reproductive organs during treatment. For example, during radiation treatment, depending on the area receiving radiation, you may be able to use a shield.

If you continue to have sex during treatment, be sure to use proper protection. Pregnancy during chemotherapy or radiation is not safe for the mother or the child. Even if your periods stop during treatment, you may still be able to conceive so always use a form of birth control. Some cancers may affect your ability to use hormonal birth control methods, such as oral medication and devices such as IUDs and hormone rings. Make sure you ask your doctor before resuming any birth control you used before your diagnosis. Since cancer treatment can compromise your immune system, be sure to always use condoms to protect against sexually transmitted diseases (STDs).

Talk to your healthcare team as soon as possible about your fertility status and options.

Talking to Your Partner About Sexual Dysfunction

Being able to talk openly with your partner about sex is very important. What worked for you both before cancer may not work now. You may need to try different things to find what works for you both. If it has been a while since you’ve been intimate, start slowly with simple kissing and touching. Here are some basic guidelines for talking to your partner:

  • Be honest.
  • Always tell your partner if something hurts or is uncomfortable.
  • If something feels good, let your partner know.
  • Be patient with yourself and your partner.
  • Set the scene by going on a romantic date or watching a movie together at home.

Talking to Your Healthcare Team About Sexual Dysfunction

Your healthcare team is made up of health professionals. You should feel comfortable telling them anything. There is nothing embarrassing about sexual dysfunction, as it can happen following cancer and its treatment. After fighting cancer, you deserve to have a healthy sex life.

You may wish to talk to healthcare professionals who specialize in areas related to sexual dysfunction including:

  • Gynecologist
  • Endocrinologist
  • Sex therapist
  • Psychologist or counselor

Talking about sexual dysfunction can be difficult. Here are some sample questions to begin your conversation with your doctor:

  • How will treatment affect my sex life?
  • What can I do to manage sexual side effects?
  • I have pain and dryness during sex. What can I do to manage this?
  • I no longer feel any desire to have sex. What can I do to feel like myself again?
  • Could you recommend a specialist?
  • Will treatment affect my fertility?

For more information on female sexual dysfunction:

American Cancer Society

Mayo Clinic