Intimacy and sex after cancer treatment

Cancer changes patients' lives, and that may include their sex lives, too. Intimacy after cancer may be influenced by the types of treatments patients receive, their self-image, the emotional toll they endure, as well as the physical toll. Sexuality refers to how people see themselves as sexual beings and how they express it with their bodies and minds through the lens of their lifestyle, self-esteem, upbringing, beliefs and, of course, health.

After cancer treatment, sexuality may feel different or interrupted for some time. Having sex may not feel the same way it did before cancer. The patient's desire to have sex may change. He or she may feel different inside. This is all normal.

The most common issues related to intimacy after cancer treatment are vaginal dryness for women and erectile dysfunction (ED) in men, but there are other possible concerns.

While this is a challenging time, intimacy doesn’t have to be complicated forever. In time, it’s possible for patients to accept and embrace any changes in their bodies and regain the desire they once had. The patient may speak with his or her care team, explore treatments and support, and gain back the pleasure he or she experienced before cancer.

Intimacy after cancer: Common issues

Many people with cancer experience one or more of these issues at some point after treatment.

Pain during sex/vaginal dryness: Women who’ve undergone cervical cancer treatment, surgery or radiation may experience vaginal dryness or pain (dyspareunia) during sex.

Gynecologic cancers and their treatments may shorten or narrow the vagina, and this also may cause pain during sex. Some treatments may even prompt menopausal symptoms that contribute to vaginal dryness and vaginal tightness.

Breast cancer survivors also may experience vaginal dryness, loss of libido and the inability to orgasm due to the hormone treatments that alter estrogen and androgen levels.

Body image issues: Patients may experience weight gain, hair loss or the inability to control their bladders, and this could impact the way they see themselves and their overall energy. When something changes feelings of sexuality, it may impact the patient's libido.

Surgery may alter the patient's appearance as well. For example, women who’ve had a mastectomy may feel less comfortable with their appearance and less sensation. They may feel sexually unattractive.

Because cancer may change how some patients look—due to surgery or other treatments—it’s a normal reaction to feel down at first.

Trouble reaching orgasm: Many people who experience orgasms before cancer have them again. If it’s a problem, ask the care team for tips and strategies. A sexual counselor may also help.

Erectile dysfunction: ED is a common side effect in men with cancer. Surgery or radiation may impact the nerves and flow of blood and affect an erection. In addition to ED, men may have problems reaching orgasm or have urine leakage while climaxing.

Because of these issues, men may experience loss of interest in sex and loss of self-confidence.

Lower libido: Many of the issues mentioned above may alter sexual desire. Some medications, such as hormone therapy, antidepressants and pain medications, may also lower libido.

Fertility: Treatments such as radiation, chemotherapy and surgery impact fertility. Treatments for men may alter hormone production that influences healthy sperm and fertility. Treatments for women may cause an irregular menstrual cycle or damage eggs.

Not all treatments negatively affect fertility, however. The type of cancer, dosage of drugs, amount of radiation, age and genetics all play a role in how cancer impacts fertility.

While fertility doesn’t influence sex necessarily, it may impact intimacy with a partner and self-esteem, resulting in a loss of sexual desire.

Longer-term sexual issues after cancer treatment

Long-term sexual dysfunction is a possibility after cancer treatment.

This may result from physical and emotional changes. Damage to pelvic nerves, blood vessels and organ structures may occur during treatments, which may contribute to sexual dysfunction.

After childhood cancer treatment, sexual dysfunction appears to persist in female survivors more so than male survivors.

Intimacy tips after cancer treatment

To reclaim their sexual identity, patients should begin by exploring their feelings surrounding image and what’s important to them, ultimately, in terms of intimacy. Then take baby steps toward making change. It’s not wrong to feel apprehensive, low self-esteem or anxiety surrounding the changes in the body and libido.

Don't hold these feelings inside. It’s important to address any issues of helplessness, depression or anxiety when it comes to sex and intimacy. Patients should consider speaking with their care team about their emotions and weigh out all their options when connecting back to their sexual life or their partner.

Some methods that may help:

• Focus on what the patient loves about himself or herself.
• Focus on how cancer, and surviving it, made the patient stronger.
• Explore ways to get closer to a partner.
• Focus on intimacy more than intercourse. Cuddling, kissing and massages may be beneficial in reclaiming the patient's sexuality.

For side effects that require medical intervention—such as erectile dysfunction or vaginal dryness—discuss treatment plans with the care team. Medications or counseling may be options in activating the patient's sexual desires. Women may incorporate Kegel exercises, unscented and water-based lubricant or vaginal dilators to manage painful sex. Doctors may prescribe a low-dose estrogen pill for vaginal dryness. For men, doctors may prescribe a medication like Viagra^® or Cialis^® to increase blood flow.

For all patients, communication with a partner is incredibly important. Helping the patient's partner understand the patient's emotions may bring the couple closer together. Consider implementing the following tips: 

• Work on relaxing.
• Consider yoga and mindfulness practices.
• Experiment with different positions.
• Keep in mind that having an orgasm doesn’t have to only happen during intercourse. Keep an open mind to other options like sex toys or exterior play like breast play.

Finding support for sexual dysfunction after cancer

Sexual dysfunction after cancer treatment is a common side effect. Talk with the care team to let them know what’s going on in order to find a solution and proper follow-up care.

Be open and help the care team understand the patient's sexual orientation and gender identity, and any surgeries or medications he or she had to transition.

The patient may ask the care team questions such as:

• What can I expect from this treatment or surgery in terms of intimacy?
• How long would this side effect last?
• Is this something I can work on myself, or do I need a medical intervention?
• How common is this for someone who had my cancer or my treatment?
• Should I see a therapist?
• Do you have any recommended reading on this topic?

Additionally, find a support group of other cancer survivors. The National Cancer Institute offers helpful tips on finding one.

It’s important to remember everyone’s experience is different. Emotions, physical appearance and relationships vary from person to person. However, the patient's sex life doesn’t have to be entirely disrupted. Moving forward, staying dedicated and working with the care team may help ensure a positive road for every patient and intimacy.