Women being treated for cancer may experience changes that affect their sexual life during, and sometimes after, treatment. While you may not have the energy or interest in sexual activity that you did before treatment, feeling close to and being intimate with your spouse or partner is probably still important.

Your doctor or nurse may talk with you about how cancer treatment might affect your sexual life, or you may need to be proactive and ask questions such as: What sexual changes or problems are common among women receiving this type of treatment? What methods of birth control or protection are recommended during treatment?

Other questions to consider asking are listed at the end of this page.

Whether or not your sexual health will be affected by treatment depends on factors such as:

• the type of cancer
• the type of treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• your age at time of treatment
• the amount of time that has passed since treatment
• other personal health factors

Some problems that affect a woman’s sexual health during treatment are temporary and improve once treatment has ended. Other side effects may be long term or may start after treatment. Your doctor will talk with you about side effects you may have based on your treatment(s):

• Chemotherapy can lower estrogen levels and cause primary ovarian insufficiency. This means the ovaries aren’t producing hormones and releasing eggs. Symptoms may include hot flashes, irregular or no periods, and vaginal dryness, which can make sexual intercourse difficult or painful. Chemotherapy can also affect vaginal tissue, which may cause sores.
• Hormone therapy (also called endocrine therapy) may cause low estrogen levels which can lead to symptoms such as hot flashes, irregular or no periods, and vaginal dryness.
• Radiation therapy to the pelvis (such as to the bladder, cervix, colon, ovaries, rectum, uterus, or vagina) can cause low estrogen levels and, therefore, 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 gynecologic cancers may affect your sexual life. Treatment for other cancers can also bring about physical changes that may affect the way you view your body. Your health care team will talk with you about what to expect and teach you how to adjust after surgery, such as after a mastectomy or an ostomy, for example.
• Medicines such as opioids and some drugs used to treat depression may lower your interest in sex.

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your health care team to learn what to expect, based on your treatment(s):

• Chemotherapy (especially alkylating agents) can affect the ovaries, causing them to stop releasing eggs and estrogen. This is called primary ovarian insufficiency (POI). Sometimes POI is temporary and your menstrual periods and fertility return after treatment. Other times, damage to your ovaries is permanent and fertility doesn’t return. You may have hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. Chemotherapy can also lower the number of healthy eggs in the ovaries. Women who are closer to the age of natural menopause may have a greater risk of infertility.
• Radiation therapy to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Some organs, such as the ovaries, can often be protected by ovarian shielding or by oophoropexy—a procedure that surgically moves the ovaries away from the radiation area. Radiation therapy to the brain can also harm the pituitary gland. This gland is important because it sends signals to the ovaries to make hormones such as estrogen that are needed for ovulation. The amount of radiation given and the part of your body being treated both play a role in whether or not fertility is affected.
• Surgery for cancers of the reproductive system and for cancers in the pelvis region can harm nearby reproductive tissues and cause scarring, which can affect your fertility. The size and location of the tumor are important factors in whether or not fertility is affected.
• Hormone therapy (also called endocrine therapy) used to treat cancer can disrupt the menstrual cycle, which may affect your fertility. Side effects depend on the specific hormones used and may include hot flashes, night sweats, and vaginal dryness.
• Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment such as immunotherapy and targeted cancer therapy may affect your fertility.

Sexual health and intimacy are important parts of a person’s well-being. They are closely linked to how you see yourself and relate to others. It can be challenging after cancer treatment to face sexual health concerns, even if you’ve been with your partner for years. But talking about your concerns openly and honestly—letting your partner know what you’re going through and understanding how they feel—may help prevent frustration and confusion.

Common Concerns and Challenges

• Worrying about intimacy after treatment.
• Struggling with body image after treatment.
• Fearing that having sex will hurt, that you won’t be able to perform, or that your partner will find you less attractive.
• Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that can also affect your sex life. This can include not being able to get or keep an erection, pain, or loss of sensation.
• Experiencing menopausal symptoms, such as hot flashes, dryness or tightness in the vagina, or other problems that can affect your desire to have sex.
• Concerns about losing the ability to have children. Depending on the type of treatment, your age, and the length of time since treatment, you may still be able to have children. Talk to your doctor or a specialist if you’re concerned about fertility.

If you need help talking about sexual health, intimacy, or fertility, there are resources to help. The first step is talking with your doctor. He or she can help you with changes you’re going through that may be related to your cancer or its treatment. Your doctor can also refer you to programs or professionals who specialize in sexual intimacy counseling for cancer survivors.

How to Get Help

Whether you have concerns about having (or not having) children, physical problems relating to sexual health and intimacy, medication side effects, or your emotional state, professionals can help you.

• Psychologists, clinical social workers, and counselors can help you talk through and process problems you’re struggling with, like stress or body image issues. Professionals who specialize in infertility counseling can also help you with the emotional considerations of various options for building your family.
• Marital counselors are trained specifically to help people strengthen their marriages and partnerships by addressing challenges. Marriage counselors can help start and guide conversations between you and your partner.
• Faith or spiritual counselors can help you cope with concerns such as feeling alone, searching for meaning, and having doubts about your faith.
• Obstetrician-gynecologists (ob-gyns) are doctors who specialize in the female reproductive system and pregnancy. They can answer questions about fertility, birth control, menopause, and reproductive health. Your ob-gyn may refer you to a fertility specialist.
• Fertility specialists (also called reproductive endocrinologists) can determine your ability to have children and offer options for starting or building a family. They evaluate cancer diagnosis, treatment, and possible late side effects of treatment to determine fertility.
• Urologists are doctors who specialize in treating the urinary tract system and male reproductive organs.
• Social workers are trained to counsel you about treatment issues and interpersonal problems related to cancer. They can connect you with resources and services in your area.
• Sex therapists may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.

If you can’t find a program in your area, look into alternatives to in-person support, such as virtual support groups and therapy by telephone, video, or text.

People on your health care team have helped others to cope during this difficult time and can offer valuable suggestions. You may also want to talk with a sexual health expert to get answers to any questions or concerns.

Most women can be sexually active during treatment, but you’ll want to confirm this with your doctor. For example, there may be times during treatment when you are at increased risk of infection or bleeding and may be advised to abstain from sexual intercourse.

Your health care team can help you:

• Learn about medicine and exercises to make sex more comfortable, including:
  • vaginal gels or creams to stop a dry, itchy, or burning feeling
  • vaginal lubricants or moisturizers
  • vaginal estrogen cream that may be appropriate for some types of cancer
  • a dilator to help prevent or reverse scarring, if radiation therapy or graft-versus-host disease has affected your vagina
  • exercises for pelvic muscles to lower pain, improve bladder retention, improve bowel function, and increase the flow of blood to the area, which can improve your sexual health
• 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, that may affect your sex life. Speaking up about side effects can help you get the treatment and support you need to feel better.
• Learn about condoms and/or contraceptives: Condoms may be advised to prevent your partner’s exposure to some types of chemotherapy that may remain in vaginal secretions. If you are of childbearing age, contraceptives may be advised to prevent pregnancy while you are receiving treatment and for a period of time following treatment. For more information, see Fertility Issues in Girls and Women.
• Get support and counseling: During this time, you can gain strength and support by sharing your concerns with people you are close to. You may also benefit from participating in a professionally moderated or led support group. Your nurse or social worker can recommend support groups and counselors in your area.

As you think about the changes that treatment has brought into your life, make a list of questions to discuss with your doctor, nurse, or social worker. Consider adding these to your list:

• What sexual problems are common among women receiving this treatment?
• What sexual problems might I have during treatment?
• When might these changes occur?
• How long might these problems last? Will any of these problems be permanent?
• How can these problems be prevented, treated, or managed?
• What specialist(s) would you suggest that I talk with to learn more?
• Is there a support group that you recommend?
• What method(s) of birth control are advised?
• What precautions do I need to take during treatment? For example, should my partner use a condom? Are there times when I should avoid sexual activity?

Even for a couple that has been together a long time, staying connected after cancer can be a challenge at first. How do you start the conversation and express your needs when it comes to sex?

It is important to talk about your concerns, feelings, and beliefs about your sex life and what would make you feel better. It is also important to take your partner’s concerns,  feelings, and beliefs into consideration.

Having an open, honest conversation is key to moving forward. Here are some tips—

• Pick a private time to talk about sex outside the bedroom.
• Ask questions to understand your partner’s concerns better.
• Focus on your partner’s comments, not on what you plan to say in response.
• Repeat what he or she says in your own words.
• Be specific and positive about what you’d like to change.
• Acknowledge that your partner’s views matter to you.

By approaching the topic of sex and intimacy openly, you can avoid blame, keep the conversation positive, and give your partner a better sense of how you’re feeling.

Starting Fresh: Dating as a Survivor

After cancer, you may experience physical and emotional changes and concerns, especially around sex, that can affect how you feel about dating. It is normal to worry about how another person will react to physical things like scars or hair loss. You may also find it awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.

How and When to Bring It Up

You may wonder about the best way and time to tell a new person in your life about your cancer experience. There’s no one “right” answer on when to tell someone. Wait until you’re comfortable and trust the person with your feelings.

It may help to write down or practice what to say. Be ready to answer any questions. You may also want to talk to your doctor or a counselor about your dating concerns and fears of becoming intimate with a new partner.

Feeling Intimate After Treatment

It may be hard to feel intimate after cancer because of physical or emotional changes. When you’re struggling with your body image, remember to—

• Be proud of your body. It got you through treatment, after all!
• Think of things that help you feel more confident.
• Focus on the positive.
• Be open to change.

When Your Partner Is a Cancer Survivor

When your partner has cancer, it can be hard to understand what he or she is going through. Your partner also may have trouble understanding what you are going through. Ask yourself—

• Am I feeling overwhelmed? Stressed?
• Do I feel lonely or abandoned?
• How will my role or situation change after treatment?
• Do I think my partner and I should talk about our sexual relationship?