What should I know and do about changes in sexuality?
ACS Answer
Sexuality includes all the feelings and actions associated with loving someone. It includes holding hands, special looks, hugging, and kissing. It is not just the act of sexual intercourse. This section addresses the side effects of therapies that affect physical sexuality. It is very important to communicate your questions and feelings to your doctor, your nurse, and, most importantly, your partner.
What to do
- Express desire for sexual contact when you feel able; do not wait for your partner to make the first move.
- Realize that the fear of having cancer, as well as cancer treatment, may decrease your sexual desire. Chemotherapy can make you very tired or sick. Radiation therapy to the genital area may cause pain during intercourse. Hormonal therapy, or removal of ovaries and testicles, will change your body's hormone levels. This can affect sexual desire.
- If you've had radical surgery, ask your doctor about the possibility of implants or reconstructive surgery.
- Understand that you cannot give cancer to your partner.
- Use alternatives if vaginal intercourse is uncomfortable:
- Between thighs or buttocks
- Between breasts
- Manual stimulation
- Oral-genital stimulation
- Caressing, fondling, kissing
Men
- If you're interested in becoming a father, ask your doctor about banking healthy sperm before radiation or chemotherapy begins.
- In about 40%-60% of men with prostate cancer, some degree of impotence (inability to get an erection) may occur within two years of receiving radiation therapy. Impotence usually does not occur right away, but instead happens gradually. Men with prostate cancer who have surgery may experience impotence immediately, but it will often improve over time.
- Radiation therapy to the genital area can cause temporary pain during ejaculation, decreased semen volume, and skin irritation near the genitals.
- Men who have testicular cancer and undergo lymph node dissection often produce little or no semen at ejaculation; semen production may take months or years to return, or may not return at all. Understand that semen is not an indicator of maleness and is not necessary for a partner's satisfaction.
- For men who have prostate cancer, blood in the semen is not unusual during diagnosis or treatment, especially a needle biopsy. This is not harmful or worrisome, but it should be reported to your doctor.
- Sometimes urination may occur accidentally during sexual activity. There is no need for concern about this. Urine is sterile and will not harm your partner.
- Use erotic stimulation, such as romantic dinners and extensive foreplay.
- Shower together and use sexual play.
- Men with prostate cancer who have had radiation seeds implanted may need to use a condom for several weeks as the seeds may become dislodged during sexual activity. Ask your doctor how long you will need to use a condom.
Women
Pain during intercourse is very common after surgery for gynecologic cancers because the treatment may shorten or narrow the vagina. To help with this:
- Use vaginal dilators after surgery as directed by your doctor.
- Use positions that give the woman control over depth and force of thrusting, such as the woman on top or both lying on their sides.
- Keep thighs close together to lengthen the vagina.
- Place your thumb and index finger around the outside of your vagina to give it "extra depth."
- Use vaginal dilators, your partner's penis or fingers, and your own fingers for penetration to keep the vagina from tightening.
- Use products such as K-Y Jelly if extra lubrication is needed. Dryness can occur after surgery, radiation therapy, or hormonal therapy.
If you have an ostomy
- Empty the pouch before sexual activity.
- Use a pouch cover.
- If a leak occurs, shower together and continue sexual play.
- Tuck the pouch into a supportive belt.
- Turn the appliance to the side.
- Try alternative positions if there is friction.
- Women can wear crotchless, lacy underwear that covers the appliance, but leaves the genital area open.
Do not
- Push yourself to have sexual activity until you feel ready
- Have intercourse if your white blood counts are dangerously low. (A low white blood cell count puts you at risk for infection.) Check with your doctor to see if this is an issue for you.
- Wait for your partner to initiate sexual interaction
- Be afraid to talk to your partner and to ask questions of your nurse or doctor
- Neglect other forms of physical intimacy besides intercourse
Call the doctor about any of the following symptoms
- If you notice new or more pain
- If you notice bleeding
- If you notice a change in erectile function or semen volume
- If you have any sexual problems or questions concerning sexual activity
Related Resources
Get more information about about sexuality and men with cancer.
Get more information about sexuality and women with cancer.
Find books that cover this and other cancer topics at the American Cancer Society bookstore.
Recommended Consultation
You should consider discussing this question with your doctor or health care team.
