Sexuality includes all the feelings and actions associated with loving someone. It includes holding hands, special looks, hugging, kissing, etc. It is not just the act of sex. This section addresses side effects of different treatments that affect your sex life and ways to relieve some common problems. It is important that you talk about any questions or concerns with your doctor or nurse, and most importantly, with your partner. Remember that warmth, caring, physical closeness, and emotional intimacy are as necessary and rewarding as any other kind of human interaction.

Cancer treatment often affects the ability of men or women to have children. Chemo, radiation, and some surgery can affect the reproductive system and cause infertility. In women, treatment may cause early menopause. It is 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 the course of treatment or within several weeks of ending treatment. Avoid pregnancy during chemo or radiation. Find out if there is a period of time you should wait after your specific type of treatment before trying to conceive. Talk with your doctor about what to expect, and about any plans to have children. Do this before treatment begins.

What the patient can do

• Realize that your sexual desire may decrease due to the fear of having cancer and treatment, as well as because of treatment itself. Chemo can make you very tired or sick. (See the section on chemotherapy.) Radiation therapy to the pelvis or genital area can sometimes cause pain during sex. (See the section on radiation therapy.) Hormone treatment and the removal of the ovaries or testicles will change your body's hormone levels. This can affect sexual desire.
• Talk with your partner about your feelings and concerns.
• Wait until you feel ready for sexual activity. Do not push yourself.
• Express desire for sexual contact when you feel able; do not wait for your partner to ask.
• Avoid intercourse if your white blood counts are dangerously low to reduce your chance of infection. (See the section on blood counts for more information.) Check with your doctor to see if this is an issue for you.
• Enjoy other forms of closeness, such as touching, caressing, and holding each other.
• If you've had major surgery, ask your doctor if implants or reconstructive surgery is possible.
• Understand that you are not contaminated:
  - You cannot give your partner cancer.
  - You cannot pass chemo or radiation on to your partner.
• Try other things if your usual sexual activities are uncomfortable, such as:
  - Manual stimulation (using hands)
  - Oral-genital stimulation
  - Caressing, fondling, kissing
  - Different positions (for instance, lying on your sides either facing or spooning, switch who is on top). New positions can allow you to control thrusting, avoid pressure on tender areas, or avoid tiring.

Men:

• Before you have chemo or radiation to the genital area, ask your doctor about saving sperm in a sperm bank.
• In about 40% to 60% of men, some degree of impotence (inability to get an erection) may slowly develop over 1 or more years after radiation to the genital area. Impotence usually does not happen right after radiation treatment. This is different from the effects of prostate surgery, which are seen right away and may improve 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 your doctor about getting serum testosterone levels checked to see if hormone replacement therapy would help you. Ask about other medicines or treatments that may 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 your semen may take months or years, or may not happen at all. 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 is not harmful or worrisome, but should be reported to your doctor.
• Sometimes, urination may occur accidentally during sexual activity. There is no need for concern about this. Urine is normally sterile and will not harm your partner.
• Use erotic stimulation, such as romantic dinners and prolonged foreplay.
• Shower together and use sexual play.
• Men with prostate cancer who have had radiation seeds implanted may need to use condoms for a few weeks as the seeds may become dislodged during sexual activity. Ask your doctor how long you will need to use condoms.

Women:

• Pain during intercourse is very common after surgery for many gynecologic cancers because the treatment may shorten or narrow the vagina. Ask your surgeon about the exact extent of your surgery. To help with this:
  - Use positions that give you control of depth and force of thrusting (e.g., woman on top, or both partners lying on their side).
  - Use your thumb and index finger at the vaginal entrance to circle around penis. This can provide extra length and keep your partner from thrusting too deeply.
  - Keep the vagina from shrinking and tightening during radiation therapy to the pelvis or vagina. You will 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, talk with your doctor or nurse about vaginal dilators to use after surgery. Be sure to find out when to start using them and how.
  - Use an unscented, uncolored lubricant such as K-Y Jelly^® or Astroglide^® if lubrication becomes a problem. Surgery, radiation, or hormone treatment can cause dryness.
  - Show your partner ways of touching or positioning that are comfortable to you, such as between the thighs or buttocks or between breasts
  - Before you try sex with your partner, check to see if there is any soreness in your genital area.
• Chemo can cause thinning of the vaginal wall. Slight bleeding after sex is not a major concern, but it may help to use extra water-based lubricant. Avoid 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 doctor if this happens.
• Chemo may cause you to stop menstruating 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. Talk with your doctor about birth control, since chemo drugs can hurt a growing fetus.
• Chemo, radiation, or surgery that removes the ovaries may cause early menopause. Ask your doctor about your chances of this happening in your situation.
• If infertility is likely, talk with your doctor about the possibility of freezing ovarian tissue or eggs. This does require special surgery and is very expensive, but it may be an option for some women.

If you have an ostomy:

• Empty the pouch before sexual activity.
• Ask your enterostomal therapist about a pouch cover that doesn't look "medical."
• If a leak occurs, shower together and continue sexual play.
• Tuck pouch into a supportive belt or cummerbund.
• Turn appliance to the side.
• Try different positions if there is friction.
• For women, try crotchless, lacy underwear or lingerie that covers the appliance, but leaves the genital area open.
• Some people are more comfortable wearing a T-shirt to cover the stoma at first.

What partners can do

• Find out how cancer and the cancer treatment are likely to affect your sexual relationship. Chemo can cause side effects such as fatigue. (See the section on chemotherapy.) Surgery and radiation in the genital area may permanently change the structure and function of the genitals.
• Learn what changes to expect if the person is taking hormones, which may affect sexual function or desire.
• Be patient during chemo or radiation. Wait for times when your partner feels ready for sexual activity.
• Offer physical closeness and touching when the patient's energy is low. Intimacy can be achieved without intercourse, erections, or orgasms. Kindness, affection, and respect go a long way toward reaching this goal.
• Find out how the patient feels about his body and about sexual activity. Sometimes, people feel unattractive after cancer treatment.
• It is normal to grieve about losses and changes in body image, which affect both of you. Consider talking with a mental health professional if you have had difficult 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 will not be interrupted.
• Use unscented, uncolored water-based lubricant (such as K-Y Jelly^® or Astroglide^®) if dryness causes discomfort for either of you.
• If you are afraid of hurting your partner, talk about it with your partner and with the doctor or nurse.

Call the doctor if the patient:

• Notices new or more pain
• Notices bleeding
• Has a change in erectile function or in the amount of semen
• Has any sexual problems or questions concerning sexual activity

For more in-depth information, see Sexuality for the Woman With Cancer, or Sexuality for the Man With Cancer. For questions about fertility options, such as freezing eggs or sperm before chemo, visit www.fertilehope.org or call 1-888-994-HOPE.

Go back to Caring for the Patient with Cancer at Home: A Guide for Patients and Families.

Last Medical Review: 04/27/2009
Last Revised: 04/27/2009