Treating Sexual Problems for Men with Cancer

Dealing with sexual problems

What to expect

It’s hard to know what will happen to any one person. For example, one man may have his erections come back after radical prostatectomy while another man may not. But if you do have a sexual problem, your health care team can often find the cause and give you an idea of your chance for recovery.

One clue that a problem is a medical one and one that may not go away is if it happens in all situations. Otherwise, it may be psychological and short-term. For example, if you have trouble getting or keeping an erection, does it happen every time you have sex? Are your erections better when you relax, when you stimulate your own penis, or when you unexpectedly see someone attractive? If you have more than one partner, are your erections better with one of them than with another?

Dealing with short-term problems

As men age or go through health changes, it’s common that feelings of sexual excitement no longer lead to erections as quickly. You may just need more time and touching to get aroused.

If you have trouble reaching orgasm during sex, you may not have found the right kind of touching. You might want to think about buying a hand-held electric vibrator. A vibrator can give very intense stimulation. Try having a sexual fantasy or looking at erotic stories or pictures. The more excited you are, the easier it is to reach orgasm.

Finding the cause of problems that appear to be permanent

The best time to talk with your doctor or cancer team about possible side effects or long-term changes in your sex life is before treatment. It’s important to know what to expect and to learn about the usual recovery process, including how long it takes. But you can bring up the subject any time during and after treatment, too. If you didn’t discuss sexual side effects before treatment, it’s best to do so soon after your treatment. This way your doctor can help you find the cause of the problem and develop a plan to help you deal with it.

What treatments are available to help with erections?

The success rates of treatments to help with erectile dysfunction (ED) vary greatly, and you may have to try a few to find the one that works best for you. In many cases, sexual counseling can help a couple discuss their options and plan how to make the new treatment a comfortable part of their sex life.

Pills

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are drugs that come in pill form. All of these drugs help a man get and keep an erection by causing more blood to flow into the penis. If you are having trouble with erections, these pills are often the first type of treatment recommended.

For men who have had certain operations that affect the nerves that help cause erections (such as a prostatectomy), using these pills may not help at first. These pills work with the nerves responsible for erections. And even with nerve-sparing surgery (saving the nerves responsible for erections that run close to the rectum and along the prostate), the nerves might still be damaged and need time to heal (sometimes up to 2 years). Many men may find the pills don’t work at all the first few months after surgery. But they are often more helpful as time goes by. At 18 to 24 months after surgery, the pills may be very helpful in getting a firm erection.

  • Doctors often recommend using one of these drugs to get erections starting within weeks or months after surgery, which can help some men recover sexual function. This is known as penile rehabilitation. (See  Cancer Can Affect a Man's Erections.) But if these pills are not producing a firm erection in the first months after surgery, it’s important to try another treatment to help restore the blood flow to the penis.

Some drugs are known to interact with pills that help ED. For example, nitrates (like nitroglycerin and other drugs used to treat heart disease) may interact to cause very low blood pressure, which can be fatal. Be sure your doctor knows about all medicines you take, even those you take rarely. You should only take these pills if they are prescribed by your doctor and come from a legitimate pharmacy. There’s a large counterfeit market for pills for ED. These pills are usually not effective to help erections and may be dangerous, so make sure you are buying them from a pharmacy you know and trust.

The most common side effects of pills to help erections are headache, flushing (skin redness warmth), upset stomach, sensitivity to light, and runny or stuffy nose.

Rarely, a man may get an erection that will not go down. If this happens, he needs to get medical treatment right away. Otherwise, the penis can have long-term damage.

In very rare cases, these drugs may block blood flow to the optic nerve in the back of the eye. This could lead to blindness. Men who have had this problem were more likely to have been smokers or had problems with high blood pressure, diabetes, or high levels of cholesterol or fat in their blood.

Penile injections

Another option is to inject the penis with a medicine that causes erections. A very thin needle is used to put the drug into the side of the shaft of the penis a few minutes before starting sexual activity. The combination of sexual excitement and medicine helps to produce a firmer and longer-lasting erection.

Penile injections are the most reliable treatment for ED, and work in about 80% to 90% of men who try them. Many men are hesitant to try the injections because they’re afraid they will hurt. But most men have little or no pain from the injections.

The first injection is usually done in the doctor’s office, where the doctor can teach the man how to do it.

Rarely, a man may get an erection that will not go down. If this happens, he needs to get medical treatment right away. Otherwise, the penis can have long-term damage.

Some men may develop scarring in the spongy tissue of the penis after repeated injections.

Urethral pellets

Another way to help with erections is a urethral pellet. A man uses an applicator to put a tiny pellet (suppository) of medicine into his urethra (the opening at the tip of the penis). As the pellet melts, the drug is absorbed through the lining of the urethra and enters the spongy tissue of the penis. The man must urinate before putting in the pellet so that the urethral lining is moist. After the pellet is put in, the penis must be massaged to help absorb the medicine.

This system may be easier than injections, but it doesn’t always work as well and can cause some of the same kinds of side effects. Because the pellet may make some men dizzy, a test dose in the doctor’s office may be needed. It can cause some burning in the urethra, too. Bits of the pellet may also enter the partner during sex and cause burning, itching, or other discomfort. And like injections, the pellet might cause a prolonged erection, which needs medical treatment right away.

Vacuum erection devices

Vacuum erection devices (VEDs) work well for some men. With a VED, the man places a plastic cylinder over his penis and pumps out air to create a vacuum around the outside of the penis. The suction draws blood into the penis, filling up the spongy tissue. When the penis is firm, the man takes the pump off and slips a stretchy band onto the base of his penis to help it stay erect. The band can be left on the penis for up to half an hour.

Some men use the pump before starting sexual touching, but others find it works better after some foreplay has produced a partial erection. The erection from a vacuum device is usually firm, but may swivel at the base of the penis, which can limit comfortable positions for sex. It may take some practice to learn how to use a VED. Most vacuum devices are prescribed by doctors, but some are available over the counter.

Penile implants (prostheses)

For men who have tried all the treatments listed above and have not found one that works well, surgery to implant a prosthesis in the penis may be an option to consider. Over the past several decades, many of these operations have worked quite well to treat permanent erection problems. Most men who have implant surgery are pleased with the results.

There are 2 main types of implants. The most common type is an inflatable implant, which uses a pump system placed entirely inside a man’s body. For this type of implant, 2 tough, inflatable silicone cylinders are put inside the penis.

  • A 3-piece inflatable implant comes closest to mimicking a normal erection. For this system, a balloon-shaped reservoir (storage tank) that contains a mixture of salt water and x-ray dye is tucked behind the groin muscles. (The x-ray dye is used so that the system can easily be checked for problems after it’s in place.) The fluid usually stays in the reservoir, leaving the cylinders in the penis empty. A pump is placed inside the loose skin of the scrotal sac. All the parts are connected with tubing.
  • In a 2-piece inflatable implant, most of the fluid is in the back of the cylinders, and the pump is put into the scrotum.

For either type, the penis looks basically the same as it does when not erect, except that it’s always a little fuller. When you are ready for sex, you stiffen the penis by squeezing the pump under the skin of the scrotum several times. This pumps the salt water into the cylinders and inflates the penis, just like blood does in a natural erection.

For the 3-piece system, when you no longer want an erection, you press a release valve on the pump to deflate the cylinders. The salt water then returns to the reservoir, and your penis becomes soft. For the 2-piece system, you bend the penis down for several seconds, which allows most of the fluid to travel back out of the penis.

A non-inflatable implant is a less common type of prosthesis that uses semi-rigid rods that are implanted in the penis. When a man wants an erection, he simply bends the rods up; otherwise he bends them down. This is a simpler device to use than an inflatable implant, but it can have drawbacks, including being the least like a normal erection.     

Each type of implant has its own pros and cons, which can include:

  • The complexity of the surgery
  • Ease of use of the implant
  • Closeness to the look and feel of a natural erection (and natural ‘soft’ state)
  • Potential side effects and long-term complications

Learn as much as you can and ask your urologist questions about the pros and cons of each type of implant before making your decision. A man who is married or in a committed relationship should include his partner in any decision about implants. Your partner needs to understand the procedure and have a chance to discuss any fears or questions with you and the doctor.

You also need to be realistic about what a prosthesis can and can’t do for you. Any penile prosthesis is just a mechanical stiffener for the penis. A penile implant can’t solve any other problems, such as low sexual desire, lack of sensation on the skin of the penis, or trouble reaching orgasm. It can’t turn a poor sexual relationship into a great one.

A couple needs to talk openly before they have sex after implant surgery. You may need to experiment with different kinds of touching or with different positions. Make sure you are truly excited before trying to have sex, rather than starting sex just because your penis is erect. Couples who have maintained mutual touching, even if an erection problem prevented penetration, tend to adjust more easily to the prosthesis.

Testosterone

If a man has a hormone imbalance, testosterone may restore his desire and erections. Most men have enough testosterone, even after age 50 or 60. But low testosterone can lead to low sexual desire and trouble with erections. It can also lead to a loss of energy.

If you think you might have low testosterone, it’s important to talk to your doctor. Tests can be done to find out your testosterone level, and you can discuss possible treatment options. Testosterone is usually not given to men who have had prostate cancer, since it might cause the cancer to grow.

Herbs or natural cures

Many herbal and dietary supplements are sold over the counter as “natural” cures for erection problems. These supplements have not been proven to help men regain erections.

It’s important to know that supplements are not strictly regulated in the United States like drugs are. Supplement makers don’t have to prove their products are effective (or even safe) before selling them. Some supplements might not even contain the ingredients on their labels, while others might contain other (potentially harmful) ingredients.

Be sure to talk to your doctor about any supplement or other over-the-counter treatment you are thinking about trying.

When is sexual counseling helpful?

Any sexual problem caused or worsened by anxiety can be helped through counseling with a mental health therapist who specializes in dealing with sexual issues. For men, problems caused by anxiety can include:

  • Loss of sexual desire
  • Erection problems without a medical cause
  • Trouble reaching orgasm
  • Premature (early) ejaculation

When a medical problem limits a man’s sexual function, speaking with a therapist can be helpful. Most counseling lasts about 2 or 3 sessions. Sex therapists may also be able to help you and your partner decide whether to have medical or surgical treatments for erection problems. (See Questions Men Have about Cancer, Sex, and Getting Professional Help.)

Is there a way to make orgasms as intense as they used to be?

Some men treated for cancer notice that their orgasms become weaker or last a shorter time than before. Sometimes, a mildly weaker orgasm is just part of normal aging. As men age, the muscle contractions at climax are no longer as strong. More severe weakening of orgasm often goes along with erection problems. In these cases, treating the erection problem may not improve a man’s orgasms. Men who have dry orgasms after cancer treatment also say they sometimes have reduced sensation.

Few medicines can make a man’s climax stronger. Most of these medicines can have serious side effects or could stop working after a few doses.

Some common-sense advice is to make sure you are as excited as possible during sex. Focus on your feelings of pleasure or on an arousing fantasy and take as long as you need to for foreplay. If you find yourself getting close to orgasm, ask your partner to tease you a little by slowing down the caresses. Let your excitement die down and rebuild several times before you actually climax.

You can practice this teasing technique during self-stimulation, too. When you feel your excitement is high, stop touching your penis, even if you lose part of your erection. Then caress yourself again, stopping and starting several times before you ejaculate. Whether by yourself or with a partner, make sure your erection is as full as can be before you use the strong, rhythmic caresses that bring on your orgasm. Some men learn to ejaculate with a soft penis. But many find they have stronger orgasms if they can delay orgasm until their erection is as firm as possible.

Special aspects of some cancer treatments

Urostomy, colostomy, or ileostomy

An ostomy allows waste to leave the body through a surgical opening (stoma) in the skin and into a pouch that you can empty.

  • A urostomy takes urine through a new passage and sends it out through an opening on the belly (abdomen).
  • Colostomy and ileostomy are both openings on the abdomen for getting rid of fecal waste (stool) from the intestines. In an ileostomy, the opening is made with the part of the small intestine called the ileum. A colostomy is made with a part of large intestine called the colon.

You can reduce the effect an ostomy has on your sex life if you take some common-sense steps. First, make sure your appliance (pouch system) fits well. Check the seal, and empty your ostomy bag before sex. This will reduce the chance of a leak. If it does leak, be ready to jump into the shower with your partner and then try again.

A nice pouch cover can make an appliance look less “medical.” You can get covers or patterns to make your own from your enterostomal therapist or your ostomy supply dealer.

Another option is to wear a special small-sized ostomy pouch during sex. Or if you have a 2-piece pouch system, turn the pouch on the faceplate so the emptying valve/clip is to the side. If you wear an elastic support belt on your faceplate, tuck the empty pouch into the belt during sex. You can also wear a wide sash around your waist to keep the pouch out of the way. Another way of keeping the pouch from flapping is to tape it to your body. Some men feel more comfortable wearing T-shirts to cover their appliances.

To reduce rubbing against the appliance, choose positions for sex that keep pressure off the ostomy. If you have an ostomy but like to be on the bottom during sex, try putting a small pillow above your ostomy faceplate. Then, your partner can lie on the pillow rather than right on the appliance.

You can get more detailed information based on your type of ostomy by calling us or visiting the Ostomies section of our website.

Laryngectomy

Laryngectomy is surgery that removes the voice box. It leaves you unable to talk the normal way, and you breathe through a stoma (opening or hole) in your neck. Since the air you breathe can’t be cleaned by the nose’s natural filter, a special type of stoma cover is needed. Besides catching dust and particles, the stoma cover helps hide the mucus that leaks out of the stoma. A scarf, ascot tie, or turtleneck can look good and hide the stoma cover.

During sex, a partner may at first be startled by breath that hits at a strange spot, and this might take some getting used to. You might also have food odors coming from the stoma. You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing cologne or after-shave lotion.

Sometimes problems in speaking can make it hard for couples to communicate during sex. If you have learned to speak using your esophagus, talking during sex is not a big problem. A speech aid built into the stoma might also work well. If you use a hand-held speech aid, communication during sex is likely to be awkward and distracting. Still, you can say a great deal without words by guiding your partner’s hand or using body language.

With a new partner, you may want to talk about the kinds of touching and positions you like before you start. You may also want to pre-select ways of signaling important messages you may want to share during sex.

Treatment for head and neck cancer

Some cancers of the head and neck are treated by removing part of the bone structure of the face. Because this can change how you look, it can affect your self-image. Surgery on the jaw, palate, or tongue can also change the way you talk. Recent advances in facial replacement devices, tissue grafting, and plastic surgery give many people a more normal look and clearer speech. Even ears and noses can be made out of new materials, tinted to match the skin, and attached to the face. All of these things can be a great help to a person’s appearance and self-esteem.

Limb amputation

Treatment for some cancers can include surgically removing (amputating) a limb. This can impact your sex life. A patient who has lost an arm or leg may wonder, for example, whether to wear his artificial limb (prosthesis) during sex.

The answer depends on the couple. Sometimes the prosthesis can help with positioning and ease of movement. But the straps that attach it can get in the way. Without the prosthesis, the partner with an amputation may have trouble staying level during sex. Pillows can be used for support.

Amputations may create ongoing pain or pain where the limb used to be. These side effects can interfere with sexual desire and distract a person during sex. If this is a problem, talk to your doctor about how to better control your pain.

Loss of a testicle

Testicles are as symbolic of manhood as breasts are of womanhood. Although some men are not upset about the loss of a testicle, others may fear a partner’s reaction. This is often more true of men who are not in a long-term relationship.

In men with testicular cancer, the surgeon usually removes the testicle with cancer and leaves the normal one. Very few men ever develop a second tumor in the other testicle. Since this operation also removes the epididymis above the testicle, that side of the scrotum looks and feels empty.

Men with testicular cancer are usually young. They may be single and dating. They may feel embarrassed by the missing testicle when showering or in locker rooms. To get a more natural look, a man can have a testicular prosthesis put in his scrotum during surgery. The prosthesis is filled with saline (salt water), and can be sized to match the remaining testicle. When seen in an intact scrotum, looks like a normal testicle. The only evidence of the operation is the scar, which is often partly hidden by pubic hair. But if part of the scrotal skin must be removed, a testicular prosthesis might not be able to make the scrotum look natural.

Penile shrinkage after prostatectomy

After prostate surgery, a man may be shocked to find that his penis is shorter than before. For up to about 6 months after surgery, it may even seem to have shrunk inside the body, much like when a man is in cold water. Penile shrinkage is common after surgery, and it’s often not something a man is told about beforehand.

The cause of penile shrinkage is not known for sure. It might have to do with surgery affecting the nerves that control erection. But studies have shown that the penis can get shorter for up to a year after surgery, so there are probably other causes, too. For instance, blood flow changes, scarring, and changes in penile tissue that result from loss of erections may play a role.

There’s no known way to prevent or treat penile shrinkage at this time. Some studies have suggested that early penile rehabilitation can help decrease shortening, especially when vacuum devices are used. But more research is needed.

Cancer of the penis

When a man has cancer of the penis or of the bottom end of the urethra, the best treatment may be removing (amputating) part or all of the penis. These operations are rare, but they can have a major effect on a man’s self-image and his sex life.

If cancer of the penis is found early, local radiation or chemotherapy creams can sometimes be used to treat it. These treatments often have little effect on sexual pleasure and function. But in most cases, the only way to stop the cancer is to remove the affected part of the penis.

Partial penectomy removes only the end of the penis. The surgeon leaves enough of the shaft to allow the man to direct his stream of urine away from his body.

Men are usually surprised to learn that a satisfying sex life is possible after partial penectomy. The remaining shaft of the penis still becomes erect with excitement. It usually gets long enough to allow penetration. Although the most sensitive area of the penis (the glans or head) is gone, a man can still reach orgasm and have normal ejaculation. His partner also can still enjoy sex and may reach orgasm in the same way as before the surgery.

Still, surgeons recognize how traumatic the loss even part of a man’s penis can be. In general, they try preserve as much of the penis as possible. But it’s important that all the cancer be removed, and this can limit how much a surgeon can safely leave.

If the shaft and glans can’t be saved, the man must have a total penectomy. This operation removes the entire penis, including the base that extends into the pelvis. The surgeon creates a new way for urine to leave the body through an opening between the man’s scrotum and his anus (the outside opening of the rectum). The man can still control his urination because the “on-off” valve in the urethra is above the level of the penis.

Some men give up on sex after total penectomy. Since cancer of the penis is most common in elderly men, some have already stopped sexual activity because of other health problems. But if a man is willing to put some effort into his sex life, pleasure is possible after a total penectomy.

A man can learn to reach orgasm when sensitive areas, such as the scrotum, the skin behind the scrotum, and the area around the surgical scars, are caressed. He or his partner may try placing a finger 1 or 2 inches inside the anus to caress the prostate. Some people prefer to use plastic or latex gloves with a water-based lubricant to touch this area, and short fingernails are a must. As long as the rectum or prostate is healthy and has not been injured by surgery, trauma, or cancer, many men find that this feels good. It does take some practice, since at first it may feel strange or cause the man to feel like he has to urinate.

Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement. You can help your partner reach orgasm by genital caressing with your fingers, by oral sex, or by using a vibrator.

Other options that rebuild or replace the penis may be available in the future.

Even though it’s very rare in the US, there are a few surgeons who will try to rebuild the penis after total penectomy if the man wants to try it. This is a complex procedure that requires microsurgery to attach nerves and blood vessels. Graft tissues must be taken from other parts of the body, such as the arm, leg, chest, back, or groin. If you are looking into this option, you will want to find out about the surgeon’s experience with this procedure. You will also want to ask about success rates, scarring, and complications the surgeon has seen. Find out about sensation in the penis, and the chances of being able to have sex after surgery. Keep in mind that there’s very little in the available medical research about success rates at this time.

Other options that might be available in the future include penis transplants, as well as creating a new penis in the lab. More research is needed on these approaches as well.

Feeling good about yourself and feeling good about sex

After cancer treatment, it’s very easy to focus only on parts of the body that have been affected. For example, if chemotherapy causes your hair to fall out, you might be more concerned about how other people will feel about the way you look. If you need to have a laryngectomy (removal of the voice box), you may fear you won’t be able to find another partner because you’ve lost your voice.

Sometimes friends and lovers do withdraw emotionally from a person with cancer. This may not be because of how the person looks, but it might be caused by other feelings or thoughts in the person who’s doing the looking. When one partner can’t bear to look at the other’s ostomy bag, for instance, it may be a sign of much deeper feelings. Maybe the ostomy reminds them of how sad they would feel if the other person died. It may be easier not to love that person so much. A partner may even be more aware of their own mortality, which can be upsetting, too. Yet all these feelings get blamed on a stoma that mars a small part of one partner’s body. The “well” partner also may feel like a failure and know that they’re letting down the partner who’s had cancer at a time when they are most needed.

Don’t give up on each other. It may take time and effort, but keep in mind that sexual touching between a man and his partner is always possible. It may be easy to forget this, especially if you’re both feeling down or have not had sex for a while. Review Cancer, Sex, and the Male Body for some tips to help you and your partner through this time. And keep in mind that you may need extra help with the changes caused by cancer that can turn your and your partner’s lives upside down.

Good communication: The key to building a successful sexual relationship

The most important part in keeping a healthy sexual relationship with a partner is good communication. Men often react to cancer by withdrawing. They might feel embarrassed or worry about not appearing strong if they open up too much. Or, or they might think their partner will feel burdened if they share their fears or sadness. But when you try to protect each other, each suffers in silence. No couple gets through cancer diagnosis and treatment without some anxiety and grief. Why not discuss those fears with one another so that you shoulder the load together rather than alone?

Sexual sharing is one way for a couple to feel close during the stress of an illness. But if your partner has been depressed and distant, you may fear that a sexual advance might come across as a demand. Still, you can bring up the topic of sex in a healthy, assertive way. It’s usually not helpful to accuse (“You never touch me anymore!”) or demand (“We have to have sex soon. I can’t stand the frustration!”). Instead, try to state your feelings positively (“I really miss our sex life. Let’s talk about what’s getting in the way of our being close.”).

Overcoming anxiety about sex

Many couples believe that sex should always happen on the spur of the moment, with little or no advance planning. But sometimes because of a cancer-related symptom or treatment side effect, it might not be possible to be as spontaneous as you were in the past. The most important thing is to open up the topic for discussion and begin scheduling some relaxed time together. Couples need to restart their lovemaking slowly.

Part of the anxiety about resuming sex can be caused by the pressure to satisfy your partner. One way to explore your own capacity to enjoy sex is to start by touching yourself. Masturbation is not a required step in resuming your sex life, but it might help. By touching your own genitals and even bringing yourself to orgasm, you can find out if cancer treatment has changed your sexual response without having to worry about frustrating yourself or your partner. It can also help you find out where you might be tender or sore, so that you can let your partner know what to avoid.

Many of us may have learned as children that masturbation was wrong or shameful. But it’s a normal and positive experience for most people. If you feel at ease with the idea, try stroking not just your genitals, but all of the sensitive parts of your body. Notice the different feelings of pleasure that you can have. Later, you can teach your partner any new discoveries you make about your body’s sensitive zones. Even if cancer treatment has not changed your sexual responses, you may find some new caresses to enhance your sex life.

Sexual activity with your partner

When you first think of restarting sexual activity, you may be afraid it will be painful, or that you’ll never reach orgasm again. Your tries may not be what you expected. But just as you learned to enjoy sex when you started having sex, you can relearn how to feel pleasure after cancer treatment. Try to make the most of this chance to look at your sex life in a new way.

When you feel ready to try sexual touching with your partner, start with plenty of time and privacy. Plan for a time when you aren’t too tired and you’re not having pain. You may want to set the scene to be especially relaxed. For instance, you could light the room with candles or put on some soft, romantic music. Although you may feel a little shy, let your partner know, as clearly and directly as you can, that you would like to have some time to be physically close.

You could even make a date for this purpose. You might say, “I feel ready for sex again, but I’d like to take things slowly. Would you be in the mood tonight to try a little touching? I can’t promise how well it will go, but we can have fun trying.”

It’s a good idea for couples to put some limits on their touching the first few times they try sexual activity after cancer treatment. A good way to start is with a special session of all-over body touching. This is the way body touching works:

  • Each partner takes a turn touching and being touched. One partner lies face down on the bed, allowing the other partner to touch the entire back, from toes to scalp. After about 15 minutes, the partner lying down turns over so the front of the body can be touched.
  • The first time you try a touching session, avoid the breasts and genitals. Your goals are to feel relaxed and to experience sensual pleasure. It’s not important to get sexually excited. If you agree on these goals before starting, the touching should not be frustrating. This type of session can help take the nervousness and pressure out of being close again.
  • While being touched, your job is to be self-centered and tuned in to your own feelings. Don’t worry about your partner’s thoughts or feelings. When you’re doing the touching, enjoy the shape and texture of your partner’s body. Try many types of touching, varying light stroking and a firmer touch, much like a massage.
  • If you both feel relaxed during the first touching session, you can add some genital touching the next time. Over a few sessions, you can slowly spend more time on genital caresses, until each of you can reach an orgasm through stroking with a hand or through oral sex, if that’s comfortable for both of you.

Many couples don’t talk much about sex. But after cancer treatment, how you approach sex may need to change. This calls for clear communication. This is not the time to let embarrassment silence you. Be sure to let your partner know, either in words or by guiding with your hand, the kinds of touches you like best. Try to express your desires in a positive way. For example, “You have the right place, but I’d like you to use a light touch,” rather than, “Ouch! That’s too rough!” Save sex until both partners really feel ready for it.

If cancer treatment has caused erection problems, penetration may no longer be possible. Yet a couple can enjoy all the other parts of sex. Don’t give up touching and caressing, just because one aspect of sex has changed.

Making sex more comfortable

If you still have some pain or feel weak from cancer treatment, you may want to try new positions. Many couples have found one favorite position and rarely try another.

The best-known way to have sex is in the “missionary position,” with the man lying on top of the woman. But if you are feeling weak or out of breath, this kind of position may take too much effort. You may be able to enjoy sex more if both of you lie side by side, either facing each other or with your partner’s back next to your front side. Or your partner can be on top. This allows your partner to move more freely while you relax or touch them.

You can look at this as a good chance to learn other ways to enjoy sex with your partner. The drawings below are some ideas for positions that may help in resuming sex.

illustration showing seven sexual positions

There’s no magic position that’s right for everyone. You and your partner need to find the one that’s best for you. Small and large pillows can help as supports. Keeping a sense of humor can always lighten up your efforts.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: February 24, 2017 Last Revised: February 24, 2017

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