Treating Sexual Problems for Women With Cancer

Dealing with sexual problems

These are some of the more common problems women notice after cancer and cancer treatment. We also have some tips on what can be done to help with them. Talk to your cancer care team about your sex life and any problems you have. Many sex-related problems can be treated and managed so that you and your partner can have a satisfying sex life.

If a sexual problem has not gotten better after you’ve worked on it for many weeks or months, see Questions women have about cancer, sex, and getting professional help.

Premature menopause

If you’ve gone through premature (early) menopause because of cancer treatment, you may be bothered by frequent hot flashes, especially at night. Some women may be less interested in sex, though the decreased interest may be linked more to stress and poor sleep than to a shortage of hormones. Still, hormone changes are the most common cause of sex problems after treatment. They can cause pain, dryness, and thinning of vaginal tissues.

Female hormones in a pill or patch can help with vaginal dryness and hot flashes. But because estrogens can promote cancers of the breast, uterus, and possibly the ovaries, and cause other health problems, too, providers are less likely to prescribe them. Some women who have vaginal dryness can now use tiny doses of estrogen in gels, creams, rings, or tablets by putting them right into the vagina. (More on vaginal dryness below.)

If you have questions or concerns about hormone therapy, talk with your health care provider about the risks and benefits as they apply to you. If you and your provider decide that hormone therapy is the best treatment for you, it’s usually best to use it at the lowest dose that works for you and for the shortest possible time. It’s important that any woman taking hormone therapy be checked each year by her provider.

If your provider does not advise hormones for you, hot flashes can also be treated in other ways, such as by taking medicines that control the nervous system’s reaction to a lack of estrogen. Some drugs that are commonly used this way are the anti-depressants called serotonin reuptake inhibitors, like venlafaxine (Effexor®), fluoxetine (Prozac®), paroxetine (Paxil®), and others. Many women with milder hot flashes may do well with exercise and relaxation techniques alone. There are many ways to treat hot flashes – both with medicines and with minor changes in your environment. Talk to your health care provider about what may work for you.

Vaginal dryness

Lubricants

Cancer treatments often reduce the amount of lubricant produced in your vagina when you are excited. You may need extra lubrication to make sex comfortable. If you use a vaginal lubricant, choose a water-based gel that has no perfumes, coloring, spermicide, or flavors added, as these chemicals can irritate your delicate genital tissues. Lubricants can usually be found near the birth control or feminine hygiene products in drug stores or grocery stores. Common brands  include K-Y Jelly® and Astroglide®. Be aware that some of the newer lubricant products include herbal extracts (such as aloe or lavender), which may cause irritation or allergic reactions in some people. Also, warming gels can cause burning in some people. Be sure to read the labels, and talk with a nurse, doctor, or pharmacist if you have questions.

Petroleum jelly (Vaseline®), skin lotions, and other oil-based lubricants are not good choices for vaginal lubrication. In some women, they may raise the risk of yeast infection. And if latex condoms are used, they can be damaged by petroleum products and lotions. Also, watch out for condoms or gels that contain nonoxynol-9 (N-9). N-9 is a birth control agent that kills sperm, but it can irritate the vagina, especially if the tissues are already dry or fragile.

Before sex, put some lubricant around and inside the entrance of your vagina. Then spread some of it on your partner’s penis, fingers, or other insert. This helps get the lubricant inside your vagina. Many couples treat this as a part of foreplay. If vaginal penetration lasts more than a few minutes, you may need to stop briefly and use more lubricant. Even if you use vaginal moisturizers every few days, it’s best to use gel lubricant before and during sex.

Vaginal moisturizers

As women age, the vagina can naturally lose moisture and elasticity (the ability to stretch or move comfortably). Cancer treatments and risk-reducing surgery (such as removing the ovaries) can speed up these changes. Vaginal moisturizers are non-hormonal products intended to be used several times a week to improve overall vaginal health and comfort. You can buy them without a prescription. Vaginal health is important not only for sex, but also for comfortable gynecologic exams.

Vaginal moisturizers are designed to help keep your vagina moist and at a more normal acid balance (pH) for up to 2 to 3 days. Vaginal moisturizers are applied at bedtime for the best absorption. It’s not uncommon for women who’ve had cancer to need to use moisturizers up to 3 to 5 times per week. Vaginal moisturizers are different than lubricants – they last longer and are not usually used for sexual activity.

Replens® and K-Y Liquibeads® are examples of vaginal moisturizers. Lubrin® and Astroglide Silken Secret® are other moisturizers that are marketed as longer lasting than typical lubricants. Vitamin E gel caps can also be used as a vaginal moisturizer. Use a clean needle to make a small hole in the gel cap and either put the entire capsule into your vagina or squeeze some of the gel onto your fingers and put them into your vagina. Be aware that vitamin E may stain undergarments.

Vaginal estrogens

Topical or systemic estrogen therapy is a treatment option for vaginal atrophy (when the vaginal walls get thinner and less stretchy) for most post-menopausal women. But hormone treatments can be a complex issue for many women and health care providers in the cancer setting.

Many women do well with local vaginal hormones to help vaginal dryness. These hormones are applied to and absorbed into the genital area, rather than taken by mouth. They come in gel, cream, ring, and tablet forms. Most are put into the vagina, although some creams can be applied to the vulva. They focus small amounts of hormones on the vagina and nearby tissues, so that very little gets in the bloodstream to affect other parts of the body. Local vaginal hormones must be prescribed. Be sure to discuss hormone treatments with your oncologist (cancer doctor) before starting to use them.

Reaching orgasm after cancer treatment

Almost all women who could reach orgasm before cancer treatment can do so after treatment, and it may be as easy as before. But for some, it may take practice.

“I’m having trouble reaching orgasm. What can I do?”

If you enjoy being touched but still have trouble reaching orgasm, you may need to try something new to push yourself toward more excitement. Here are a few ideas that might help a woman reach orgasm.

Have a sexual fantasy during sex. A fantasy can be a memory of a past experience or a daydream about something you’ve never tried. A strongly sexual thought can distract you from negative thoughts and fears about performing.

Use a hand-held vibrator for extra stimulation. Hold it yourself, or ask your partner to caress your genitals with it. You can steer your partner to the areas that respond best and away from those that are tender or uncomfortable.

Change the position of your legs during sexual activity. Some women reach orgasm more easily with their legs open and thigh muscles tense. Others prefer to press their thighs together.

Tighten and relax your vaginal muscles in rhythm during sex or while your clitoris is being stroked. Or, tighten and relax the muscles in time with your breathing. This helps you focus on what you’re feeling. Contract your vaginal muscles and pull them inward as you inhale, and let them relax loosely as you exhale.

Ask your partner to gently touch your breasts and genital area. Experiment with your partner to find the type of touch that most excites you.

Pain during sex

Pain is a common problem for women during vaginal sex. It’s often related to changes in the vagina’s tissues or size and vaginal dryness. Pain can also be in a non-sexual part of the body, and it can keep you from feeling pleasure during sex. Pain may even make it hard for you to use sex positions that you enjoyed in the past.

Non-genital pain

If you’re having pain other than in your genital area, these tips may help lessen it during sex.

Plan sexual activity for the time of day when you feel the least pain. If you’re using pain medicine, take it an hour before you plan to have sex so it will be in full effect when you’re ready.

Find a position that puts as little pressure as possible on the sore areas of your body. If it helps, support the sore area and limit its movement with pillows. If a certain motion is painful, choose a position that doesn’t require it or ask your partner to take over the movements during sex. You can guide your partner on what you would like.

Focus on your feelings of pleasure and excitement. With this focus, sometimes the pain lessens or fades into the background.

Genital pain

Another side effect of some cancer treatments is genital pain. Sex may cause pain in the vagina itself or in the tissues around it, like the bladder and rectum. Sometimes the vagina is shorter and narrower after surgery or radiation. But hormone changes are the most common cause of vaginal pain after cancer treatment. If you don’t produce enough natural lubricant or moisture to make your vagina slippery, the vagina can be dry and painful. It can cause a burning feeling or soreness. The risk of repeated urinary tract infections or irritation also increases.

If you have genital pain during sex:

  • Always tell a health care provider about the pain. A number of common problems can cause pain, and most of them can be treated. Do not let embarrassment keep you from getting medical care.
  • Make sure you feel very aroused before you start vaginal sex. Your vagina expands to its fullest length and width only when you are highly excited. This is also when the walls of the vagina produce lubricating fluid. It may take a longer time and more touching to get fully aroused.
  • Spread a large amount of water-based lubricating gel around and in your vagina before vaginal penetration. You can also use lubrication suppositories (soft gel pellets) that melt during foreplay.
  • Let your partner know if any types of touching cause pain. Show your partner ways to caress you or positions that don’t hurt. Usually, light touching around the clitoris and the entrance to the vagina won’t hurt, especially if the area is well-lubricated.
  • For vaginal sex, try a position that lets you control the movement. Then, if deep penetration hurts, you can make the thrusts less deep. You can also control the speed.

One position that often works well is for you to kneel over your partner with your legs on either side of their body. Either sit up or lean forward and support yourself with your arms. An advantage of this position is that your partner can easily caress your breasts or clitoris. This may add more pleasure to sex.

Another good position is for partners to lie on their sides, either with your partner behind you, like spoons, or face to face.

Using Kegel exercises to learn to relax the vaginal muscles

Once a woman has felt pain during sex, she often becomes tense in sexual situations. Without knowing it, she may tighten the muscles just inside the entrance of the vagina. This makes vaginal penetration even more painful. Sometimes she clenches her muscles so tightly that her partner cannot even enter her vagina.

Learning to be aware of pelvic muscles and how to control them is important in understanding and treating vaginal pain. You can become aware of your vaginal muscles and learn to relax them during vaginal penetration. Exercises that teach control of the pelvic floor and vaginal muscles are called Kegels (pronounced kee-guls). (They are named for the gynecologist Dr. Arnold Kegel, who came up with them.)

The first step is to find your vaginal muscles. Imagine that you are urinating and contract the muscles you would need to stop the stream. Another way to identify the pelvic floor muscles is to put your finger about 2 inches into the vagina and tighten or contract the pelvic floor muscles. When you do this, you should be able to feel at least a slight twitch of the vaginal walls around your finger.

Once you have located the muscles, practice controlling them. Research has shown that women with good pelvic floor strength and control have a stronger arousal response.[C3]  As with any exercise, the more you practice, the more you can do. The basic Kegel exercise is to tighten your vaginal muscles and hold for 3 to 6 seconds, then relax the muscle completely for 3 to 6 seconds. Repeat this until your muscles feel tired or you are unable to hold the muscles firmly. You may first start by doing it 5 to 10 times. Over time, this number should increase in order to build up strength and tone. Once you can do it 20 to 25 per session, you can start again at 5 to 10 times but hold the muscle tight for longer, from 6 to 10 seconds. Repeat this exercise once or twice a day. People around you can’t tell that you are doing Kegels, so you can practice whenever you want.

Along with enhancing arousal, Kegel exercises can add to a couple’s pleasure during sex. If a woman tightens and relaxes her vaginal muscles during sex, she may focus more on the feelings that are building. Her partner can feel the movement of her vagina. This movement may add to their excitement.

One of the most important benefits of Kegel exercises is less discomfort because you can learn to relax your vagina during entry and sex. Start by making sure your vagina is wet when you and your partner are both aroused. Take a few seconds to tighten your vaginal muscles. Then let them relax as much as possible before your partner enters. Agree ahead of time that if you feel any pain, your partner will stop and you can do a set of Kegel exercises to tire the pelvic floor and help relax the vaginal muscles.

If vaginal penetration is painful and difficult, you can do a set of pelvic floor muscle exercises before intimacy to make your vagina less reactive and more relaxed. You or your partner can also gently stretch your vagina with a finger before trying penetration. Lubricate a finger and slowly slip it inside your vagina. Use the Kegel movements to tighten and release your vaginal muscles as you slowly move it deeper in. When one finger is no longer painful, try using 2 fingers, and then 3, before you try your partner’s penis. Remember to use plenty of gel, and go slowly.

Using a dilator for vaginal tightness

A vaginal dilator is a plastic or rubber tube used to enlarge or stretch (dilate) the vagina. Dilators also help women learn to relax the vaginal muscles if they are used with Kegel exercises. They come in many forms.

The dilator feels much like putting in a large tampon for a few minutes. Even if a woman isn’t interested in staying sexually active, keeping her vagina normal in size allows more comfortable gynecologic exams.

Vaginal dilators are often used after radiation to the pelvis, cervix, or vagina. (Your provider will tell you when to start.) They can be used several times a week (3 times a week for 10 to 20 minutes is recommended) to keep your vagina from getting tight from scar tissue that may develop. Since scarring in the pelvis can develop over many years after radiation, dilators can be a good tool for you to use throughout your life.

Your health care provider may suggest a certain way to use the dilator. Here is a typical way a vaginal dilator is used:

  • Lubricate the dilator with a water-based gel.
  • Lie down on your bed at a time when you know you’ll have at least 15 minutes of privacy. Gently and slowly slip the dilator into your vagina. If your vagina feels tight, hold the dilator still while you contract and relax your vaginal muscles. (Do Kegel exercises, described above.)
  • When your pelvic floor muscles feel tired, your vagina will be relaxed and looser. You should be able to push the dilator farther in. You may need to repeat this process several times (or over days) before the dilator can be put all of the way into your vagina.
  • When the dilator is in as far as is comfortable, leave it in your vagina for about 10 to 15 minutes. If the dilator slips out, gently push it back into your vagina.
  • Before you take it out, gently push the dilator back and forth to give a gentle stretch in length. You can rotate the dilator by doing wide circles to gently stretch in width.
  • When done, remove it, and wash it with a mild soap and hot water. Be sure to rinse all the soap off so no film is left to irritate your vagina the next time you use it.

Dilators usually come in a set or a series of different sizes, but a woman may be given one dilator in the size needed to fit her vagina. If you have a set, start off with the smallest size and slowly work up to the larger sizes in order to allow for comfortable penetration.

Dilators work best when used regularly after radiation or surgery to keep the vagina from shrinking. Women must heal before using a dilator, but don’t wait until you have an overly tight vagina. The dilator will not work nearly as well. If you go for many months without vaginal penetration, it’s very important to use your dilator to keep your vagina in shape.

Your gynecologist or radiation oncologist can give you dilators, but you can also buy them online and have them shipped for privacy.

Special aspects of some cancer treatments

Urostomy, colostomy, or iIeostomy

An ostomy is a surgical opening created to help with a body function. The opening itself is called a stoma. A urostomy takes urine through a new passage and sends it out through a stoma on the abdomen (belly). A colostomy and ileostomy are both stomas on the belly for getting rid of body waste (stool).

You can reduce the effect of ostomies on your sex life if you take some common-sense steps. First, make sure the appliance (pouch system) fits well. Check the seal and empty your pouch 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 pouch cover can help make an appliance look less “medical.” Sewing patterns or ready-made covers are available from your enterostomal therapist or ostomy supply dealer.

Another option is to wear a special small-sized ostomy pouch during sex. Or, if you have a 2-piece 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. Or you can 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. You may also find that you feel more comfortable wearing something like a short teddy or T-shirt to cover your appliance.

To reduce rubbing against the appliance, choose positions for sex that keep your partner’s weight 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.

Laryngectomy

Laryngectomy is surgery that removes the voice box. It leaves you without the normal means of speech, and you breathe through a stoma (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, necklace, or turtleneck can look good and hide the stoma cover.

During sex, a partner may be startled at first by breath that hits at a strange spot. You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing perfume.

Sometimes problems in speaking can make it hard for couples to communicate during sex. If you’ve 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. But neither method lets you whisper in your partner’s ear. Still, you can say a great deal 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 these scars are so visible, they can be devastating to 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 now let many people look more normal and speak more clearly. Ears and noses can even be made out of plastic, 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 the artificial limb (prosthesis) during sex.

The answer depends on the couple. Sometimes the prosthesis helps 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 sexual activity. If this is a problem, talk to a health care provider about how to better control your pain.

Feeling good about yourself and feeling good about sex

After cancer treatment, it’s easy to focus only on the part of the body that’s been affected. For example, a single woman who has had a laryngectomy may fear she won’t be able to find another partner because she has lost her voice.

Sometimes friends and lovers withdraw emotionally from a person with cancer. This may not be due to how the person looks, but may be caused by some feelings or thoughts in the person who’s doing the looking. When one partner cannot bear to look at the other’s ostomy appliance, for instance, it may be a sign of much deeper feelings. Maybe they’re angry because they have to take over the partner’s usual tasks of paying bills and doing housework. Or the ostomy may remind one partner of how sad they would be if the other person died. It might be easier not to love that person so much. A partner may even be more aware of their own chance of death, which can be upsetting, too. Yet all these feelings get blamed on a stoma, which is a small part of one partner’s body. The “well” partner, in turn, may also feel like a failure and know that they’re letting the partner who’s had cancer down at a time when they are needed most.

Don’t give up on each other. It may take time and effort, but keep in mind that sexual touching between a woman and her partner is always possible. It may be easy to forget this, especially if you’re both feeling down or haven’t had sex for a while. See "Keeping your sex life going despite cancer treatment" in Cancer, Sex, and the Female Body for some tips to help you and your partner through this time. Read the suggestions to help you through some of the changes that cancer may have brought to your life, your self-esteem, and your relationships.

Changes in the way you look

The most obvious change caused by cancer treatment, mostly chemo, will likely be hair loss. You may expect to lose the hair on your head, but other body hair, such as eyebrows, eyelashes, and pubic hair, are often affected, too. You may also lose weight and muscle mass if you have trouble eating. On the other hand, many women gain weight during or after chemo. Chemo and some other treatments may cause your skin to get darker, become dry and flaky, or may make you look very pale. Your nails may become discolored or ridged.

Some physical changes can be covered up or made less obvious. For instance, if you’re just starting chemo, you may want to shop for a wig before your hair begins to fall out. Wigs are warm and often not comfortable, so you may decide to mostly wear your wig outside the home or hospital. You can also use scarves, turbans, hats, or caps. Some women leave their heads uncovered. Still others switch back and forth, depending on whether they’re in public or at home with family and friends.

It’s a good idea for a couple to discuss how each feels about wearing a wig or head covering during sex. There’s no right or wrong choice.

Disguising weight loss, skin color and nail changes, and even infusion catheters is a bigger challenge. For the most part, clothes that fit well look better. Wearing something too tight or too baggy will draw attention to your weight change. High necks and long sleeves can hide a catheter, but may be too hot in warm weather. Look for thin fabrics that will be cool while covering you.

Ways to cope with changes in how you look

Feeling good about yourself begins with focusing on your positive features. Talk to your cancer care team about things that can be done to limit the damage cancer can do to the way you look, your energy, and your sense of well-being. When you’re going through cancer treatment, you can feel more attractive by disguising the changes cancer has made and drawing attention to your best points.

This mirror exercise can help you adjust to body changes:

What do you see when you look at yourself in the mirror? Many people notice only what they dislike about their looks. When they look in the mirror, they see pale skin, hair loss, an ostomy, or skinny legs. They fail to see a classic profile, expressive eyes, or a nice smile.

Find a time when you have privacy for at least 15 minutes. Be sure to take enough time to really think about how you look. Study yourself for that whole time, using the largest mirror you have. What parts of your body do you look at most? What do you avoid seeing? Do you catch yourself having negative thoughts about the way you look? What are your best features? Has cancer or its treatment changed the way you look?

First, try the mirror exercise when dressed. If you normally wear clothing or special accessories to disguise changes from treatment, wear them during the mirror exercise. Practice this 2 or 3 times, or until you can look in the mirror and see at least 3 positive things about your looks.

Once you’re comfortable seeing yourself as a stranger might see you, try the mirror exercise when dressed as you would like to look for your partner. If you’ve had an ostomy, for example, wear a bathrobe or teddy you like. Look at yourself for a few minutes, repeating the steps in the first mirror exercise. What’s most attractive and sexy about you? Give yourself at least 3 compliments on how you look.

Finally, try the mirror exercise in the nude, without disguising any changes made by the cancer. If you have trouble looking at a scar, bare scalp, or an ostomy, take enough time to get used to looking at the area. Most changes are not nearly as ugly as they seem at first. If you feel tense while looking at yourself, take a deep breath and try to let all your muscles relax as you exhale. Don’t stop the exercise until you have found 3 positive features, or at least remember the 3 compliments you paid yourself before.

The mirror exercise may also help you feel more relaxed when your partner looks at you. Ask your partner to tell you some of the things that are enjoyable about the way you look or feel to the touch. Explain that these positive responses will help you feel better about yourself. Remember them when you’re feeling unsure.

Changing negative thoughts

Your thoughts can make a sexual experience good or bad. Become more aware of what you tell yourself about how attractive or sensual you feel. You may be setting yourself up for failure with thoughts like, “How could someone want a woman with one breast?” Almost all of us have put ourselves down now and then. But there are ways to turn these thoughts around.

Write down the 3 negative thoughts you have most often about yourself as a sexual person. Some may be connected to your cancer treatment, but other thoughts may have started years ago.

Now write down a positive thought to counter each negative thought. For example, if you said, “No one wants a woman with a urostomy,” you could say to yourself, “I can wear a lacy ostomy cover during sex. If someone can’t accept me as a lover with an ostomy, then they’re not the right person for me.” The next time you are in a sexual situation, use your positive thoughts to override the negative ones you usually have. If you have a favorite feature, this is a good time to indulge yourself a little and play it up.

If negative thoughts intrude and you find yourself overwhelmed or discouraged, you may want to talk with your cancer care team about working with a mental health professional.

Depression is common during and after cancer treatment and has a huge effect on your life, including your thoughts, relationships, and overall wellbeing. If you lack interest in things you usually enjoy or are unable to feel pleasure and happiness, please talk to your cancer care team.

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. Many people react to cancer by withdrawing. They 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 a 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?

Sex is one way for a couple to feel close during the stress of an illness. But if you or your partner has been depressed and distant, 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 simply 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 you’re dealing with a cancer-related symptom or treatment side effect that makes it impossible to be as spontaneous as you would have been in the past. The most important thing is to open up the topic for discussion and begin scheduling some relaxed time together – start slowly.

Part of the anxiety about sex is caused by the pressure to satisfy your partner. One way to explore your own capacity to enjoy sex is to start by touching yourself. Self-stimulation (or masturbation) is not a required step in restarting your sex life, but it can be helpful. By touching your own genitals and bringing yourself pleasure, you can find out if cancer treatment has changed your sexual response without having to worry about frustrating 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 self-stimulation was wrong or shameful. But it’s a normal and positive experience for most people. If you feel relaxed with the idea, try stroking not just your genitals, but all of the sensitive areas of your body. Notice the different feelings of pleasure that you can have. When you’re ready, 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 first few 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 when pain is well-controlled. You may want to create a relaxed environment. 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 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 that it will go perfectly, 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 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 helps 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 different types of touching, varying from light stroking to 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, partners can slowly spend more time on genital caresses, until each one is able to reach an orgasm through stroking with a hand, or oral sex, if that’s comfortable for both of you.

Many couples don’t talk much about sex. But after cancer treatment, your sex life 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 vaginal penetration until both partners really feel ready for it.

Making sex more comfortable

If you still have some pain or feel weak from cancer treatment, you might want to try new positions. Many couples have found one favorite position, particularly for vaginal penetration, and rarely try another. The best-known way to have intercourse (or vaginal penetration) is in the “missionary position,” with the male partner lying on top of the woman. But after cancer treatment, other ways might be more comfortable. You may be able to enjoy intercourse more if both of you lie side by side, either facing each other or with your back next to your partner’s front side. Another position that may work well is for you to sit or kneel with one leg on either side of your partner. This allows you to move more freely while your partner relaxes or touches you.

These are some ideas for positions that may help.

illustration showing seven sexual positions

There is 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 the mood.

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.

Last Medical Review: January 12, 2017 Last Revised: January 12, 2017

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