Sexual intimacy and cancer

Side effects will vary from person to person, and depend on the type of treatment and medicines you have. Some people have no side effects, while others have many.

Changes to sex drive or desire – Your libido might change because of tiredness, pain, anxiety, changes in hormone levels, and loss of confidence and self-esteem. For some people, libido may return to your usual levels after treatment ends, but for others, low libido may continue. Hormones can also change with age, and it’s common for libido to decrease as you get older. Even if you feel like having sex, you might feel anxious about your partner/s seeing how your body has changed.

Pain during sex – Radiation therapy to the pelvic area or rectum may make sex painful. This usually improves after treatment ends.

Incontinence – Trouble controlling the flow of urine (urinary incontinence) or flow of faeces (faecal incontinence) is a common side effect of treatment for cancer of the prostate, bladder, bowel, uterus, vulva, vagina and penis. This may be temporary or permanent. Having bladder or bowel issues can be embarrassing and you may worry about having accidents or leaking during sexual activity. You can use a sex blanket, cover sheets or have sex in wet areas like a shower.

Weak pelvic floor muscles can affect bladder and bowel control. The hospital continence nurse or physiotherapist can suggest exercises to strengthen the pelvic floor muscles and manage urinary symptoms. Start these exercises before treatment and continue to do them regularly after treatment.

Leaking urine at orgasm – After surgery for prostate or vulvar cancer, you might leak a small amount of urine when having an orgasm. This is usually temporary but is sometimes ongoing. You may feel embarrassed and nervous at the thought of leaking urine during oral sex and/or masturbation. Reassure your partner/s that urine is sterile.

Changes to the anus – Radiation therapy to the abdomen or pelvic area may irritate the lining of the bowel and rectum. This can cause bowel  problems, and the skin inside the anus may be more sensitive. If the anus area is sensitive after radiation therapy, take it slow and work up to full penetration. Fingering, rimming, using small dildos and picking positions where you control the speed and angle of penetration may help. Although sensitivity to the anal area may improve after a few months, some changes are permanent.

Sex with a stoma – Some types of surgery for bowel, anal, ovarian or bladder cancer create a stoma. This is an opening in the abdomen that allows faeces and urine to be collected in a small plastic bag. Sometimes a stoma is needed for only a short time, but sometimes it is permanent. Planning can help make sexual intimacy for people with a stoma satisfying and fulfilling. Consider wearing clothing like a slip or cummerbund to cover the stoma. You could secure the bag with tape to stop it moving. Talk to a stomal therapy nurse about products such as smaller pouches or a stoma cap. Do not use the stoma for sex.

Early menopause – Some cancer treatments can cause menopause symptoms or early menopause. These include surgery to remove both ovaries; hormone therapy to block oestrogen; and radiation therapy and chemotherapy, which can damage the ovaries. Menopause symptoms can include a dry vagina and mood changes, both of which can affect libido.

Changes to the vagina – Cancer treatment may cause temporary or permanent changes to the vagina. Surgery may shorten the vagina, and pelvic radiation therapy can narrow the vagina, causing thinning of the walls and dryness. If you have a surgically created vagina (vaginoplasty), speak to your doctor about the effects of radiation therapy.

Penetration with fingers, a penis and/or sex toys such as dildos or other objects may be difficult and painful. A narrower vagina will also make cervical screening uncomfortable. Talk to your doctor about the options for keeping the vagina open. They may suggest using dilators in different sizes to dilate and extend the vagina. Using extra lubrication may make sexual intercourse more comfortable. Choose a water-based or silicone-based gel without perfumes or colouring.

Changes to the prostate – Pleasure experienced from rubbing or stimulating the prostate during sex may change with certain prostate cancer treatments. If you have radiation therapy, the prostate may feel less sensitive. You won’t feel the same pleasure if the prostate is removed with surgery (radical prostatectomy). It may take time to adjust to this change and for you to become more aware of other pleasurable sensations.

Changes to the penis – Surgery for prostate or penile cancer may shorten or shrink the penis. After prostate cancer surgery, the difference is often small, usually about 1 cm. Changes in size may happen because of scar tissue or the nerves not working properly.

Erection problems – After surgery for prostate cancer or bowel cancer, getting and keeping a firm erection can be difficult. This is known as erectile dysfunction or impotence. How long the problem lasts will depend on your age, how easily you got an erection before surgery and how much the   erectile nerves were damaged. Having radiation therapy or taking androgen deprivation therapy can also cause erection problems.

You don’t need an erect penis to have an orgasm. However, firmer erections are needed for penetrative sex. Erection problems can make having penetrative sex more difficult or painful, and you may find this makes you feel anxious and frustrated. Doing pelvic floor exercises can help improve erections. Other options include using erection aids such as a vacuum pump, constriction ring around the base of your penis, or medicines. Ask your doctor for more details about these methods.

Other ways to experience pleasure include masturbation or oral sex, but you may be worried about how your sexual partner/s may feel. Open and honest communication about what has changed and nonsexual touching can help maintain intimacy in a relationship.

Changes in ejaculation – After some types of surgery and radiation therapy (e.g. for prostate cancer), you won’t be able to ejaculate semen. This is known as dry orgasm. This is because semen is no longer produced. If ejaculating semen was an important part of enjoying sex for you or your partner/s, you might want to discuss this change with them.

Changes to how you enjoy sexual intimacy and activity can be challenging and upsetting. Give yourself time to adjust. There are several ways to adapt  how you have sex during or after cancer treatment. You might find some of the following tips useful.

Talk about what has changed – Share any concerns about having sex or being intimate with your partner/s. Tell them when you are ready to have sex, what still works for you, what doesn’t and if they should do anything differently.

Try other forms of intimacy – Show affection by cuddling, holding hands, lying together naked, kissing and massaging. Talk about what has changed to avoid misunderstandings and take the pressure off going further.

Explore different ways to have sex – If the way you used to have sex has changed, try different sexual positions; explore different erogenous zones;  manual sex, including fingering and fisting; mutual masturbation; oral sex; genital rubbing; personal lubricants (lube); vibrators and other sex toys; erotic images and stories; sexual fantasies and kink.

Plan ahead – Using lubricants (lube) and erection devices, taking medicines, and managing incontinence or stomas may all mean you have to plan when to have sex. Some people say they miss spontaneity, others find that scheduling sexual activity gives them something to look forward to.

Focus on other aspects of your relationship – Many people in relationships do not see sex as important. How you feel about sex may also change as you get older. Spend time together doing things you both enjoy that also bring you closer. That way, sex isn’t the only way that you show your affection and share intimacy.

Use relaxation and meditation techniques – Feeling relaxed can help with sexual pleasure. Use free apps and podcasts to guide you through learning relaxation and meditation techniques. Many treatment centres run meditation programs.

Explore what has changed on your own – Touch and masturbation can help you to understand any changes in how you feel in a way that you have complete control over. You can figure out what feels good to you, or what feels sore or numb, without feeling self-conscious or pressure to “perform” or to keep going if you don’t want to. Once you feel comfortable exploring your body, you can show your partner/s what feels good and works best.

Seek assistance – Ask your health care team how to manage any sexual changes. Your doctor can also refer you to a sexual health physician, sex  therapist or psychosexual counsellor.

Coping with treatment and recovery may affect your relationship with sexual partners. Your established roles may change, they may worry about hurting you, or you might feel too tired for intimacy.

Research suggests that communicating during treatment can help partners work through any issues. If you find that the changes after cancer treatment are getting in the way of a fulfilling sexual life, ask your GP or cancer specialists for a referral to a counsellor, sexual health physician or sex therapist.

Adolescence and the young adult years are a time for exploring your sexuality and identity, including your sexual orientation and gender. This process can be more complex if you are diagnosed with cancer. If you’ve recently started exploring your identity, needing to have treatment for cancer can interrupt this.

Feeling isolated – If you already feel different or isolated from people your own age because of your sexual orientation, gender or intersex variation, cancer can make you feel even more lonely.

Worrying about disclosure – Getting diagnosed and treated for cancer means accessing many health services. It can be challenging to talk about your sexual orientation, gender or intersex variation with others when you are still working it out yourself or have only recently come out. Some young people hide their identity from health professionals, because they fear being judged, discriminated against or outed to family.

Get in touch with Canteen. This organisation offers counselling in person, via phone, email or direct message (DM). Canteen also runs online forums and camps. If you’re feeling anxious or depressed, call QLife on 1800 184 527.

If you’re single, you may feel nervous about hook-ups or starting a new relationship during or after treatment. You may wonder if you have to tell a new person about your cancer diagnosis and when to do this. This could depend on whether the relationship is casual, or you see it becoming more long term.

It may help to take new relationships slowly and share personal information when you feel you can trust the person. You can discuss how to adapt your sexual activity, try more activities without penetration, or change the length and intensity of your sexual encounters. You can also talk to a psychosexual or relationship therapist for more suggestions.

You might decide that you want to focus on your health and wellbeing or that you don’t have the energy for hook-ups or a new relationship.

Tips for hooking up

• Set boundaries via messages before meeting.
• Consider adding something about your cancer journey on your dating profile.
• Share details of your diagnosis and side effects when you feel ready. You don’t have to reveal everything in one go. You can disclose the details over several conversations. It can be in person or via text.
• Practise what you want to say and how you say it, so it feels more natural.
• Talk to a psychosexual or relationship therapist for strategies and support.