Sexuality, Intimacy and Cancer
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Sexuality, Intimacy and Cancer
Treatment side effects
The most common treatments for cancer are surgery, radiation therapy, chemotherapy and hormone therapy. Other treatments you may have include immunotherapy and targeted therapy. You may have just one treatment, or a combination of a few.
These treatments, as well as the cancer itself, can have temporary or permanent effects on your sexuality by changing:
- your feelings
- the body’s production of the hormones needed for sexual response
- the physical ability to give and receive sexual pleasure
- your body image, how you see yourself, and your level of self-esteem
- roles and relationships.
When you are first diagnosed with cancer, it’s completely natural to feel a range of emotions. These can include grief, anger, anxiety, sadness, fear, guilt, self-consciousness, shame and depression, which can in turn affect your sexuality.
It’s normal to focus mostly just on getting well. As treatment progresses, you may start to notice more effects on your sexuality. These will take some time to adjust to.
Surgery
Any cancer surgery – especially one that creates a scar or removes a body part, such as a breast or testicle – may affect your sense of self and body image. This can affect how you feel about your sexuality. Some surgery in particular may have specific impacts on your sex life:
Hysterectomy – This removes the uterus and sometimes the cervix. A hysterectomy may shorten the top part of the vagina, but doesn’t change your ability to have sex. The clitoris and lining of the vagina will remain sensitive, so you will usually be able to feel sexual pleasure and reach orgasm. Because there will be no contractions in the uterus during orgasm, sexual pleasure may be affected for some people.
Orchidectomy or orchiectomy – One or both testicles may be removed. If one testicle is removed, there should be no lasting effect on your sex life or fertility. Your remaining testicle should make enough testosterone and sperm to conceive a child. The scrotum’s appearance can be maintained with an artificial testicle.
Having both testicles removed (bilateral orchidectomy), which is rarely required, means you will no longer produce sperm. This causes permanent infertility. You can store sperm before the surgery to use later. Your body will also produce less testosterone, which may affect your sex drive, but this can be improved with testosterone replacement therapy.
Penectomy – Part or all of the penis may be removed to treat penile cancer. The part of the penis that remains may still get erect with arousal and may be long enough for penetration. It is sometimes possible to have a penis reconstructed after surgery, but this is still considered experimental and would require another major operation.
Prostatectomy – This removes the prostate. Side effects may include: erection problems, not ejaculating semen during climax (dry orgasm), semen going backwards into the bladder instead of forwards (retrograde ejaculation), leaking urine during sex, loss of pleasure, pain during orgasm and penile shortening.
Vagina – A small section of the vagina may be removed to treat vaginal cancer. There should be enough vaginal tissue left for penetration. Some
people need surgery that removes the whole vagina (vaginectomy). A vaginal reconstruction may be an option, but after surgery scar tissue can form, making intercourse painful and difficult.
Vulvectomy – Removing part or all of the vulva will change the look and feel of your genital area. This can affect how you enjoy sex and also your body image. If the clitoris has been removed, it may still be possible to have an orgasm by stimulating other sensitive areas (erogenous zones) of your body. It can take time for you and your partner to adjust to these changes.
Radiation therapy
Radiation therapy (also called radiotherapy) uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. It can be delivered externally or internally.
Side effects often relate to the body part treated, and may include:
- fatigue – your body uses a lot of energy dealing with the effects of radiation. Many people feel very tired during and after treatment
- skin effects – your skin may be very sensitive or painful to touch
- loss of appetite – you may lose your appetite and lose weight
- hair loss – you may lose some or all of the hair on your head, face or body. It usually grows back when radiation therapy has finished.
Radiation therapy to the pelvic area – Often used to treat cancer of the bladder, bowel, cervix, ovary, uterus, vulva, prostate or rectum. It’s important to talk to your doctor about ways to preserve your fertility, such as egg or sperm storage, before any treatment begins.
Radiation therapy may cause bowel issues or diarrhoea. This is usually temporary, but may be permanent. You may also lose your pubic hair.
The radiation oncologist will try to avoid the ovaries, especially if you haven’t been through menopause. If radiation affects the ovaries, they stop producing hormones. This brings on menopause symptoms, and your periods become irregular or stop. Periods may return after treatment, but infertility may be permanent.
“I didn’t really realise the radiation would affect my sexuality until it happened. I don’t think anyone can tell you what the pain, discomfort and exhaustion will do to you.” DONNA
Radiation therapy to the pelvic area can cause short-term inflammation of the vulva and vagina. Scar tissue from treatment can leave the vagina shorter and narrower (vaginal stenosis). These side effects make sexual penetration painful. A vaginal dilator may be useful after treatment. Using water-based lubricants and moisturisers can help, and in some cases, oestrogen-based creams will be suggested.
Erectile dysfunction is common after radiation therapy to the pelvis. It usually starts about 6–18 months after treatment and tends to worsen over time. You may ejaculate less semen, which may be slightly discoloured. Not having erections regularly can also lead to penile shortening.
Radiation therapy to the breast or chest – This can cause the skin in this area to become red and dry, or develop a sunburnt look. It usually returns to normal 4–6 weeks after treatment. Radiation therapy to the armpit may increase the risk of lymphoedema in the arm. Some people develop fluid in the breast/chest (seroma) that can last up to 12 months, or in some cases, up to five years. Changes often can’t be noticed under clothing. If you’re unhappy with how the breast/chest looks, you may be able to have an operation to reduce the size of your other breast.
Radiation therapy to the testicle – Radiation therapy can damage the blood vessels and nerves needed for erections, causing temporary or permanent erectile dysfunction. It may also inflame the urethra, so ejaculating may be painful for some weeks. Reduced sperm production is common, and may be temporary or permanent. Even if you’re not sure if you want children in the future, it’s worth talking to your doctor about storing sperm before treatment.
Protecting your partner during radiation therapy
You may be advised to use some form of barrier during specific sexual activities to reduce any risk to your partner from treatment and avoid pregnancy. Your doctor will advise how long you need to use this.
Internal radiation – Your doctor will usually advise you to avoid sexual contact or use barrier contraception (such as condoms) during treatment.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells. The drugs are called cytotoxics and they particularly affect fast-growing cells such as cancer cells. Other cells that grow quickly, such as the cells involved in hair growth, can also be damaged.
The side effects of chemotherapy vary depending on the individual and the type and dose of drugs given. Most side effects are short-term and
gradually improve once treatment stops, but sometimes chemotherapy causes long-term side effects. Common side effects include fatigue, nausea, vomiting, diarrhoea, constipation, hair loss and mouth ulcers – all of which may affect your self-esteem and desire to have sex.
Sexuality effects – Chemotherapy can also directly affect the hormones linked to libido, but desire for sex usually returns to normal after treatment ends. Some chemotherapy drugs can affect the nerves needed for the penis to become erect, but this is usually temporary.
Fertility changes – Having chemotherapy can lower the levels of hormones produced by the ovaries. This may cause irregular periods – though they often return to normal after treatment. Sometimes chemotherapy can bring on menopause. After menopause, you can’t fall pregnant naturally. If you think that you may want children one day, talk to your doctor about egg-storing options before you start any treatment. As chemotherapy can cause birth defects, use contraception during treatment to avoid pregnancy.
Chemotherapy drugs may lower the number of sperm produced and their ability to move (motility). This can cause temporary or permanent infertility. Talk to your doctor about any sperm preservation options before you start treatment.
Bloating – Chemotherapy for ovarian or bowel cancer can be given as liquid directly into the abdominal cavity (intraperitoneal chemotherapy). This can cause the belly to swell a little, which may affect your body image, but the liquid will drain away after a short time.
Genital effects – Thrush is a common side effect, especially when taking steroids or antibiotics to prevent infection. It can cause vaginal dryness, itching or burning and a whitish discharge. Chemotherapy for vulvar cancer can worsen any skin soreness from radiation therapy.
Chemotherapy suppresses the immune system, so viruses can thrive where they might otherwise be controlled. This means that genital warts or herpes flare-ups can occur and people who have never had an outbreak may suddenly have one. Talk to your doctor for more advice.
Hormone therapy
Hormones, which are naturally produced in the body, can cause some cancers to grow. The aim of hormone therapy (also called endocrine therapy or androgen deprivation therapy, ADT) is to lower the amount of hormones the tumour receives. Hormone therapy can be used for a short time or long term to help reduce the size of the tumour and slow down the spread of the cancer.
Anti-oestrogen drugs – Drugs such as tamoxifen, goserelin and aromatase inhibitors are used in hormone therapy to treat oestrogen-sensitive cancers. Oestrogen encourages some types of breast cancer to grow, so anti-oestrogen drugs can help to slow cancer growth or stop new breast cancers from forming.
Some people have no side effects from these anti-oestrogen drugs, while others experience symptoms similar to menopause, including vaginal dryness or discharge, pain during intercourse, hot flushes, weight gain, decrease in sex drive and arousal, night sweats, urinary problems and mood swings. You should have regular gynaecological check-ups during and after hormone therapy, as there is a small risk of developing cancer in the lining of the uterus (endometrial cancer) with some drugs.
Androgen deprivation therapy (ADT) – This is a type of hormone therapy that slows the production of testosterone and is used to treat prostate cancer. Side effects include hot flushes and night sweats, weight gain, fatigue and loss of muscle strength, effects on your memory and emotions, breast enlargement and tenderness, loss of bone density (osteoporosis), and increased risk of heart disease and diabetes. When your body is depleted of testosterone, you may find your sex drive decreases, which can also lead to difficulty getting an erection.
Hormone therapy for cancer can interact with hormones used by some trans and non-binary people as part of gender affirmation. It may also interact with maintenance hormones taken by intersex people. You may not be able to continue with these hormones during your cancer treatment. This can impact on your body image and sense of self. Talk to your doctor about the options and what they mean for you.
Immunotherapy and targeted therapy
Other drug treatments for cancer include immunotherapy and targeted therapy. Immunotherapy uses substances that encourage the body’s own natural defences (immune system) to fight cancer. Targeted therapy attacks specific features of cancer cells to stop the cancer growing and spreading.
Side effects for these treatments vary depending on the particular drug that is used, but can include swelling, weight gain, fatigue, pain, and depression, all of which may affect your libido or ability to have sex. Your doctor will explain if you need to use barrier protection, such as condoms, during sex if you are having these treatments.
Palliative treatment
Palliative treatment aims to improve someone’s quality of life by managing the symptoms of cancer, without trying to cure the disease. Many people think palliative treatment is only for at the end of life, but it can help at any stage of advanced cancer. As well as slowing the spread of cancer, palliative treatment can relieve pain and manage symptoms.
Many people say that sexuality and intimacy continue to be important to them even when cancer is advanced. It’s okay to talk to your health care team about the impact of any treatment on your sex life or your ability to be intimate.
If you have a partner, try to spend intimate or quality time together, rather than as a “patient” and “carer”, during palliative treatment. If you are in hospital or hospice care, ask your treatment team if it’s possible to use a double bed so you can cuddle and be together. Intimacy can provide comfort and maintain connection during this time. Even if sexual intercourse is no longer possible or desired, you may enjoy physical closeness through touching, massage or simply lying beside each other.
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This information is reviewed by
This information was last reviewed August 2022 by the following expert content reviewers: Dr Margaret McGrath, Head of Discipline: Occupational Therapy, Sydney School of Health Sciences, The University of Sydney, NSW; Yvette Adams, Consumer; Dr Kimberley Allison, Out with Cancer study, Western Sydney University, NSW; Andreea Ardeleanu, Mental Health Accredited Social Worker, Cancer Counselling Service, Canberra Health Service, ACT; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria; Dr Kerrie Clover, Senior Clinical Psychologist, Psycho-Oncology Service, Calvary Mater Newcastle, NSW; Maree Grier, Senior Clinical Psychologist, Royal Brisbane and Women’s Hospital, QLD; Mark Jenkin, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Dr Rosalie Power, Out with Cancer study, Western Sydney University, NSW; Dr Margaret Redelman OAM, Medical Practitioner and Clinical Psychosexual Therapist, Sydney, NSW; Kerry Santoro, Prostate Cancer Specialist Nurse Consultant, Southern Adelaide Local Health Network, SA; Simone Sheridan, Sexual Health Nurse Consultant, Sexual Health Services – Austin Health, Royal Talbot Rehabilitation Centre, VIC; Prof Jane Ussher, Chair, Women’s Heath Psychology and Chief Investigator, Out with Cancer study, Western Sydney University, NSW; Paula Watt, Clinical Psychologist, WOMEN Centre, WA.