During and after receiving treatment for cancer, women of all ages, with early and advanced diseases, will have concerns and questions about sexuality and sexual activity. It is common for women with different types of cancer to struggle with their body image; have less desire for sexual intimacy and/or find that penetration during sexual activity has become painful. Even if your health care providers do not ask about this normal and important aspect of health, you should not hesitate to discuss your feelings or ask questions about the impact of cancer treatments on your sexual health. This article attempts to answer common questions that arise, but certainly does not address every question. As with any concern, talk with your health care providers about your particular situation.
What Concerns Could Arise?
Some women experience a loss of desire for sex, an inability to have an orgasm, experience pain during sex or just do not find sex pleasurable. Sexuality is an important factor in quality of life for many women. Know that these concerns are not uncommon and your healthcare team can provide guidance. Write down your questions and concerns so you don't forget to ask about them. If your provider cannot help, ask them to recommend someone who can.
Can I have sex during treatment?
There are a few factors that determine if sexual activity is safe during treatment.
- In general, sexual activity is fine during treatment as interest, energy and comfort levels allow. While women may not feel up to sexual intimacy after surgeries or during chemo and radiation; hugging, holding hands and massages may feel good and be comforting.
- If you had surgery involving the pelvic area (gynecologic cancers, colorectal and anal cancers), you may need to allow extra time for healing before having sex that involves vaginal or rectal penetration (with penis, fingers, toys, vibrators or dilators). If you are being treated for an oral cancer, use caution during oral sex.
- If you have a low white blood cell count or low platelet count (concern arises with platelets below 50,000), you will need to refrain from any sexual activity that involves vaginal or anal penetration. This is because there is an increased risk of infection or bleeding when your counts are low.
Tips for healthy and safe sexual activity:
- Be sure to use a reliable form of birth control to prevent pregnancy- even if you think your periods have stopped or your fertility has been affected.
- Chemotherapy can be excreted in vaginal secretions for 48-72 hours after a treatment. You should use a condom for oral sex or intercourse during this period to prevent your partner from being exposed to the chemotherapy. (This includes IV and oral chemotherapy).
- Think outside the box about sexual activity - it does not have to involve intercourse or oral sex. Use kissing, touching, caressing to satisfy each other.
- Keep communication open. Talk about what feels good and what doesn't; communicate with your partner when you are tired or uncomfortable.
- Cancer surgery may result in a particular position being painful. Try different positions to find what is best for you and your partner. For example, if lying on your back during penetration is painful, having both partners lying on their sides may be more comfortable.
- Talk with your healthcare team about coping with changes in your body image and sexual health. For some, talking with other women in a support group can help. While others may find more intensive help from a mental health provider, with expertise in working with women with cancer, useful.
- Some practical tips for body image concerns include exercise, maintaining a healthy weight, dressing in clothing that makes you feel attractive, wearing pretty undergarments or learning beauty techniques to manage side effects such as facial coloring, eyebrow loss, etc. (see resources below). For women with an ostomy, using an ostomy cover or camisole as camouflage can help with concerns about others noticing the bag (do an online search for ostomy covers).
Coping with Vaginal Changes During and After Cancer Treatment
Vaginal dryness, which can cause intercourse/penetration to be painful, is one of the most common problems during and after cancer treatment. Vaginal atrophy is an inflammation, shrinking and thinning of the vaginal tissue. These are most often caused by a lack of estrogen to the vaginal tissue. Surgery can lead to a shortened vagina. Radiation therapy that includes the vaginal area can cause fibrosis (scarring).
There are a few steps that can help alleviate the discomfort caused by vaginal changes:
- Use a vaginal lubricant during sexual activity (such as K-Y Jelly, Astroglide). There are many varieties or lubricants available; some contain fragrances, flavors or herbal ingredients. These can be irritating to some women.
- Avoid Vaseline or skin lotion as a lubricant. These can damage condoms and may raise the risk of yeast infection.
- Apply the lubricant to your vaginal area and your partner's penis, fingers or any sex toys you may be using for penetration.
- Use a vaginal moisturizer, such as Replens or K-Y SILK-E. These should be applied 2-3 times a week, regardless of sexual activity. These are estrogen free and work to help the vaginal tissue regain its natural moisture. They can also be used in conjunction with lubricants.
- For some women, vaginal estrogens may be effective. These come in several forms, including a cream (typically used daily for 3 weeks, then 2x a week), tablet (inserted 2x a week), and a ring that excretes estrogen slowly over a 3-month period. Most of the estrogen is absorbed locally, with only a small amount entering the bloodstream. Discuss this option with your oncology team, as some women with a history of a hormonally based tumor are advised to avoid these products.
- After radiation therapy, using dilators helps to keep the vagina open and decreases scarring, making intercourse/penetration as well as vaginal exams more comfortable. Learn more about dilator use after radiation therapy.
How to Get Started
You've had a period of time without sex and now feel ready to rekindle your sex life, but how do you get started? Set the mood- what sparked romance for you and your partner before cancer? Music, a romantic meal or an evening out? Relax and don't pressure yourselves to have sex the first go at it. Take your time, enjoy each other and most of all, communicate.
Sexuality After Cancer
Sexuality encompasses much more than sex; it includes the physical, psychological, emotional and social aspects of sex. In the real world, this means how you see yourself, how does your partner view you, how do you date after cancer, how do you fulfill your need for sexual relationships after cancer and so much more.
How cancer affects your sexuality is different for every woman. Some find the support they need through their healthcare team, their partner, friends or fellow survivors. You may find the support you need to reconnect with your own sexuality through a support group or a close friend. There are a number of online groups that host discussion boards where you can "talk" about concerns with someone who has been there.
For those that find things more difficult, a mental health provider can help you cope with the physical and emotional trauma cancer brings and determine how to move forward, whether with a partner or looking for one. Look for a therapist with expertise in working with people with cancer and/or sexual and relationship issues.
Resources & Further Reading
Groups with discussion boards, chat rooms or email support lists: