Women, Sexual Health, and Cancer

Many women affected by cancer worry about their sexual health. Sexual health is an important part of life. Sexual health is more than sex. It is the physical, psychological, emotional, and social aspects of sex. How you see yourself, how your partner sees you, starting and maintaining sexual relationships, and the importance of sex to your quality of life are all part of your sexual health. Cancer affects each woman’s sexuality differently.

Common Sexual Health Concerns During and After Treatment

Cancer and its’ treatments can affect a woman’s sexual health. They can lead to pain, hormonal changes, and changes in how your body looks and works. Some concerns women have are:

• A loss of desire for sex and/or other intimate activities.
• Inability to have an orgasm.
• Sex that causes pain or discomfort.
• Feeling that sex is less enjoyable.
• Worry about body changes and how they look.

These worries are normal. You are not alone. Be sure to talk with your provider about your concerns.

How can I have safe sex during treatment?

Often, having safe and protected sex is fine during treatment but you should check with your provider. If you are not interested or feeling well enough to have sex, there are other ways to be intimate. Hugging, holding hands, and massages may feel good and be comforting. It is important to talk with your partner about how you are feeling and what you are comfortable with.

There are times when you should be extra careful or need to avoid sex. Some things to keep in mind:

• If you had surgery on your pelvic area (gynecologic cancers, colorectal and anal cancers), you may need time to heal before having sex that involves vaginal or rectal penetration (with penis, fingers, toys, vibrators, or dilators). Talk to your provider about your healing time.
• If you are being treated for oral cancer, use caution during oral sex.
• If your blood counts are low, you should not have sex. You are at risk for infection if your blood counts are low.
• If you have mouth sores (mucositis), don’t give oral sex.
• Do not have vaginal intercourse if you have open sores on the genitals or in the vagina.
• Do not have anal sex if you have sores in the rectal area, rectal bleeding, or tears in the rectal tissue.
• Chemotherapy can be found in saliva and vaginal secretions for 48-72 hours after treatment. During this time, do not do open-mouth kissing and use a condom or dental dam for oral sex or intercourse (vaginal or anal) so that your partner is not exposed. (This includes IV and oral chemotherapy).
• You should always use a safe method of birth control to avoid getting pregnant during cancer treatment. Some chemotherapies can cause issues for an unborn child and you should not get pregnant while taking them. Medications often have a certain amount of time that you should wait before trying to get pregnant. You can learn more about your treatments in our medication sheets or talk to your pharmacist.

Tips for Making Sex More Comfortable

• You have to talk to your partner. Tell them if you are too tired or uncomfortable for intercourse. Use “I” statements. For example, “I love you and want to feel close to you. I’d feel better if we cuddle tonight.”
• Kissing, touching, cuddling, or massage can be intimate and help us feel close to our partner.
• Ready to try having sex again? 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. Take your time, enjoy each other, and most of all, talk to each other.
• Vaginal dryness can be an issue. Lubricants, moisturizers, and estrogen supplements can be helpful. Your provider may also suggest you use a vaginal dilator to help maintain the elasticity of your vagina.
• Cancer surgery may make some positions painful. Get creative. Try different positions to find what is best for you and your partner. For example, if lying on your back during penetration is painful, lying on your sides may be more comfortable.
• Your provider may refer you for pelvic floor physical therapy. This can help rehab the muscles in your pelvis and may make sex more comfortable after treatment.
• Changes to your appearance can be very hard to cope with. It is okay to set boundaries about where and when touching is ok, wearing clothing during sex, or covering up certain parts. What matters is that you feel comfortable in your own skin. It is also okay to say “no” or “stop” at any time. Talk with your partner before sex about how your body has changed and how this makes you feel.

Support

Sexual health can be hard to talk about. 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.

Many cancer centers have sexual health programs or clinics. Talk with your healthcare team about coping with changes in your body image and sexual health. You may also want to work with a therapist who has training in sex, intimacy, and cancer. Your provider can refer you to the help you need.

Resources & Further Reading

• The American Cancer Society's Sex and the Adult Female with Cancer and Managing Female Sexual Problems Related to Cancer
• NCI's Self-image and Sexuality, and "Facing Forward: Life After Cancer" (Includes good information on communicating wth your partner).
• Living beyond breast cancer (lbbc.org) – Sex and Intimacy after a Breast Cancer Diagnosis.
• Female Sexual Health After Cancer, Livestrong.org.
• There are currently several programs to help manage the appearance-related side effects of cancer treatment.
  • Sephora: Classes for Confidence
  • Walgreens: Feel More Like You