Sex After Cancer

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Here are some key takeaways:

  • Talk to your doctor about how cancer treatment will affect your sex life before treatment begins. Your doctor may be able to help you navigate treatment options that can better preserve your sexual functioning.
  • Any type of cancer can affect your sex life, not just genitourinary cancers, though genitourinary cancers are more likely to directly affect your sex life.
  • When it comes to erections after cancer surgery, it can take up to two years to regain full sexual functioning.
  • During cancer treatment and afterward, continue to talk to your doctor about exploring treatment options. If one option doesn’t work, others might.

In the days and weeks following a cancer diagnosis, sex might not necessarily be the first thing on a person’s mind. Newly diagnosed patients might find themselves overwhelmed with information about their cancer and treatment options. There may be a great deal of fear and uncertainty about the future. Doctors may recommend treatment that can include surgery, radiation, chemotherapy, and hormone therapy, each of which can have a long-term impact on your health and life. If you are a cancer survivor, your doctor may address various quality of life concerns you may have as you heal and recover. Yet, during the course of treatment and after, there’s one subject that is often neglected.

Sex.

Cancer treatment can affect your sex life both during and after treatment. In fact, if continued sexual functioning is important to you, this factor could have an impact on the course of treatment you choose for certain types of cancers. Preserving sexual functioning can even impact aspects of your recovery protocol. Unfortunately, some patients only discuss their sex life with doctors after a course of treatment has been chosen and after treatment has already actively begun to impact their sex life. By this point, it may be too late to make treatment choices that can preserve sexual functioning. According to the Fred Hutchinson Cancer Research Center, some types of preventative measures to preserve sexual functioning need to happen when selecting types of treatment, or they need to be implemented during the surgical healing process.

More concerning is the fact that patients cannot count on their doctors to bring up sex when discussing the potential side effects of cancer treatment, and they can’t count on their oncologist to mention treatment protocols for cancer’s sexual side effects. According to the Journal of Oncology Practice, 46% of cancer survivors report sexual health issues, and 74% reported that they hadn’t received care for their sexual dysfunction following cancer treatment. These are alarming numbers given that there are 14.5 million cancer survivors.

What’s the key takeaway?

It is incredibly important to talk to your doctor about how cancer will affect your sex life before you begin treatment. Don’t expect your doctor to bring it up, even if your cancer could potentially have a direct effect on sexual functioning. Doctors may be embarrassed and patients may be embarrassed, but when it comes to taking preventative measures to protect your sexual functioning during treatment and getting the care you need after treatment, the conversation about sex is essential.

In this article, we’ll explore how cancer treatments can affect your sex life, and then we’ll explore some of the treatment options available. The good news is that there are many treatments available to help you address these concerns and many patients go on to enjoy satisfying sex lives after cancer.

How Cancer Treatment Can Affect Female Sexual Health

Cancer treatments like surgery, radiation, chemotherapy, and hormone therapy can affect female sexual health in many ways. Let’s take a closer look:

  • Surgery. Surgical treatments for cancer that can affect female sexual functioning include (but of course aren’t limited to) hysterectomy, radical cystectomy, abdominal perineal resection, vulvectomy, pelvic exenteration, lumpectomy, and mastectomy.
    • Hysterectomy. According to the American Cancer Society, a hysterectomy (the removal of the uterus, cervix, and sometimes parts of the vagina) can shorten the vagina and result in numbness in the genital area. It can also result in reduced lubrication. According to the Asian Pacific Journal of Cancer Prevention, a hysterectomy can result in short-term loss of orgasm, pain during sex, and anxiety or dissatisfaction. Long-term effects of hysterectomy can include lower levels of lubrication and lower libido.
    • Radical cystectomy is a surgical procedure where the bladder, uterus, ovaries, fallopian tubes, cervix, front wall of the vagina, and urethra are removed. The American Cancer Society notes that patients should speak to their doctor about whether the nerve bundles that run on either side of the vagina can be left intact during surgery. If it is possible to preserve these nerves, patients can increase their chances of being able to orgasm after surgery.
    • The abdominal perineal resection used to treat colon cancer, results in the removal of the colon and rectum, and sometimes requires that the ovaries, uterus, and rear of the vagina must be removed. The removal of the ovaries results in menopause, but abdominal perineal resection shouldn’t damage the nerves that cause orgasm. Another type of surgery that can impact sexual functioning is the vulvectomy (a surgery in which the vulva is removed). There are different types of vulvectomies performed, from partial to radical. Women may have difficulty reaching orgasm after a vulvectomy, and it can also result in numbness, scar tissue, narrowed entrance to the vagina, and changes in the appearance of the vagina.
    • Pelvic exenteration is an extensive procedure involving the removal of the uterus, ovaries, fallopian tubes, cervix, vagina, and in some cases, the bladder, urethra, and rectum; after this procedure, the vagina is usually rebuilt, but patients may experience difficulty reaching orgasm.
    • A lumpectomy or mastectomy to treat breast cancer shouldn’t affect sexual function, but some women may report sexual difficulties due to changed body image. Breast surgery can also result in loss of sensation in the breast, which can alter a woman’s sexual experience. Other surgeries for cancer can also affect body image, which can impact a woman’s sex life.
  • Radiation Therapy. According to the American Cancer Society, radiation, particularly in the pelvic region, can result in sexual dysfunction. Some of the effects of radiation may be temporary and may involve swelling and tenderness in the pelvic area and temporary damage to the vaginal wall. But, sometimes the damage caused by radiation can cause scarring, or the narrowing of the vagina, which can result in pain during sex. If the ovaries are exposed to radiation, they may stop working, which can cause infertility, or early menopause.
  • Chemotherapy & Hormone Therapy. Chemotherapy and hormone therapy can affect sexual desire according to the American Cancer Society. During treatment, chemotherapy treatment can lead to pain during sex. And some women may experience early menopause or infertility after chemotherapy. According to the Asia Pacific Journal of Cancer Prevention, chemotherapy can result in lower estrogen, progesterone, and testosterone levels in women, which can lead to premature menopause. Fatigue related to chemotherapy can also reduce sex drive during the course of treatment, and loss of hair can result in body image issues that can reduce interest in sex. Tamoxifen, a hormone therapy for cancer treatment has been associated with decreased arousal, loss of lubrication, and pain during sex.

This is a general overview of the different types of cancer treatments and how they can affect a woman’s sex life, but this overview doesn’t address the effect that each type of cancer might have on your sex life. Different types of treatments will have different effects on your sexual functioning. And women undergoing surgery for non-genitourinary cancer can also experience sexual difficulties, so it’s important to talk about sex, regardless of the type of cancer you are facing, and it is important to talk to your doctor about these possible side effects before treatment begins. The American Cancer Society notes that common sexual issues women struggle with following cancer treatment include:

  • Premature Menopause
  • Infertility
  • Vaginal Dryness or Atrophy
  • Difficulty Reaching Orgasm
  • Pain During Sex
  • Body Image Concerns

Fortunately, there are treatment options available for many of these concerns. Read on below to learn more.

Women issues after cancer

Managing Female Sexual Problems After Cancer

 Before we go into a discussion of potential treatments for female sexual dysfunction following cancer treatment, it is important to note that sexuality and sexual health is complex. Sexual health involves emotional and psychological components as well as physical components. According to the Asia Pacific Journal of Cancer Prevention, issues like religion, culture, and self-image can play a role in sexual difficulties. Illnesses like hypertension, diabetes, metabolic syndrome, and thyroid disorders can affect sexual health. Certain medications, like SSRIs and beta blockers can also impact sexual desire and functioning. When it comes to assessing female sexual health following cancer treatment, it is important for each patient to understand and take stock of her own personal baseline before treatment. In other words, you know yourself best. Take stock of how often you had sex or wanted sex before treatment.

Female sexual problems related to cancer treatment include premature menopause, infertility, vaginal dryness or atrophy, difficulty reaching orgasm, pain during sex, and body image concerns. What are some of the treatments available to help with these issues? Let’s take a look.

  • Early Menopause or “Chemopause.” Removal of the ovaries or a hysterectomy can result in menopause. Radiation therapy, hormone therapy, and chemotherapy can also sometimes lead to “ovarian failure” or early menopause. Menopause or ovarian failure is also associated with infertility. If your ovaries are no longer releasing eggs or if your ovaries have been removed, you may no longer be able to become pregnant, or may need A.R.T. or I.V.F. treatment in order to become pregnant. Reduced sexual desire due to early menopause may be treated with hormone replacement therapy for some cancer patients. Unfortunately, according to Asian Pacific Journal of Cancer Prevention for many cancer patients, hormone-replacement therapies are not recommended because they can trigger cancer recurrence or regrowth. If your cancer is not sensitive to testosterone or estrogen, you may be prescribed hormone-replacement therapies. If your cancer is sensitive to hormone-replacement therapy, other options may exist. For example, estrogen rings, creams, or tablets applied directly to the vagina may be an alternative for some lower-risk patients. For women suffering from issues with lubrication, non-medicated lubricants can also be a solution. Women suffering from difficulties with arousal have the option of using an F.D.A. approved prescription device called the EROS-CVD, which enhances blood flow and sensation necessary for arousal and orgasm. For women who cannot take hormone replacement therapies, who are experiencing early menopause due to cancer treatment, a daily wellness supplement like ArginMax for women may be an option. According to the Journal of Sex & Marital Therapy, ArginMax was found to increase sexual desire in postmenopausal women. Women who were undergoing the menopausal transition reported improvements in lubrication and frequency of intercourse. The Female Sexual Functioning Index was used to gauge satisfaction in this study. This scientifically validated self-reporting measure has been used to assess desire, arousal, lubrication, orgasm, and pain in women suffering from female sexual arousal disorder. ArginMax contains L-arginine, which is believed to improve circulation, a factor which is important for arousal and orgasm. In female cancer patients treated with ArginMax, the Journal of Community and Supportive Oncology reported that breast and gynecological cancer survivors reported higher quality of life based on FACT-G scores, though ArginMax didn’t improve sexual desire, arousal, lubrication, or pain in this population. Sexual desire and sexual health is complex, so patients need to consider which targeted therapies best meet their needs. The Asia Pacific Journal of Cancer Prevention notes that mindfulness could have a positive impact on sexuality after cancer, further demonstrating that sexual health is complex and involves both physical and psychological components.
  • Vaginal Dryness and Atrophy. The American Cancer Society notes that hormone replacement therapy may be able to help alleviate vaginal dryness, but this therapy could be dangerous to some cancer survivors and patients who are sensitive to certain hormones. Lubricants without additives may be able to help, as can vaginal moisturizers. Vaginal estrogen gels, creams, or suppositories can also help, but again, these may not be options for all cancer survivors. Non-hormonal therapies, like ArginMax for Women could have a benefit for these patients, particularly those experiencing dryness due to early menopause or “chemopause.”
  • Difficulty Reaching Orgasm. Sex involves physical and psychological aspects. Patients may be referred for counseling to address psychological components that may be affecting orgasm. The EROS-CVD, an F.D.A.-approved device may also be helpful in improving arousal.
  • Pain During Sex. Various options for treating pain during sex exist. The Asian Pacific Journal of Cancer Prevention notes that patients suffering from vaginal pain during sex due to shortening of the vagina due to surgery or scarring may benefit from using vaginal dilators. However, the use of dilators is often most beneficial during the healing process right after surgery. This is another reason why it is important to talk to your doctor about the impact of surgery and cancer on your sex life before any treatments begin. The Asian Pacific Journal of Cancer Prevention further notes that there is only one F.D.A.-approved medication to treat pain during sex, Premarin Vaginal Cream.

There are many treatments available to help women resume a healthy and enjoyable sex life after cancer. The key takeaways are this:

  • Talk to your doctor about how cancer treatment will affect your sex life, before treatment begins.
  • Any type of cancer could impact your sex life, not just genitourinary cancers.
  • Explore options available to preserve sexual functioning (and fertility), before treatment.
  • After cancer surgery or treatment, continue talking to your doctor about options available. Many post-operative and post-treatment options can help. If the first option you try fails, there may be alternatives available. Don’t give up.
How Cancer Treatment Can Affect Male Sexual Health

Cancer treatment can affect a man’s erection, ejaculation, sexual desire, sexual response, and infertility. Treatments like surgery, radiation, hormone therapies, and chemotherapy can affect a man’s sexual health in a variety of ways. Let’s take a closer look:

  • How Cancer Treatment Can Affect Your Erection. Certain surgeries can affect a man’s ability to have and sustain an erection. These surgeries include radical prostatectomy (removal of the prostate and seminal vesicles), radical cystectomy (removal of the bladder, prostate, upper urethra, and seminal vesicles to treat bladder cancer), abdominoperineal resection (removal of the lower colon and rectum to treat colon cancer), total mesorectal excision (removal of the rectum and tissues that support it), and total pelvic exenteration (removal of the bladder, prostate, seminal vesicles, and rectum). The American Cancer Society notes that men should talk to their doctor about how these surgeries will affect their sex life, before treatment begins. Surgery can impact your erection if the nerves that help cause an erection are removed or injured during the surgical procedure. The American Cancer Society describes these nerves as fanning “out like cobweb around the prostate,” which means that they are easily damaged during certain types of surgery. Men should talk to their doctor about how their surgery may impact their erection because it may be possible for their doctor to perform nerve-sparing surgery. When nerves on the left and right side of the prostate can be spared, some men are able to recover the ability to have an erection, though healing of the nerves can take up to two years. Other men retain the ability to have an erection, but they have weak erections, or may suffer from painful erections. Because it can take a while for the sensitive nerves to heal, penile rehabilitation after surgery  may be started soon after surgery. Medicines that help with erections can help to this end. Surgery isn’t the only cancer treatment that can impact your erection. If radiation therapy damages the nerves in the pelvis, this can also impact your ability to have an erection. Radiation can also damage or lead to hardening of the arteries in the pelvis, reducing blood flow, and also leading to erectile dysfunction. Some men have the option to treat prostate cancer with either radiation or surgery, but the American Cancer Society notes that the outcome for both is about the same, but the progression of erectile dysfunction can differ for each treatment. Hormone therapy can impact your erection because androgen deprivation therapy can reduce sexual desire and lead to erectile dysfunction. Some men who undergo hormone therapy may get their sexual desire back, but others do not. Erectile dysfunction drugs don’t work when the issue is the loss of sexual desire. Chemotherapy and other types of cancer treatment can also affect erections and sexual desire. Some types of chemotherapy can cause nerve damage, but research indicates that chemotherapy therapies should not damage the nerves responsible for erection. Men who undergo stem cell transplants and suffer graft-versus-host disease may also experience difficulties with erections.
  • How Cancer Can Affect Your Ability to Ejaculate. First, it is important to note that a man may still be able to experience pleasure and orgasm even if he is unable to ejaculate. The American Cancer Society notes that this is called a “dry ejaculation.” Various types of cancer treatments can affect your ability to ejaculate. Surgeries that remove the prostate and seminal vesicles can result in semen no longer being produced. Nerve damage from surgery can also damage a man’s ability to make semen. It is important to note that the nerves responsible for making semen are different than the nerves responsible for erection. A man may be unable to ejaculate, but may be able to have and maintain an erection and orgasm. Other surgeries can block the path that semen takes when leaving the prostate and seminal vesicles (sometimes resulting in retrograde ejaculation, which is neither painful nor dangerous). Men report different experiences with “dry ejaculation,” some noting stronger orgasms and others noting that their orgasms are weaker. Prostate surgery can sometimes result in urine leakage during ejaculation, but this is not dangerous nor harmful. Radiation therapies can sometimes result in lower amounts of semen being produced and result in temporary painful ejaculation.
  • How Cancer Treatment Can Result in Changes to Sexual Desire. It is normal while undergoing a life-changing illness to experience lower levels of sexual desire. Fatigue and pain from cancer treatment will generally result in lower levels of desire. Cancer treatment itself can sometimes also impact sexual desire. Men who suffer from pain during sex, may experience lower levels of sexual desire. Hormone therapies that reduce testosterone can reduce desire. Surgery to remove the testicles can also result in lower levels of desire.
  • Infertility. Certain types of chemotherapy can affect a man’s fertility. If you are interested in having children, it is important to speak to your doctor before cancer treatment begins. Some surgeries can also impact fertility.

This is an overview of the some of the ways that cancer treatment can impact a man’s sex life. It is possible, with some of these treatments, for doctors to take steps to preserve sexual functioning. This is why it is important to speak to your doctor about how cancer treatment will affect your sex life and fertility before treatment begins. Fortunately, there are a range of treatment options for men struggling with sexual dysfunction after or during cancer treatment. Let’s take a look.

Managing Male Sexual Problems After Cancer

There are a range of therapies available to treat sexual dysfunction in men following cancer treatment. Let’s take a closer look:

  • Treatments for Erectile Dysfunction. There are a range of treatments for erectile dysfunction available, including medication to promote erections and penile rehabilitation. According to the American Cancer Society, pills for erectile dysfunction work by increasing blood flow to the penis. The American Cancer Society further notes that men may need to be patient when taking pills for erectile dysfunction, because these pills may not work right away. For some men, it can take up to two years for injured nerves to heal. At this point erectile dysfunction medication may work better. Another option is the penile injection, which delivers medication directly to the penis. According to the American Cancer Society, penile injections are the most reliable form of ED treatment available. Another option is the use of urethral pellets. Vacuum devices can aid in moving blood into the penis, with blood being kept in the penis through the use of a band. Penile implants, or prosthesis are a final option if other options listed above do not work.
  • Treatments for Lack of Desire. Hormone therapy, or reduction in testosterone following cancer treatment can result in a reduction in sexual desire. Some men may be able to take testosterone replacement to get their hormones back to a normal level.
  • Pain. Medications to manage pain during sex might help men resume sexual activity.
  • Counseling. Cancer can change the way your body works, the strength of your erection, your ability to maintain an erection, and the way you ejaculate. It can affect your desire for sex. It can result in changes to your body and body image. Some men benefit from receiving counseling or treatment from a sex therapist to address concerns related to performance anxiety, body image issues, and sexual dysfunction. According to the European Journal of Cancer, while many sexual problems can be linked to nerve damage, blood vessel damage, and changed hormone levels, these physical issues don’t explain all problems. Depression, anxiety, relationship conflict, and self-esteem issues can also contribute to sexual dysfunction.

These are just some of the treatments available for men suffering from sexual dysfunction after cancer treatment. When it comes to sex after cancer and sex during cancer treatment, the good news is that there are many options available to help you maintain a healthy sex life.

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