Both women and men dealing with cancer may experience sexual side effects as changes and challenges psychologically and physically in relation to their sexuality.

Psychological reasons for changes with sexual feelings and routines may be related to depression, anxiety, changes in body images, reduced self-esteem, stress, vulnerability, a need for more sensual contact versus sex, negative self-perceptions about sexuality, and other factors. Additionally, physical sources of sexual changes may be effects of the disease and cancer treatments.

Psychological Factors

A sex therapist offers the following advice about sexuality for people affected by cancer from Cure magazine’s article Sexuality After Breast Cancer by Jeannine Walston. Her comments extend beyond women and breast cancer.

Ursula Ofman, PsyD, a sex therapist in New York City who works with cancer patients, believes women need to communicate sexual problems to their healthcare provider, other survivors, and especially their partner.

Medical institutions should offer “proactive attention to educate women about common side effects from treatments,” she says.

“Women are often reluctant to address sexual difficulties, and they need to talk about them. Women and their partners should discuss it outside of the bedroom with space for reflection and without pressure to act sexually,” she adds.

In Dr. Ofman’s clinical experience, the best predictor of sexual function after cancer is sexual function before cancer. Research also reflects this tendency. “Women who have a good sex life before cancer adjust better after,” she explains.

A major challenge to sexual functioning can be avoidance. “Getting sexually started again can be extremely difficult for women and men alike,” notes Dr. Ofman. “Women and their partners need to develop comfort to explore sexually without expectation. Many couples learn sexual pleasure comes from new activities and routines.”

Dr. Ofman encourages partners to be compassionate and gently inquisitive. “A supportive partner who is interested without placing demands helps women gain acceptance for feeling desirable and capable again.”

Physical Sexual Side Effects

The location, type, size, and stage of cancer, as well as its treatments, are major factors influencing physical side effects. They may be temporary or permanent, emerge during or immediately after cancer treatments, and develop as a late or delayed effect. The information organized by gender and select cancer treatments describes physical sexual side effects and is not comprehensive. People with cancer must ask their doctor, nurse, and/or other health providers about physical sexual side effects. Details about side effects need to be provided before making treatment decisions. This information also helps patients prepare for any known sexual effects and other medical resources for support.

Women

All women do not negotiate these side effects. But, research indicates that these are the most common ones.

• Challenges with achieving climax
• Diminished interest in or lack of desire for sex
• Physical pain with penetration
• Reduced size of the vagina
• Dryness of the vagina

Sexual Side Effects from Cancer Treatments

Surgery

The ways in which surgery impacts sex is strongly influenced by cancer’s location, type, size, and stage. Surgery that removes the uterus, fallopian tubes, or ovaries may cause infertility.

Radiation

Sexual side effects associated with radiation may happen in women receiving pelvic area treatments. Infertility may occur in women treated with radiation in the abdomen.

Chemotherapy

Chemotherapy may cause losses to the libido from chemotherapy, sexual desire from nausea, fatigue, hair loss, and weight loss or gain, estrogen production in the ovaries resulting in menopausal symptoms such as a thinning vagina and dryness linked to pain during penetration, and even infertility.

Along with surgery, radiation, and chemotherapy, other cancer treatments may have sexual side effects. Ask your doctor and use other resources with additional knowledge about sexual side effects from specific types of cancer and its treatments.

Men

All men do not negotiate these side effects. But, research indicates that these are the most common ones.

• Challenges with normal erections, climax, and orgasms
• Loss of libido
• Pain during sex

Sexual Side Effects from Cancer Treatments

Surgery

Some surgical procedures damage nerves in the pelvic area associated with the flow of blood to the penis. Surgeons work to avoid this. But, some men do experience challenges with erections and even infertility.

Radiation

Erectile dysfunction sometimes occurs due to radiation impacting the pelvis. The amount of radiation and extent to which the pelvic area is treated influences the level of erectile dysfunction. Radiation can create nerve damage in the pelvic area, block flow of blood, and/or decrease testosterone. Radiation can slow down or stop sperm cell production, which may cause infertility. The target area of radiation, a mild or high dose, type of shield applied, and other factors influence damage to sperm.

Chemotherapy

Chemotherapy may result in libido loss, blocks in erection, and reductions in testosterone. Fortunately, these challenges can return after final treatment. Chemotherapy may also cause infertility, especially when given in high doses, with multiple drugs, and alkylating agents.

Along with surgery, radiation, and chemotherapy, other cancer treatments may have sexual side effects. Ask your doctor and use other resources with additional knowledge about sexual side effects from specific types of cancer and its treatments.