Patient Guide

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Sexuality Self Care

Chemotherapy, radiation, and surgery can cause physical and emotional changes that may affect your sexuality and intimate relationships. There’s much you and your health care team can do to lessen this common side effect of cancer treatment.

Many patients lose interest in sex during treatment or have concerns about body image. Men may have difficulty with erections. Women may experience pain during intercourse, vaginal dryness, or early menopause. Sex is a sensitive subject for many of us, but we encourage you to talk with your partner and your doctor about any concerns you have.

During this time, you’ll need to take extra precautions if you are sexually active when undergoing chemotherapy or radiation. Use birth control for as long as your doctor or nurse advises. Some medications have been linked to birth defects.

The goal is to improve your quality of life where sexuality is concerned. Learn more about:

Also see information on fertility and cancer and our resource list for stores, websites, books, and other sources of information and support.

Getting Help from Your Medical Team

If lack of desire is a problem, you are fearful about sexual activity, or experience any of the symptoms described below, we encourage you to talk with your doctor or nurse during clinic hours. They can evaluate if further medical testing is necessary and what treatments or counseling may help.

  • Women: Reduced interest in sex, vaginal dryness, discomfort, pain, bleeding after or during intercourse, vaginal discharge, signs of premature menopause, hot flashes, irritability, or headaches.  Depending on the issue, these options may help: water soluble lubricant, topical cream, vaginal dilator, medication, hormone replacement therapy (HRT), or a change in the dose or type of HRT you are using.
  • Men: Loss of sexual desire, erection problems, trouble reaching orgasm, premature ejaculation, or pain. Your doctor will work with you to determine the cause (physical, hormone changes, or anxiety) and get you started on a therapeutic plan, which may include hormone supplementation or medications to treat erectile dysfunction.

See more about how your health care team can help.

Finding New Ways to Feel Sexual Pleasure

Keeping an open mind can help your sex life during treatment.

  • Explore other ways to be intimate, such as holding hands, massaging, kissing, and sharing your fantasies.
  • Learn new ways to give and receive sexual pleasure. At times when intercourse is not possible, help each other reach orgasm through touching and stroking.
  • Try cuddling and being physically close; at times that can be pleasure enough.
  • Enjoy self-stimulation. No matter what kind of treatment you have had, the ability to feel pleasure from touching almost always remains.

Overcoming Fatigue

Unfortunately, fatigue can be a long lasting problem after treatment.

  • Try to plan sex for the part of the day when you feel the most energetic.
  • Remember that sexual pleasure doesn’t always need to involve penetration.
  • Talk to your partner about other ways you can give each other pleasure, like touching, cuddling, or kissing.

Preventing Pain During Intercourse

If you are experiencing pain during intercourse, talk to your doctor or nurse. Trying these options may also help:

  • Plan sexual activity for the time of day when you are feeling the best.
  • If you are taking pain medication, take it at an hour when it will be in full effect during sex.
  • Find a position for touching or intercourse that puts as little pressure as possible on the sensitive or painful areas of your body.
  • Empty your bladder before touching or intercourse. Feelings of fullness can interfere with feelings of sexual relaxation and pleasure.
  • Let your partner know if any kinds of touching cause pain. Show your partner ways to caress or positions that aren’t painful.

Tips for Women

  • Make sure you feel adequately aroused before you start intercourse. Take time to get in the mood with stroking, relaxation, or imagery. When you are aroused the vagina expands to its fullest length and width.
  • Use a water-soluble, bacteriostatic lubricating gel, such as K-Y Jelly or Astroglide on the external genitalia for pleasuring, and in the vagina and on your partner or sex toy for ease of penetration.
  • Learn to relax vaginal muscles during intercourse. Kegel exercises help you learn to relax these muscles. Ask for instruction if you haven’t learned these exercises before. Kegels also strengthen some of the muscles that control the flow of urine.

Making Sexual Activities Safer

Much sexual contact is safe, with certain precautions.

Kissing

Kissing is a wonderful way to maintain closeness with those you love and is usually okay. However, during chemotherapy and for a short time afterward, avoid open-mouth kissing where saliva is exchanged because your saliva may contain chemotherapy drugs. Ask your doctor or nurse how long you need to avoid open-mouth kissing, because it depends on what type of chemotherapy you receive.

Also, to reduce the risk of infection, avoid kissing anyone who has open mouth sores, cold sores, or symptoms of an infection such as a cold or the flu.

When to Restrict Sexual Activity

Sexual intercourse is restricted at times when:

  • Platelet counts are less than 50,000.
  • White blood counts are low (neutropenic- neutrophil count less than 500).

Sexual activity is restricted when:

  • Vaginal or rectal bleeding is present.
  • Your partner has a sexually transmitted infection (STI), which can be spread by sexual activity that involves the mouth, anus, vagina, or penis. Chlamydia and herpes are examples of STIs.

Condoms

Latex condoms should be used:

  • To avoid sharing bodily fluids (like saliva, semen, and vaginal secretions) that contain traces of chemotherapy drugs during certain treatments and for a period afterward. Talk to your doctor or nurse about how long you need to use a condom because the time recommendations depend on the drugs you receive. This applies to all kinds of sexual intercourse, including oral, anal, and vaginal sex.
  • If you and your partner are not in a mutually monogamous relationship, to avoid infections and STIs.
  • To prevent pregnancies. Some medications have been linked to birth defects.

Oral Sex

Oral sex is acceptable with certain precautions. To reduce the risk of infection, genitals should be cleansed before and after oral sex. Avoid contact with the rectal area.

 Oral sex should be avoided if:

  • Chemotherapy may be in body fluids. Talk to your doctor or nurse about how long this is a concern after treatment.
  • Your platelet or neutrophil counts are low.
  • There are open sores in the mouth or on the genitals.

Anal Sex

Wear condoms during anal sex.

Avoid anal sex if:

  • You or your partner’s platelet count is less than 50,000.
  • You or your partner is neutropenic (neutrophil count below 500).
  • There is bleeding, diarrhea, hemorrhoids, anal fissures, or tears.

Avoiding Infection

As in other areas of your life during cancer treatment, it’s very important to avoid infections.

  • Wash hands before and after sexual activity.
  • Urinate after sex. This rinses out bacteria that may cause infection in the urinary tract.
  • Avoid sexual contact with people who have infectious diseases (colds, flu, cold sores) or sexually transmitted infections.
  • If you and your partner are not mutually monogamous, use latex condoms or other barrier protection to minimize transmission of sexually transmitted infections (STI). This includes oral, anal, and vaginal sex.
  • If your partner has a suspected or known Sexually Transmitted Infection (STI), a condom may not be a sufficient barrier during and after treatment. That means no sexual activity is best until the STI is treated and resolved.
  • Wear condoms during anal sex to reduce the risk of infection during or after treatment.