Living with Cancer-Related Sexuality Changes

As cancer survival rates increase, more attention is being paid to quality-of-life issues such as sexuality.   Initially you may be concerned about lifestyle changes or limitations from cancer and do not focus on sexuality issues until you are resuming your life.  Treatments and/or the disease itself can cause changes in sexuality, but health care providers rarely ask about sexuality issues. This causes you to think you are the only one with sexuality issues.

What may surprise many clinicians is their patients’ continued interest in sexual issues, given their age, illness or disability.  Unlike other side effects from the disease or its treatment, sexuality issues do not resolve after years of disease-free survival.  But it is not easy to talk about despite living in a culture that is saturated with overtly sexual images, graphic lyrics, and explicit advertising.


Sexuality is a broad term including social, emotional, and physical components. It is not just genitals or gender, but includes body image, love of self and others, relating to others, and pleasure.  It is genetically endowed (whether a person has XX or XY chromosomes), pheno-typically embodied (how masculine or feminine a person is), hormonally nurtured, is not age related, but is matured by experience and can’t be bought sold or destroyed despite what is done to a person.  Sexuality includes affection, sexual orientation, sexual activity, eroticism, reproduction, intimacy, gender roles, and encompasses feelings of trust.   Sexuality is limited only by imagination and physical challenges.

Expressions of sexuality include style of dress, body art, values and attitudes as well as hugging, touching, kissing, acting out scenarios/fantasies, sex toys, masturbation, sexual intercourse, oral-genital stimulation,  either alone or with others.  Sexual behaviors may involve oral, vaginal, and/or anal penetration.  Sexual behaviors are influenced by

  • Religious beliefs
  • Age
  • Education
  • Level of comfort with one’s body and physical functioning
  • Experiences of sexual abuse and trauma
  • Your partner’s wishes
  • Comfort level with your own sexual orientation & gender identity.

Sexuality includes four phases: sexual desire or libido which is your interest in sexual activities; sexual arousal is the ability of the penis to engorge with blood and become hard enough to use and the vagina to lubricate; orgasm is the height of sexual pleasure and the resolution phase when the genitals return to their normal, non-excited state.  Sexual dysfunction is when any ONE of these phases doesn’t work properly.  It should be remembered that sexual dysfunction is not an all or nothing phenomena, but occurs on a continuum – in terms of frequency and severity.


Treatment decisions made at the time of cancer diagnosis impact your interpersonal relationships, sexuality, and reproductive capacity. What are possible causes of sexual dysfunction in a person with cancer?  Most often they are treatment-related due to the changes in physiologic, psychological, and social dimensions of sexuality and disruption in one or more phases of the sexual response cycle.


Fatigue can be the result of any cancer treatment: chemotherapy, surgery, or radiation therapy.  Often you don’t have the energy to think about sex, much less engage in sexual activities.   Scheduling sexual activities is a way to get around this.  If you have energy in the morning, then have sex then.

Gastrointestinal side effects such as nausea, vomiting, or diarrhea can diminish your pleasure in sexual activity or take away your desire.  Take medication to decrease these symptoms before engaging in sexual activity.

Alopecia or hair loss affects how you feel about your body.  It is often traumatic for women when their hair falls out.  Your body certainly looks different without any hair anywhere and you might feel uncomfortable around your partner until you get used to the way it looks.  Wearing scarves, hats or wigs can help you feel more comfortable.

Scars from surgery also contribute to how you feel about your body as well as weight gain or weight loss.  Finding sexy camisoles or teddies can help you feel more comfortable with your body changes.  Partners report being happy their partners are alive and that scars don’t bother them.

Pain can distract you from all activities, not just sex.  It is important to make sure and treat your pain before engaging in sexual activities.  If sexual activities increase pain because of vaginal dryness, it is important to use water soluble lubricants to help with this. If a woman has severe vaginal dryness and pain and itching, she may need to use a water-soluble vaginal moisturizer several times a week to increase vaginal comfort.

Low libido can be the result of any cancer treatment and can be treated with testosterone if a man does not have prostate cancer.  You may find it helpful to read or watch erotica to improve libido.  Often women with low libido have a hard time engaging in sexual activities.  Increasing affection (hugging, touching and kissing) can arouse a woman, which helps her become interested in sexual activities.  If a woman has had radiation therapy to her vaginal area, she may have scarring in that area and need to use a vaginal dilator with lubricants to be able to engage in penile vaginal intercourse.

Erectile dysfunction can be permanent or temporary depending on the cancer treatment.  Men with this can ask their health care provider for oral medication for this or can get a penile vacuum erection device, learn to use penile injections or get a penile implant depending on their preference.  What works for one man, might not work for another.

Orgasms may change after cancer: they may be less forceful, take longer, or not happen at all.  Changing positions can be helpful as can the use of erotic devices.  Depending on their treatment, some men may have “dry” orgasms or retrograde ejaculations where the seminal fluid goes into the bladder and then out of the body with urination. They continue to experience pleasure with orgasm, but it is different.

Insomnia is a problem that you may have experienced at various times in your life, but it is worse since your cancer diagnosis.  Sleeping restores your energy and is a time for the body to heal.  You will not be very interested in sexual activities if you can’t sleep.  It is important to get help for this so you have energy to enjoy your life.

Depression can happen at any time in your life, but cancer survivors have a 20-40% rate of depression.  When you are depressed, you are not interested in any activity including sex.  It is important to have your depression treated so that you enjoy your life.

Anxiety can keep you from focusing on sexual activities and enjoying them.  It can also interfere with your sleep and your concentration.  It is important to have this treated.

Fertility loss can be devastating for someone who has undergone cancer treatment.  Sometimes you have the luxury of sperm-banking or egg-banking, but often this is not an option because the cancer needs immediate treatment.  Couples need counseling to help them deal with this loss and to find out other options for having children.  If you are single, you may feel that no one will be interested in you if you are sterile, but you would be surprised at how little this affects your dating prospects.

One of the most important factors in adjusting sexually after surviving cancer is a woman’s feelings about sexuality before cancer.  Often you have adopted a pattern of sexual behavior before your diagnosis and attempt to return to it after treatment.  If you experience discomfort or failure to function as before, do not stop trying.   During the time of treatment, the cancer experience encourages a more intimate and intense interpersonal relationship which gives you the opportunity to build on as your relationship grows.  One of the most important factors in improving your sexual relationship is talking about it.  Ask your health care practitioner about sexual concerns; they can address them or refer you to someone who can. You do not have to suffer in silence…there is help available.

Category: Experts Speak

Tags: affection, alopecia, Breast Cancer, cancer survival, caregiver support group, Caregivers, erectile dysfunction, fatigue, fertility loss, Fertility-Sexuality, insomnia, libido, reproduction, sexual activity, sexual dysfunction, sexual orientation, sexuality