Pelvic radiotherapy can cause changes that affect your sex life and the way you feel about yourself. Physical changes can make having sex difficult, reduce your sex drive (libido) and affect the way you feel about your body (your body image). Tiredness, a low mood or anxiety can also lower your sex drive.
Men may develop problems with getting or keeping an erection. This is more likely to happen if you’ve also had surgery to the pelvic area or chemotherapy treatment. Hormonal therapy for prostate cancer can also affect a man’s sex life.
For some people, these difficulties are temporary and gradually improve over time. But even permanent changes can be improved. Sexual difficulties can also be caused by other medical conditions and they’re common as people get older.
It can be difficult to talk about your sex life and any problems you’re having. But doctors and specialist nurses are used to dealing with intimate problems. They can often give you advice and support if things aren’t going well.
Your hospital doctor, specialist nurse or GP can also refer you to a counsellor or sex therapist. A sex therapist can help you adjust to physical changes and explore different ways of getting sexual satisfaction. If emotional problems are affecting your sex life, ask your doctor to refer you to a counsellor or doctor who specialises in emotional support.
Men may be referred to an erectile dysfunction (ED) service. This is a clinic for men who have problems getting and maintaining an erection. You may see doctors who specialize in the physical and psychological causes of ED, and ways to treat it. You will be asked about your general health and the problems you’ve been having. Some men may have blood tests and an examination of their genitals.
If you have a partner, talk to them about the effect that treatment is having on your sex life. It’s good to look at ways of overcoming any problems as a couple. You can talk to a sex therapist or counsellor in detail about the effects these changes are having on you and your partner.
There are organisations that can also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a list of qualified practitioners and the Sexual Advice Association offers a confidential helpline.
Low sex drive (libido)
If you have a partner and your sex drive is low, let them know how you feel. Explaining why you don’t feel like having sex can reassure them that the reason isn’t that you no longer find them attractive. You can show your partner how much you care in other sensual and physically affectionate ways. There are different reasons for low sex drive:
- Coping with cancer and its treatment can cause anxiety, depression and low self-esteem.
- Tiredness (fatigue) may carry on for months after treatment.
- Late bladder and bowel effects may lower your sex drive because they affect the way both men and women feel about themselves sexually.
- Occasionally, men who’ve had pelvic radiotherapy make less testosterone. This is important for sex drive.
If sexual difficulties don’t improve, it may be a good idea to ask for advice rather than letting things drift between you.
One way to improve things may be to treat any late effects of pelvic radiotherapy that are causing you problems. Men may be prescribed a testosterone replacement therapy. This isn’t always suitable for men who had prostate cancer.
For women, treatments for vaginal dryness will make sex more comfortable and improve your sex drive. And if you don’t have much energy, it can help to have sex in different, less energetic ways or to have quicker sexual contact.
Managing menopausal symptoms may help improve your sex drive. If you’ve had an early menopause, talk to your cancer doctor about taking hormone replacement therapy (HRT).
Occasionally, doctors may prescribe the hormone testosterone for women who are distressed by their low sex drive. We normally think of testosterone as a male hormone, but women also produce it in small amounts. Doctors usually only consider prescribing it if other treatments haven’t worked.