Sex life and pelvic radiotherapy

Your cancer doctor or specialist nurse may advise you to wait for a few weeks to allow side effects to settle.

Pelvic radiotherapy may affect your fertility. But, if you could become pregnant or father a child, it is important to use effective contraception for sometime after having pelvic radiotherapy. This is because the effects of radiation may damage a baby conceived during this time. Your specialist doctor can tell you how long you will need to use contraception for. Your doctor or nurse can arrange support to help you cope with fertility issues.

Some men have erection difficulties after treatment but, there are effective treatments for this. Pelvic radiotherapy can also cause changes to ejaculation. Men who’ve had radioactive seeds placed in their prostate should use condoms for a few weeks to protect their partner.

Women may have vaginal changes. These can make sex uncomfortable. There are creams, lubricants and other treatments which can help.

If you are having sexual difficulties that don’t improve talk to your cancer doctor or specialist nurse. They are used to dealing with intimate problems.

Having sex during treatment

You may be advised to wait a few weeks after radiotherapy before having sex. This is to allow any inflammation and side effects to settle. Ask your doctor or nurse for advice on this, as it can vary.

You may find that you don’t feel like having sex for a while. This may be because of ongoing side effects, anxiety, or how you feel about yourself sexually. You, and your partner if you have one, may need a period of time to adjust.

It’s not unusual to feel nervous about having sex for the first time after pelvic radiotherapy, but it’s perfectly safe for both you and your partner. If you have sexual difficulties that don’t improve, it’s important to let your cancer specialist and specialist nurse know.

It can be embarrassing 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 or GP can also refer you to a counsellor or sex therapist.


Effects on sex life in men

Protecting your partner

If you’ve had brachytherapy with radioactive seeds placed in the prostate gland it’s advisable to use condoms during sex for the first few weeks after treatment. This is in case a radioactive seed moves from the prostate into the semen. However, it’s very rare for this to happen.

Contraception

Sperm produced during and for some time after pelvic radiotherapy may be damaged. This could cause abnormalities in a child conceived soon after treatment.

To prevent this, your doctors will recommend that you use contraception during and for six months or more after treatment.

Difficulty having or maintaining an erection

Radiotherapy to the pelvic area can reduce your ability to have an erection (erectile dysfunction or ED). If you are affected, you may find your erections aren’t as strong as they were before the treatment. You may get an erection but then lose it, or you may be unable to have an erection at all.

Although you may feel embarrassed, you should talk to your doctor if you’re having problems. There are effective treatments for ED caused by pelvic radiotherapy.

Remember that sex is not only about penetration – there are other ways to have intimacy with your partner, such as oral sex, mutual masturbation or using sex toys. Some men try to avoid intimate moments with their partner because they fear that they will ‘not be able to perform’. However, most of the time the partner is satisfied with a hug and kiss.

Changes in ejaculation

Some men may have a sharp pain when they ejaculate. This is because radiotherapy can irritate the tube that runs through the penis from the bladder (the urethra). The pain should get better a few weeks after treatment finishes.

After pelvic radiotherapy, the amount of semen you produce is reduced. This means that, when you ejaculate, you may notice that only a small amount of fluid comes out. Some men don’t produce any semen at all, and this is known as a dry ejaculation. Although you will still be able to orgasm (climax), some men find the sensation feels different from before.


Effects on sex life in women

Contraception

Some hospitals may advise that you can still have penetrative sex during radiotherapy. Pelvic radiotherapy will bring on the menopause, but your periods may not stop completely until after treatment is over. If you’re having sex during treatment, it’s very important to use effective contraception to prevent pregnancy until your periods stop completely. This is because radiation may cause damage to a baby conceived during or shortly after radiotherapy.

If you have problems with your bowels, such as loose stools or diarrhoea, you should use a barrier form of contraception instead of the contraceptive pill. This is because diarrhoea can affect the way that the contraceptive pill is absorbed.

You should always talk to your specialist nurse or doctor before you stop using contraception.

Effects on the vagina

Radiotherapy to the pelvis can make the vagina narrower, less stretchy and drier. This may make having sex uncomfortable.

It may also be more difficult for you to have internal examinations.

Narrowing of the vagina

Your specialist nurse may recommend that you use vaginal dilators to try to prevent the vagina from narrowing. Dilators are tampon-shaped, plastic rods of different sizes that you use with a lubricant. Using a vibrator or having regular penetrative sex may also help prevent vaginal narrowing.

You may be advised to gently start using the dilator shortly after your radiotherapy has finished.

Your specialist nurse or radiographer will advise you on how helpful a dilator may be for you and explain how to use them.

Vaginal dryness

This can make having sex uncomfortable, but there are lots of vaginal lubricants and creams that can help. You can buy them from chemists and some supermarkets. 

Creams that contain a small amount of the female hormone oestrogen can also be used to help with dryness and vaginal narrowing. These are available on prescription from your doctor. Hormone creams are not recommended if you have had womb (endometrial) cancer. Your specialist nurse can give you advice.

Moisturising creams and lubricants

There are creams you can use regularly to help with dryness, as well as lubricants you can use during sex to make it more comfortable and pleasurable.

Replens MD® is a cream that binds to the wall of the vagina and helps rehydrate cells and make the vagina less dry. Hyalofemme® helps to hydrate the cells giving a moisturising effect. Both creams are applied every two or three days.

Water-based lubricants including Senselle®, Astroglide®, Sylk®, Vielle® or Durex® Lube can be bought at chemists or some supermarkets. Organic lubricant products such as Yes® or V Gel® are available to buy online. Not all water-based products are the same and some can cause skin irritation. You may need to try a few different ones until you find one that suits you.

Oestrogen creams or pessaries

These contain very small amounts of oestrogen and can be used as a cream or as a tablet that’s inserted into the vagina (pessary). They help with dryness and may prevent the vaginal wall from becoming thin. They are not recommended in all situations, so always check with your cancer specialist first.

Back to Pelvic radiotherapy explained

About pelvic radiotherapy

Pelvic radiotherapy can be used to treat cancers of the bladder, rectum, anus, prostate, vulva, vagina, womb or cervix.

Side effects during treatment

You may have side effects during and shortly after your treatment. The healthcare team will help you to manage these.

Follow up

If side effects don’t go away, or you develop any new symptoms after treatment is over tell your cancer doctor.