Sex and the side effects of cancer treatment

Most people have some side effects during cancer treatment. Your cancer doctor or nurse will explain what to expect. Some side effects can change how you feel about your body and sex or how your body works during sex. These may include:

  • tiredness
  • feeling sick
  • pain
  • problems with erections
  • early menopause
  • vaginal dryness or changes.

Side effects often get better after treatment. But some people find they have sexual problems for a longer time after treatment ends. Talk to your healthcare team. They can often give advice or treatment to help.

There are some things that you can do yourself that may help if sex is difficult. Try spending time as a couple being close and intimate without having sex. Plan to spend time together on days when you feel better. If you want to have sex, choose a comfortable position and, if it helps, use a lubricant.

If you find any side effect difficult to cope with, try not to ignore it. You may feel embarrassed talking about it, but your healthcare team can help.

Side effects of cancer treatment

Most people have some side effects during cancer treatment. Your cancer doctor or nurse will explain what to expect. Some side effects can change:

  • how you feel about your body
  • how you feel about sex
  • how your body works during sex.

Side effects often get better after treatment. But some people find they have sexual problems for a longer time after treatment ends. If you find a side effect difficult to cope with, try not to ignore it. You may feel embarrassed talking about it, but your healthcare team can help. You may have some other questions about sex and side effects that we don’t cover here. You can always talk to your cancer doctor or nurse about these.


Tiredness

At times during and after treatment, you might have less energy, need more rest or get tired more easily. When you are tired, you may be less interested in sex or even in spending time with other people.

It might help to just spend time as a couple being close and intimate without having sex. Sometimes this leads on to sex. But it is also a way to build trust and confidence together. If you want to have sex, choose a comfortable, relaxed position. Don’t put pressure on yourself to make it last a long time or to orgasm (come).

We have more information about coping with tiredness.


Feeling sick

Some cancer treatments, such as chemotherapy and some types of radiotherapy, are more likely to cause sickness and nausea. Your doctor will give you drugs to prevent sickness. Tell your doctor or nurse if you still feel sick so they can help.

Your treatment may only make you feel sick at certain times. For example, chemotherapy is most likely to make you feel sick in the hours or days after you have it. If you can work out a pattern, try to spend time with your partner when you feel well.

We have more information about coping with sickness that you may find helpful.


Pain

Any type of pain can make you less interested in sex. You might not want to have sex because you feel uncomfortable. Or you might be scared that sex will be painful.

Your partner may not want to have sex if they are worried about hurting you. Try to find a position that feels comfortable for you both.

You can also ask your doctor or nurse for advice about painkillers and ways to reduce the pain.


Problems with erections

Some people find they have problems getting an erection during cancer treatment. This may be because you are feeling tired or sick. But sometimes cancer treatment causes other physical changes that make it difficult to get an erection.

Low testosterone

Some cancer treatments can affect male testosterone hormone levels. Hormones are chemicals in the body that help control how the body works. Low levels of testosterone can make it difficult to get an erection, and can sometimes make you less interested in having sex. It can also cause other problems such as thinning of the bones (osteoporosis), tiredness and a low mood.

If your testosterone levels don’t recover, you can take testosterone replacement therapy (TRT). You usually take this as injections or as a gel or patch on your skin. TRT can improve sex drive, erections, mood and tiredness. It also helps prevent long-term problems, such as thinning of the bones (osteoporosis).

Damage to the nerves and blood supply

Sometimes cancer, or cancer treatment to the pelvic area, can damage the nerves and blood supply to the penis and testicles. Your pelvic area is the area between your hips and below your belly button. Damage to this area can cause problems with getting an erection or how you ejaculate.

There are treatments that may help if you are having erection problems, but it can depend on exactly what is causing the problem. It is always best to ask someone from your healthcare team for expert advice.

We have more information for men about coping with sexual problems.


Early menopause

Some cancer treatments can affect female hormone levels. These help control periods, fertility (being able to get pregnant and give birth) and how your body works during sex.

These hormone levels change naturally during the menopause (usually in a woman’s mid-40s to mid-50s). When this happens, periods gradually stop and you can’t get pregnant anymore. Some women also have symptoms such as:

  • hot flushes and sweats
  • vaginal dryness
  • mood changes
  • poor concentration
  • less interest in sex.

If cancer treatment affects your hormone levels, you might have some of these symptoms. They may improve as your hormone levels recover after treatment.

If your hormone levels don’t recover, you will have an early menopause. This is also called premature ovarian insufficiency (POI). You won’t be able to get pregnant and you may continue to have menopausal symptoms.

Your doctor or nurse can talk to you about treatments that can help with these symptoms. They may also talk to you about treatment to replace the hormones that are at a low level. This also helps prevent long-term problems such as thinning of the bones (osteoporosis) or heart disease.

It can be hard coping with this when you are already coping with cancer. As well as the symptoms, you may be dealing with some difficult feelings about losing your fertility.

If you want to talk, you can call the Macmillan Support line on 0808 808 00 00. There are also organisations that give advice and support about early menopause. You can find details of these in our booklet Sex and relationships – support for young people affected by cancer.


Vaginal dryness

During sex, the vagina usually produces some natural fluid. Without this, sex can sometimes feel uncomfortable or painful. Vaginal dryness can happen during cancer treatment because you are tired, stressed or less interested in sex. It may also happen if your treatment affects your hormone levels.

If you want to have sex, a lubricant may help with dryness and make sex more comfortable. Lubricant is a gel or liquid that you use inside the vagina. Your GP can prescribe a lubricant or you can buy it from a pharmacy or other shop, or online.


Vaginal changes

Cancer of the cervix or vagina may be treated with surgery or radiotherapy. Sometimes these treatments cause scarring or nerve damage. They can also make the vagina narrower and less stretchy. If this happens, you might find sex less comfortable, or find it harder to orgasm (come).

There are treatments that may help if you are having sexual problems, but it can depend on what is causing the problem. It’s always best to ask someone from your healthcare team for advice.

We have more information for women about coping with sexual problems.