Can I stay sexually active during cancer? Is cancer sexually transmitted? Can I still have sex after a hysterectomy? Is it safe to have sex during chemo? We’ve answered all these blush-inducing questions and more, to help you feel more confident in the tricky territory of cancer and sex.
To help you find the answers you need, here’s a list of what this article covers:
- Can people with cancer still have sex?
- My partner has cancer. What’s going to happen to our sex life?
- Can chemo be sexually transmitted?
- Can cancer be sexually transmitted?
- How could cancer affect my vagina?
- How do I have sex after prostate surgery?
So, let’s get started!
Yes! Cancer can have a big effect on your sex life, and things might change physically and emotionally. You or your partner might not have any interest in sex during cancer treatment, and that’s totally understandable (and should be respected by your partner!) But equally, a cancer diagnosis doesn’t have to mean you’re sentenced to a life of celibacy. Just like sex without cancer, it’s a case of figuring out your boundaries and limits, what you and your partner are comfortable with, and what feels good.
Firstly, just like sex before cancer, it’s different for everyone. The best thing you can do is communicate with your partner and find out what they actually feel and think, rather than trying to second guess the situation. But you’re right to expect some changes.
If your partner is undergoing chemotherapy or radiotherapy, there are a whole host of side effects that could have a diminishing effect on their sex drive. Nausea, fatigue, and pain are three very common symptoms, as well as depression, loss of confidence, and body image issues related to changes in their appearance. So it’s good to be aware that your partner’s sex drive might decrease or disappear altogether while they’re living with cancer.
However, try not to assume that as soon as cancer happens, sex and intimacy are completely off the table (unless your partner has made this clear). Intimacy can be a great expression of love and support, and losing that completely could be difficult for both partners.
The “sex spectrum”
One thing that can be helpful is to think about intimacy as a whole “spectrum” of actions. Intimacy can be everything from an affectionate squeeze of the elbow as you pass each other in the kitchen, to setting aside time to just cuddle and kiss on the sofa, to… well, we’ll leave the rest to your imagination.
When you’re living with cancer, there might be things on the “spectrum” that aren’t possible or don’t feel right – but that doesn’t mean you should abandon everything!
The key (as always) is communication. Talk to your partner and figure out when and how you can still connect intimately in your relationship.
Here’s an example. Let’s say you’ve had a mastectomy and you feel self-conscious about the scars you have from the procedure. Your scars make you feel self-conscious about sex, too, because you don’t want your partner to compare your body to how it used to look, or to feel like you are fragile because of your history with cancer.
One way to “accept and adjust” to these feelings might be to agree with your partner that they will avoid touching this area. You could also try wearing some clothing in bed that conceals your scars.
If you want to overcome the issue more comprehensively, you could work towards touching the scars yourself, and asking your partner to reassure you that they still find you (and your breasts) beautiful, scars and all. If you feel comfortable with it, you could even try some lingerie designed to comfortably conceal mastectomy scars (not every post-surgery bra is flesh-coloured and clinical-looking, and some are pretty sexy!).
Some or all of these solutions might help you to feel comfortable with intimacy at different times. Discovering what works in your relationship will require talking about it openly and honestly.
Another way of feeling closer and re-establishing intimacy with your partner during cancer is to do small, intimate acts for them, without expecting anything in return. Setting up a relaxing atmosphere with some scented candles, giving your partner a foot rub with some luxury lotion, or a shoulder rub with some massage oils that won’t irritate their skin – all of these things can help to build closeness and intimacy between partners who feel pushed apart by cancer.
Timing is everything! If you’re going through chemo, the medication stays in your bloodstream and bodily fluids for a certain amount of time. This time period is the “half-life” of the treatment and can vary widely between different drugs. For this reason, it’s advisable to use barrier contraception (condoms) during chemotherapy and for a few days after chemotherapy, to avoid giving your partner “second-hand chemo”.
Likewise, swapping any other bodily fluids should be avoided for a short period, too – so kissing during chemotherapy should be limited to a peck on the cheek rather than the full french experience for a few days. (This is also the reason your doctor may advise you to flush twice while you’re having chemo – the drugs are in all your bodily fluids…).
However, in periods between treatments it may be possible to french kiss, have sex without a condom, and generally get down to business however you see fit. Talking to your doctor about how to time your sexual activity is your best bet – they’ll know the half-life of the specific drug you’re taking and will be able to advise you on how you and your partner can have safe sex during chemo. It might feel awkward to discuss sex with your doctor, but they’re used to hearing all sorts of things, so nothing you ask can surprise them. Try to remember that sex and intimacy are a very normal part of everyday life, and there’s no shame in getting the information you need.
(One thing to note: whether you’re using condoms or not, you should always use some form of contraception for the whole duration of chemotherapy in order to prevent pregnancy. Research shows that chemotherapy drugs can effect foetal development and result in serious birth defects.)
Radiotherapy and sex
If you’re having external radiotherapy and want to have sex, there’s no risk to your partner and you can do anything that feels comfortable. But there is one form of internal radiotherapy that can be transmitted during sex, called “seed implantation therapy” or brachytherapy.
Usually used in early cases of prostate cancer, this treatment involves implanting tiny seeds of radioactive material into the prostate, where they remain and hopefully destroy the cancer. Though it is safe to have sex after this treatment, you should use a condom for a few months. This is in case a radioactive seed “shoots out” at an inopportune time. A condom will protect your partner from any undue exposure.
We don’t tend to think about cancer as a sexually transmitted disease, and technically it isn’t. But some forms of cancer can be triggered by the HPV virus, which is often passed on through sexual contact. For example, cervical cancer itself is not sexually transmitted, but one virus which causes it, can be. The main types of cancer that can be caused by HPV are located in areas that are involved in sexual contact: oral, anal, cervical, penile, and vaginal cancers.
There’s an increasing awareness of HPV recently due to the availability of the vaccine, but there’s also a lot of misinformation out there – so let’s get our facts straight:
- There are hundreds of different strains of HPV – and 80% of people will be infected with at least one at some point in their lives.
- Most of those strains are harmless, but around 12 “high-risk” types are known to cause cancer. So if you’ve been diagnosed with a strain of HPV, that doesn’t mean you’re automatically going to get cancer.
- The best way to know if you have any strains of HPV, harmless or high-risk, is to keep on top of your testing. For both men and women, this means attending regular sexual health screenings, and for women this also includes cervical smear tests.
- If you’re eligible for the HPV vaccine, it’s a great idea to get it, as it can protect against some of the more high-risk strains of HPV. However, the vaccine does not currently prevent all strains, so it’s still important to get tested for HPV regularly.
Sex after hysterectomy and other surgeries
A range of surgeries can affect the vagina, such as hysterectomy (removal of the uterus), oophectomy (removal of the ovaries), but also vagectomy (removal of some/all of the vagina, also known as colpectomy), and vulvectomy (removal of part of the vulva). These surgeries can result in scarring, soreness and loss of sensation. Having your ovaries removed also triggers the menopause, regardless of age, which can lead to decreased libido, vaginal dryness and changes in appearance that might affect your confidence.
Sex after hysterectomy or oophectomy might be scary to think about at first, but once you’ve recovered from surgery, you should be able to have sex if you want to. Doing exercises to strengthen your pelvic floor muscles, taking hormone treatments to help with menopausal symptoms, and talking to someone about your feelings after the operation are all things which can help you to enjoy sex again.
Vaginal dryness and cancer treatment
Usually, when you’re aroused, the vagina produces natural lubrication that helps sex to feel good. There are hundreds of reasons this can go wrong even if you’re not living with cancer. Dryness can be caused by infections or using the wrong soap. If you are living with cancer there are a few extra reasons that you may be experiencing dryness. As well as gynaecological surgeries and menopause, chemotherapy and other treatments can cause vaginal dryness. If your vagina feels drier than usual, or you have problems with lubrication during sex, a sensitive, non-irritant lubricant will be your new best friend. Sex without proper lubrication can be really uncomfortable and even painful, so please don’t suffer in silence!
Lubricants are a gel that you can apply before and during sex, and they can be used externally or inserted with a small applicator. Though they’re associated with sex, if you’re experiencing vaginal dryness it’s a good tip to apply an internal lubricant (with an applicator) on a more regular basis; and even daily. Think about it like moisturising your face, just in a more private area; you’d moisturise your face more than once a week if you were experiencing dry skin!
If the outside of your vaginal area (your vulva) is uncomfortably dry, there are also sensitive vulva moisturisers available which can help to soothe sore skin and increase sensation in that area.
Staying sexually active after prostate cancer might initially present a challenge. You or your partner might have a catheter fitted, have hormone treatments that reduce libido or have surgery that may cause incontinence or erectile dysfunction. The prospect of these outcomes might be quite scary and certainly have the potential to affect a person’s confidence or their relationships. But since erectile dysfunction and incontinence are actually very common problems, there are plenty of treatments and solutions designed to help you overcome them.
Tablets such as sildenafil (Viagra®), tadalafil, vardenafil and avanafil can help you get and maintain an erection. Contrary to popular belief, the idea of these tablets (called PDE5 tablets) is not to cause a spontaneous, inescapable erection – you will only get an erection if you are sexually aroused after taking the tablets. Similar therapies are also available as injections, creams, or even tablets inserted into the end of the penis.
If you continue to have problems with sex after prostate surgery, you might be suffering from low testosterone, which can be treated with hormone therapy. There is also the option of an implant, which is inserted into the penis and either keeps it fairly rigid (but flexible) at all times, or allows you to “inflate” the penis using a pump located in the scrotum.
Finally, if you or your partner are experiencing sexual problems after prostate surgery (or any cancer treatment), it’s very possible that there is a psychological element at play, too. Going through cancer can be a traumatic experience for everyone involved, and it’s a good idea to talk things through. Getting things out in the open might help you to work past a mental block, which might, in turn, have a positive effect on your libido.
Sex is a very personal thing, and it can be embarrassing or hard to talk about with your partner sometimes, never mind with your doctor! But it’s important to remember that even when you’re going through cancer, you’re still you – and you deserve to have the kind of closeness, intimacy, and sex that you want to have. Communication really is key, whether that’s talking to your partner in bed or to your doctor about your options.
If you have any tips on how to stay close with your partner or how to date whilst living with cancer, we’d love to hear them. You can share them with us and our whole community on our Facebook or Twitter pages, or by emailing us at email@example.com.