Illustration portraying sexual frustration. A man and a woman are awkwardly sitting on a bed. Both are frowning. The woman has her arms crossed.

Cancer treatments – including surgery, radiation, chemotherapy, immunotherapy and more – can be incredibly challenging for both the body and mind. After treatment, many patients strive to return to their everyday lives, only to find that sex may look and feel different. This can be unexpected, emotional or even frustrating.

It’s important to know that you are not alone. According to the American Cancer Society, most cancer patients experience changes in libido or sexual function at some point during or after treatment. These changes may include:

  • Early symptoms of menopause
  • Erectile dysfunction
  • Weight fluctuations
  • Joint and nerve pain
  • Fatigue
  • Nausea
  • Bladder or bowel issues
  • Changes in appearance, such as hair loss or skin changes
  • Mood shifts

 

Talk About It

It’s completely normal to have questions about how cancer treatment may affect your sex life. Your cancer care team is there to help, but they may not address every concern unless you bring it up. Don’t hesitate to ask questions – before, during or after treatment – so you can stay informed.

You can also share information about your gender identity or sexual orientation with your team. If you are transgender, let them know about any procedures you’ve had or medications you’re taking as part of your transition. This information is confidential, and your care team is here to support you with respect and understanding.

Talking about how cancer has affected your sex life can also feel intimidating with a partner, whether they are new or long-term. A therapist specializing in sex therapy can guide you in addressing your concerns and improving communication with your partner, address changes in body image and self-esteem and explore new strategies for improving sexual desire and function.

If you are experiencing genital pain, ask about a referral to a pelvic floor physical therapist or physical rehabilitation and medicine physician (PM&R). They can help by teaching you exercises to manage discomfort as well as to better identify the causes of musculoskeletal pain and discomfort.

 

Tips for Women

If you’re experiencing sexual difficulties, consider these tips after consulting with your care team:

  • Combat vaginal dryness by using a water-based lubricant that is free from perfumes, coloring, spermicide, herbal additives and flavors.
  • Vaginal estrogen therapy may help if your vaginal walls have become thinner or less elastic. However, hormones may not be suitable for everyone, depending on the type of cancer- always check with your oncologist before starting hormonal therapy for sexual function.
  • Explore self-touch. Masturbation can help you identify sensitive or sore areas.
    • Consider:
      • Experimenting with different kinds of touch
      • Synchronizing vaginal muscle movements with your breathing
      • Changing leg and body positions during sex
      • Using a vibrator for additional stimulation
      • Imagining a sexual fantasy

If you’re taking pain medication, plan to take it about an hour before sex. Communicate with your partner about what feels good and what doesn’t.

For women who experience vaginal tightness, using a vaginal dilator may help. A pelvic floor physical therapist can help to identify which dilators may be most appropriate, and they can educate on how to use to meet your individual needs.

 

Tips for Men

According to the National Cancer Institute, men can address sexual challenges with the following tips, after consulting their care team:

  • Ask about nerve-sparing surgery if your treatment involves areas like the prostate, rectum or testicles, as this can reduce nerve damage.
  • Medications for erectile dysfunction may help but let your care team know about all medications you’re taking to avoid interactions.
  • Pelvic floor physical therapy can help to increase blood flow and strengthen pelvic muscles needed for erection and urinary continence.
  • Consider a penile prothesis, which can help achieve and maintain erections.

If you’ve had chemotherapy, be aware that some chemotherapy medications can linger in semen for weeks. Using a condom during this time may be necessary for your safety and your partner’s.

 

Navigating Life with a Urostomy, Colostomy or Ileostomy Bag

Yes, you can still enjoy intimacy while living with an ostomy bag. The following tips can help:

  • Ensure a proper fit for your pouch system.
  • Empty the bag and check the seal before sex to reduce the risk of leaks.

You might also try stylish ostomy covers designed with lace or other attractive patterns to feel more comfortable.

 

I Have Had a Tracheostomy or Laryngectomy. Won’t Communication Be Hard During Sex?

For individuals who’ve had a tracheostomy (surgery that removes the windpipe) or laryngectomy (surgery that removes the voice box), communication during intimacy may feel difficult at first. Ask your care team about:

  • Speech aids or electronic voice boxes
  • Learning esophageal speech techniques with a speech therapist
  • How to address symptoms of dry mouth if your salivary glands have been affected by cancer treatment

If you’re concerned about odors from your stoma, avoiding spicy or garlic-rich foods before sex can help. Light cologne or perfume may also make you feel more confident.

 

UofL Health is Here for You

For the past 40 years, UofL Health – Brown Cancer Center has been a leading face of world-renowned academic research and cancer care, helping patients face cancer with new hope throughout Kentuckiana and around the globe. Patients and their partners have access to sexual health psychotherapy from an AASECT Certified Sex Therapist through the SOAR ON® Loyd Family Wellness Program. Our Thrive Clinic uses a multidisciplinary approach to help individuals affected by cancer manage numerous effects of cancer, including sexual dysfunction.

Call 502-562-HOPE (4673) to learn more about the Brown Cancer Center and make an appointment.

 

Additional UofL Health Resources:

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Laura Jones, LCSW

Laura Jones, LCSW, joined UofL Health as a social worker in the Oncology department and found her passion working with patients and their families. She is now director of oncology screening, outreach and wellness. As a Louisville native, she works to improve the community where she grew up. With a master's in social work from University of Louisville, she began her career in legal advocacy, helping people impacted by domestic violence. This led her to UofL Health where she constantly strives to provide patient-centered care and improve access to care from cancer screening through survivorship.

All posts by Laura Jones, LCSW
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