Sexual Health and Cancer Treatment: Women

Aprobado por la Junta Editorial de Cancer.Net, 09/2019

Cancer treatment can cause physical and emotional changes, including to your sex life. Doctors call these types of changes "sexual side effects." They include changes in your interest in sex and your ability to take part in sexual activity.

Sexual side effects can be physical, mental, or emotional. Cancer treatment can affect your mood, body image, energy level, and sense of well-being. And all of these can affect your sex life.

Talk openly with your health care team about your sexual health. Do this before starting treatment, if possible. They can evaluate symptoms and address your concerns before, during, and after treatment. Sexual side effects may also be a factor in choosing a treatment plan. If you are very concerned, you might want to get a second opinion.

Symptoms and side effects

Sexual problems may develop during, right after, or years after treatment. These may go away after awhile or be permanent. Every woman is different. Tell your health care team about your symptoms, including any new ones or changes in symptoms.

Potential sexual side effects include:

  • Decrease or loss of sexual desire

  • Inability to achieve or maintain sexual arousal

  • Decrease or loss of lubrication

  • Difficulty or inability to achieve orgasm

  • Pain during sex

  • Pain or numbness of the genitals

Treatments that can cause sexual problems

Some treatments are more likely than others to affect your sex life. The following treatments may cause sexual problems.

Radiation therapy. Side effects of radiation therapy often lower sexual desire. These may include:

  • Fatigue

  • Nausea

  • Vomiting

  • Diarrhea

Meanwhile, radiation therapy to the pelvis can cause vaginal dryness, soreness, and pain. These side effects may last a few weeks after treatment. Scar tissue can also form, narrowing or shortening the vagina. Such changes can make penetrative sexual activities painful or even impossible.

Menstrual periods may suddenly stop for women who have not been through menopause. This is called early-onset menopause. It may include the following sexual symptoms, which can contribute to pain during sex:

  • A lower sex drive

  • Vaginal dryness

  • Vulvar and vaginal itching

  • Vulvar and vaginal irritation

Chemotherapy. Side effects from chemotherapy can affect sexual desire and self-image. These may include:

  • Weight gain or loss

  • Nausea

  • Vomiting

  • Diarrhea

Types of chemotherapy that are injected into the pelvis or bladder can cause pelvic irritation. This can make sex painful until the body heals. Also, younger women have a risk of a sudden loss of ovarian function. This side effect may be temporary or permanent.

Ask your doctor about possible sexual side effects of any anti-cancer drugs, including targeted therapy or immunotherapy, that is part of your treatment plan.

Other drugs. Medications for side effects of treatment may decrease interest in sexual activity. These include certain painkillers or antidepressants.

Gynecologic surgery. Surgery on a woman's reproductive organs may affect the length of the vagina, nerves, muscles, and blood supply. Surgery may also cause narrowing of the vagina or chronic pelvic pain. These changes can impact sexual function. Women who have not been through menopause experience early-onset menopause when both ovaries are removed.

Colorectal or bladder surgery. Sometimes, surgery removes part or all of the colon, rectum, or bladder. This may require a colostomy or urostomy. These can affect your confidence and body image. A colostomy is a surgical opening for waste to leave the body. A urostomy is a surgical opening for urine to leave the body. You wear a bag with the waste in it, and this might make you avoid showing your body to a partner.

Breast cancer surgery. Losing part or all of a breast can affect body image. Also, surgery can change or eliminate sensation (feeling) in the breast.

Hormonal or endocrine therapy. Anti-estrogen treatments may cause symptoms commonly seen with menopause. These include:

  • Hot flashes

  • Vaginal dryness

  • Pain during intercourse

  • Lowered sex drive

Emotional and sexual problems

Mental health plays a key role in sexual health. These cancer-related emotions and conditions can impact your sexual function:

  • Fear of recurrence, or return of the cancer

  • Feelings of powerlessness, sadness, or frustration

  • Negative feelings about body changes

  • Stress

  • Depression

  • Anxiety

  • Relationship conflict or lack of communication

Your partner may also experience some of these mental health challenges. Talk to each other about your feelings and concerns, including sexual health. Having these feelings without talking about them can get in the way of being intimate, both physically and emotionally.

Managing side effects

Relieving side effects affecting your sexual health is an important part of cancer care. This is called palliative care or supportive care. Your health care team can recommend ways to manage symptoms:

Vaginal moisturizers. These are non-hormonal, nonprescription products. They provide moisture to the vagina. This improves vaginal health and comfort during sexual activity.

Vaginal lubricants. These are water-, silicone-, or oil-based products. They reduce vaginal friction to increase comfort and sexual pleasure.

Pelvic floor physical therapy. This helps women with tight or tender pelvic floor muscles. Exercises promote muscle relaxation and strengthening. This can also reduce pain during sex.

Vaginal dilators. These devices stretch the vagina and reduce tightness. This may increase comfort for women who have pain during penetration. Vaginal dilators come in various diameters (widths). You can increase the dilator size as vaginal stretch improves. People often use these together with pelvic floor exercises. Vibrators can also be used as vaginal dilators and may improve blood flow.

Low-dose vaginal estrogen. A flexible ring, cream, or tablet delivers estrogen to the vagina. This can help restore vaginal health. Ask your health care team if these medications are right for you.

Intravaginal didehydroepiandrosterone (DHEA). This may treat vaginal dryness or pain without increasing estrogen levels. It may be a good option for women with an estrogen-sensitive cancer, such as some types of breast cancer.

Vaginal lidocaine. This goes at the vaginal opening just before sexual activity. It may decrease pain and increase satisfaction.

Many times, these treatments are used in combination to improve sexual comfort and pleasure.

Ask your doctor about different sexual health treatments and the possible risks and side effects. Your health care team can also help with emotions that affect your sex life. Options include:

Related Resources

Your Sexual Health and Cancer: What to Know, What to Do

Moving Forward Video: Dating and Sexuality

How to Maintain Your Sexual Health During and After Lung Cancer

More Information

American Association of Sexuality Educators, Counselors and Therapists: Locate a Professional

LIVESTRONG: Female Sexual Health after Cancer

Section on Women’s Health-American Physical Therapy Association: Physical Therapist Locator

International Society for the Study of Women’s Sexual Health: Search a Provider