Sexual Health and Cancer Treatment: Women

Aprobado por la Junta Editorial de Cancer.Net, 12/2017

You may experience physical and emotional changes during and after treatment. These may affect your desire and ability to have sex. Even treatments not targeting reproductive organs may affect your:

  • Body image

  • Mood

  • Energy level

  • Sense of well-being

Talk openly with your health care team about sexuality. They can evaluate symptoms and address your concerns before, during, and after treatment.

Symptoms and side effects

Sexual problems may develop during, immediately after, or years after treatment. Tell your health care team about your symptoms, including new ones or changes in symptoms.

Potential sexual side effects:

  • Decrease or loss of sexual desire

  • Inability to achieve or maintain sexual arousal

  • Decrease or loss of vaginal and vulvar lubrication

  • Difficulty or inability to achieve orgasm

  • Pain during sex

  • Pain or numbness of the genitals

Treatments that affect sexual health

Directly or indirectly, these treatments often affect a woman’s sexual health:

Radiation therapy. Side effects of radiation therapy often decrease 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:

  • Reduced sex drive

  • Vaginal and vulvar dryness

  • Vaginal and vulvar itching

  • Vaginal and vulvar 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 irritation. This can make sex painful until the body heals.

Also, younger women risk sudden loss of ovarian function. This side effect may be temporary or permanent. 

Other drugs. Medications other than chemotherapy may decrease interest in sexual activity. These include certain painkillers or antidepressants.

Gynecologic surgery. Surgery on 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. A colostomy is a surgical opening for waste to leave the body. A urostomy is a surgical opening for urine to leave the body. Both procedures can affect sexuality and sexual function.

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

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

  • Hot flashes

  • Vaginal and vulvar dryness

  • Pain with intercourse and sexual touch

  • Lowered sex drive

Mental health effects

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

  • Fear of recurrence, which is a return of the cancer

  • Feelings of powerlessness, sadness, or frustration

  • Negative feelings about body changes

  • Stress

  • Depression

  • Anxiety

  • Relationship conflict or lack of communication

Even your partner may experience these mental health challenges. It is important to discuss sexuality and sexual health with your partner and share any barriers to intimacy.

Managing side effects

Relieving side effects affecting your sexuality is an important part of cancer care. Your health care team can recommend ways to manage symptoms. Here are some examples:

Vaginal moisturizers. These are non-hormonal, nonprescription products. They provide moisture to the vagina and can also be applied to the vulva. This improves vaginal and/or vulvar health and comfort during sexual activity. These products may need to be used 3 to 5 times per week for relief. For best absorption, use at bedtime.

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

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 with 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 and is another option if non-hormonal moisturizers and lubricants are not effective. 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 estrogen-sensitive cancers.

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

Hormone replacement. This is the most effective way to manage hot flashes for some women. However, women who are receiving hormonal or endocrine therapy for cancer may not be able to take hormone replacement therapy. For these women, other medicines such as paroxetine (multiple brand names), venlafaxine (Effexor), gabapentin (Neurontin), and clonidine (Catapres, Kapvay) can also help with hot flashes. However, talk with your doctor about these options. Ask about the risks and benefits.

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

Additionally, your health care team can address mental health effects on sexuality. Support resources may include:

This information is based on ASCO recommendations for addressing sexual problems in people with cancer. Please note that this link takes you to another ASCO website

Related Resources

Dating, Sex, and Reproduction

Talking with Your Doctor About Sexual Health

Moving Forward Video: Dating and Sexuality

Side Effects

More Information

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

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

LIVESTRONG: Female Sexual Health after Cancer

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