For many people, sexual intimacy is an important part of life. Cancer treatment can affect sexual activity and intimacy in several ways:
- your desire to have sex (your libido)
- your body’s ability to respond to sexual stimulation
- how you feel about your body (body image)
- how you feel about sex and intimacy
- how you feel about your relationships.
The stress of a cancer diagnosis and treatment can affect your sex life too. Many people find changes to sexual activity and intimacy to be one of the most difficult aspects of life after cancer. While talking about these changes can be hard, the challenges of cancer can also strengthen a relationship, and lead to new ways to express intimacy.
Treatment side effects and sexual intimacy
Side effects will vary from person to person and depend on the type of treatment and medicines you have. Some people have no side effects, while others have many.
Changes to sex drive or desire
Your libido might change because of tiredness, pain, anxiety, changes in hormone levels, and loss of confidence and self-esteem. For some people, libido may return to your usual levels after treatment ends, but for others, low libido may continue. Hormones can also change with age, and it’s common for libido to decrease as you get older. Even if you feel like having sex, you might feel anxious about your partner/s seeing how your body has changed.
Pain during sex
Radiation therapy to the pelvic area or rectum may make sex painful. This usually improves after treatment ends.
Incontinence
Trouble controlling the flow of urine (urinary incontinence) or flow of faeces (faecal incontinence) is a common side effect of treatment for cancer of the prostate, bladder, bowel, uterus, vulva, vagina and penis. This may be temporary or permanent. Having bladder or bowel issues can be embarrassing and you may worry about having accidents or leaking during sexual activity. You can use a sex blanket, cover sheets or have sex in wet areas like a shower.
Weak pelvic floor muscles can affect bladder and bowel control. The hospital continence nurse or physiotherapist can suggest exercises to strengthen the pelvic floor muscles and manage urinary symptoms. Start these exercises before treatment and continue to do them regularly after treatment.
Leaking urine at orgasm
After surgery for prostate or vulvar cancer, you might leak a small amount of urine when having an orgasm. This is usually temporary but is sometimes ongoing. You may feel embarrassed and nervous at the thought of leaking urine during oral sex and/or masturbation. Reassure your partner/s that urine is sterile.
Changes to the anus
Radiation therapy to the abdomen or pelvic area may irritate the lining of the bowel and rectum. This can cause bowel problems, and the skin inside the anus may be more sensitive. If the anus area is sensitive after radiation therapy, take it slow and work up to full penetration. Fingering, rimming, using small dildos and picking positions where you control the speed and angle of penetration may help. Although sensitivity to the anal area may improve after a few months, some changes are permanent.
Sex with a stoma
Some types of surgery for bowel, anal, ovarian or bladder cancer create a stoma. This is an opening in the abdomen that allows faeces and urine to be collected in a small plastic bag. Sometimes a stoma is needed for only a short time, but sometimes it is permanent. Planning can help make sexual intimacy for people with a stoma satisfying and fulfilling.
Consider wearing clothing like a slip or cummerbund to cover the stoma. You could secure the bag with tape to stop it moving. Talk to a stomal therapy nurse about products such as smaller pouches or a stoma cap. Do not use the stoma for sex.
Early menopause
Some cancer treatments can cause menopause symptoms or early menopause. These include surgery to remove both ovaries; hormone therapy to block oestrogen; and radiation therapy and chemotherapy, which can damage the ovaries. Menopause symptoms can include a dry vagina and mood changes, both of which can affect libido.
Changes to the vagina
Cancer treatment may cause temporary or permanent changes to the vagina. Surgery may shorten the vagina, and pelvic radiation therapy can narrow the vagina, causing thinning of the walls and dryness. If you have a surgically created vagina (vaginoplasty), speak to your doctor about the effects of radiation therapy.
Penetration with fingers, a penis and/or sex toys such as dildos or other objects may be difficult and painful. A narrower vagina will also make cervical screening uncomfortable. Talk to your doctor about the options for keeping the vagina open. They may suggest using dilators in different sizes to dilate and extend the vagina. Using extra lubrication may make sexual intercourse more comfortable. Choose a water-based or silicone-based gel without perfumes or colouring.
Changes to the prostate
Pleasure experienced from rubbing or stimulating the prostate during sex may change with certain prostate cancer treatments. If you have radiation therapy, the prostate may feel less sensitive. You won’t feel the same pleasure if the prostate is removed with surgery (radical prostatectomy). It may take time to adjust to this change and for you to become more aware of other pleasurable sensations.
Changes to the penis
Surgery for prostate or penile cancer may shorten or shrink the penis. After prostate cancer surgery, the difference is often small, usually about 1 cm. Changes in size may happen because of scar tissue or the nerves not working properly.
Erection problems
After surgery for prostate cancer or bowel cancer, getting and keeping a firm erection can be difficult. This is known as erectile dysfunction or impotence. How long the problem lasts will depend on your age, how easily you got an erection before surgery and Sexual intimacy and cancer 37 how much the erectile nerves were damaged. Having radiation therapy or taking androgen deprivation therapy can also cause erection problems.
You don’t need an erect penis to have an orgasm. However, firmer erections are needed for penetrative sex. Erection problems can make having penetrative sex more difficult or painful, and you may find this makes you feel anxious and frustrated. Doing pelvic floor exercises can help improve erections. Other options include using erection aids such as a vacuum pump, constriction ring around the base of your penis, or medicines. Ask your doctor for more details about these methods.
Other ways to experience pleasure include masturbation or oral sex, but you may be worried about how your sexual partner/s may feel. Open and honest communication about what has changed, and non-sexual touching can help maintain intimacy in a relationship.
Changes in ejaculation
After some types of surgery and radiation therapy (e.g., for prostate cancer), you won’t be able to ejaculate semen. This is known as dry orgasm. This is because semen is no longer produced. If ejaculating semen was an important part of enjoying sex for you or your partner/s, you might want to discuss this change with them.
Safety concerns for partners
Your doctor may advise you to use barrier protection during specific sexual activities to reduce any risk to your partner from cancer treatment and to avoid pregnancy.
- Chemotherapy – The drugs may be released into your body fluids. For penetration, use condoms or internal condoms. For oral sex, use condoms, internal condoms or dental dams (latex squares). Wear latex gloves if using hands for penetration. If you have anal sex, use condoms. Clean sex toys after each use, and do not share between partners without using a new condom. Ask your doctor or nurse how long you need to use protection.
- Internal radiation therapy (brachytherapy) – If you have radioactive seeds inserted to treat prostate cancer, you will usually be advised to avoid anal sex or use barrier protection (such as condoms) during treatment. Ask your doctor how long to wait before having sex.
Adapting to changes in your sex life
Changes to how you enjoy sexual intimacy and activity can be challenging and upsetting. Give yourself time to adjust. There are several ways to adapt how you have sex during or after cancer treatment. You might find some of the following tips useful.
- Talk about what has changed
- Try other forms of intimacy
- Explore different ways to have sex
- Plan ahead
- Focus on other aspects of your relationship
- Use relaxation and meditation techniques
- Explore what has changed on your own
- Seek assistance
See Sexuality and Intimacy for more information on how cancer can impact your relationship with yourself and others.
Communicating with your partner/s
Coping with treatment and recovery may affect your relationship with sexual partners. Your established roles may change, they may worry about hurting you, or you might feel too tired for intimacy.
Research suggests that communicating during treatment can help partners work through any issues. If you find that the changes after cancer treatment are getting in the way of a fulfilling sexual life, ask your GP or cancer specialists for a referral to a counsellor, sexual health physician or sex therapist.
Sexual activity and LGBTQI+ young people
Adolescence and the young adult years are a time for exploring your sexuality and identity, including your sexual orientation and gender. This process can be more complex if you are diagnosed with cancer. If you’ve recently started exploring your identity, needing to have treatment for cancer can interrupt this.
- Feeling isolated – If you already feel different or isolated from people your own age because of your sexual orientation, gender or intersex variation, cancer can make you feel even more lonely.
- Worrying about disclosure – Getting diagnosed and treated for cancer means accessing many health services. It can be challenging to talk about your sexual orientation, gender or intersex variation with others when you are still working it out yourself or have only recently come out. Some young people hide their identity from health professionals, because they fear being judged, discriminated against or outed to family.
Get in touch with Canteen. This organisation offers counselling in person, via phone, email or direct message (DM). Canteen also runs Sexual intimacy and cancer 41 online forums and camps. Call 1800 226 833 or visit canteen.org.au. If you’re feeling anxious or depressed, call QLife on 1800 184 527.
Sexual activity and single people
If you’re single, you may feel nervous about hook-ups or starting a new relationship during or after treatment. You may wonder if you have to tell a new person about your cancer diagnosis and when to do this. This could depend on whether the relationship is casual, or you see it becoming more long term.
It may help to take new relationships slowly and share personal information when you feel you can trust the person. You can discuss how to adapt your sexual activity, try more activities without penetration, or change the length and intensity of your sexual encounters. You can also talk to a psychosexual or relationship therapist for more suggestions.
You might decide that you want to focus on your health and wellbeing or that you don’t have the energy for hook-ups or a new relationship.
Fertility after cancer
Many LGBTQI+ people hope to start a family. The path to becoming a parent is different for everyone. Having biological children is one way of starting a family, and one that is possible for some LGBTQI+ people. But it can be made difficult due to cancer treatments affecting your fertility.
Before starting treatment, it’s important to discuss how cancer treatments may affect your ability to conceive a child or maintain a pregnancy ( fertility ) and your options for fertility preservation. You can still consider your fertility later, but there may not be as many options available after treatment.
Your doctor may not discuss whether you want children in the future if they make assumptions based on your sexual orientation, gender or intersex variation. If fertility matters to you, let your health professional know.
How cancer treatments affect fertility
Cancer and its treatment may affect your fertility. This will depend on the type of cancer, whether you’ve had surgery, chemotherapy or radiation therapy, and your age.
Infertility caused by treatment can be temporary – difficulty conceiving may happen only during treatment or for months or years after treatment. Sometimes it is permanent. Treatments can also cause early menopause. You will be advised to avoid conceiving during cancer treatment and for a period of time afterwards.
Ways to preserve fertility
There are different ways to preserve fertility before and after treatment. Keep in mind that these methods don’t work all of the time.
For more information about options before and after treatment, see our female options before and after treatment and our male options before and after treatment sections.
Checking fertility after treatment
After treatment, you may want to do some tests to see how your fertility has been affected.
See our Fertility after cancer treatment sections.
Pregnancy after treatment
You might be advised that you need to wait several years after treatment ends before trying to get pregnant. There are many ways to approach conceiving a child, either on your own, or with a partner.
If you or your partner can become pregnant, options include:
- Your partner could have their eggs fertilised with donor sperm through IVF and then carry the pregnancy.
- If your eggs were collected before treatment or are undamaged after treatment but you’ve had your uterus removed, you could consider reciprocal IVF. This means you go through the IVF cycle and once the embryos mature, they are transferred to your partner to carry the pregnancy.
- If your eggs have been damaged, but you have your uterus and your partner has ovaries, your partner’s eggs could be fertilised with donor sperm and then you carry the pregnancy.
- If neither of you can provide eggs, you could use donated eggs.
If you and your partner produce sperm, you will need an egg donor and a surrogate to start a family. If your sperm has been damaged, your partner may be able to provide sperm. If neither of you can provide sperm, you could use donated sperm.
If you are single, you could consider using eggs and/or sperm donated by another person or from overseas.
Expert content reviewers:
The chief investigators on the project were Prof Jane Ussher, Prof Janette Perz, Prof Martha Hickey, Prof Suzanne Chambers, Prof Gary Dowsett, Prof Ian Davis, Prof Katherine Boydell, Prof Kerry Robinson and Dr Chloe Parton. Partner investigators were Dr Fiona McDonald and A/Prof Antoinette Anazodo. Research Associates were Dr Rosalie Power, Dr Kimberley Allison and Dr Alexandra J. Hawkey.
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The information on this webpage was adapted from LGBTQI+ People and Cancer (2023 edition). This webpage was last updated in December 2023.
