Regaining sexual health after cancer treatment

By Nicole Brudos Ferrara

Difficulties in the bedroom are challenging at the best of times, but sexual hiccups while recovering from cancer treatment add insult to injury. If you've been diagnosed with cancer, you should know that treatment for certain cancer types can cause a range of symptoms that can make sex difficult.

Cancers in the pelvic area, including colorectal, bladder, prostate, cervical, endometrial (uterine), ovarian and vaginal cancer, are more likely to cause difficulty with sex after treatment. The diagnosis and treatment of breast cancer also can cause side effects that make sexual activity challenging.

Many chemotherapy treatments for cancer come with side effects that quickly douse the fires of passion, including loss of libido and erectile dysfunction.

Having cancer also affects emotions. If you have cancer, you may feel anxious and worn out from your diagnosis, treatment or prognosis. These emotions can affect your attitude toward sex and intimacy with a partner.

Read on for an overview of how cancer and cancer treatment can affect sexual health and how you can achieve a healthy sex life after cancer treatment.

Common sexual side effects of cancer treatment

When discussing how cancer treatment affects sexuality, Jennifer Vencill, Ph.D., a Mayo Clinic psychologist, breaks sexual function into four domains: desire, arousal, the ability to achieve orgasm or ejaculate, and pain. She stresses that there can be significant overlap between these domains. "Sex and sexuality are multifactorial," she says. "They're incredibly complex."

The emotional effects of coping with a cancer diagnosis, combined with the physical side effects of treatment, can significantly affect sexual desire, also known as libido. "Lowered interest in sexual activity is very common during or following cancer care," says Dr. Vencill.

The ability to become aroused is also a frequent casualty of cancer treatment. "We might see changes during or after cancer treatment in how one's body experiences sexual arousal," says Dr. Vencill. "Changes might include difficulty with erections and thinning or dryness of the vulvovaginal tissues."

A common side effect of surgery to treat cancer is numbness, which can reduce sensitivity, making it difficult to achieve orgasm or ejaculate. "It is very common for patients to experience changes in their sensitivity," says Dr. Vencill. "This might be numbness in parts of the body, neuropathy or tingling sensations that can really disrupt the ability to reach sexual climax. Ejaculatory function can be greatly impacted by prostatectomy surgery or other prostate cancer treatments."

Cancer treatment can also lead to pain and discomfort during sexual activity. This might be related to surgery in the pelvic area or reproductive organs, or hormonal changes brought on by such surgeries. An oophorectomy, for example, is a surgery to remove one or both ovaries. This can cause hormone levels in the body to change dramatically, leading to vulvovaginal dryness and pain or discomfort with penetrative intercourse. Chemotherapy or radiation in the pelvic area also can cause vulvovaginal dryness that can cause pain with penetration.

"A surgical procedure, especially to the pelvis, can impact the nerve endings and muscle groups that are directly involved in our sexual response," says Dr. Vencill. "But there's also an indirect cascade effect of treatment — loss of libido or decreased desire, fatigue, nausea because of chemotherapy, and body image concerns."

Cancer's emotional effects on sexuality

A range of emotions often accompany the diagnosis and treatment of cancer — for both people with cancer and their intimate partners.

"We can't neglect the mental and emotional impact that treatment can have on the patient and their sexual partners," says Dr. Vencill. "For partners who are also caretakers, navigating sex amid cancer treatment and the cancer survivorship period can be a unique and challenging reality."

"We can't neglect the mental and emotional impact that treatment can have on the patient and their sexual partners," says Dr. Vencill. "For partners who are also caretakers, navigating sex amid cancer treatment and the cancer survivorship period can be a unique and challenging reality."

Psychological and emotional stress is a barrier to sexual health, according to Dr. Vencill. The experience of cancer and cancer treatment is a major life stressor that affects people physically, emotionally, mentally and interpersonally. "Stress, anxiety and depression are all common for cancer patients and their families who often battle cancer alongside them in their own ways and have their own experiences at the same time," she says.

Sexual side effects from cancer treatment can cause added stress and anxiety, but they can be buffered by positive support from a partner, says Dr. Vencill. "It's important to have conversations around mental and emotional well-being, and to talk about sexual health when you feel ready."

Dr. Vencill says that a person's comfort level with discussing sex predicts how successful they will be in overcoming sexual health challenges that can occur with cancer treatment. She encourages people to talk openly with their partners about how they feel, both emotionally and physically, about how cancer treatment is affecting their sexual health.

"This can be really, tough," she says. "Most of us are not encouraged or trained to talk about sexual health concerns in an open way."

If this is a struggle, ask your health care provider for a referral to a sexual health specialist. "If these are hard conversations to have, seeking support from a professional who can help you through these discussions can be enormously helpful," says Dr. Vencill.

How to regain sexual function after cancer treatment

The news isn't all dour. The sexual side effects that occur with cancer treatment can be overcome.

"When I think about regaining sexual functioning, three words come to mind: patience, exploration and support," says Dr. Vencill. "We need to be patient with our physical and mental health as we recover from an ordeal that can be incredibly traumatic."

"When I think about regaining sexual functioning, three words come to mind: patience, exploration and support," says Dr. Vencill. "We need to be patient with our physical and mental health as we recover from an ordeal that can be incredibly traumatic."

Be patient with yourself and your partner as you rediscover your optimal sexual health after cancer treatment. It will take time to recover emotionally and explore what is normal for your sexuality after cancer treatment.

"Exploration could mean relearning your body sensations and erogenous zones, something that we refer to as body mapping in the sex therapy world," says Dr. Vencill, "Or it might be getting comfortable in a body that has drastically changed in how it looks or functions. This might mean exploring sexual aids and things that you perhaps previously hadn't thought about incorporating into your sex life — whether solo or with a partner."

Dr. Vencill says it can be beneficial to take some time to explore your sexuality without a partner to fully understand your new sexual health "normal" following cancer care. "It's helpful to do that exploration on your own before you move into partner exploration to get a sense of baseline and personal comfort."

Treatment is available to recover sexual health after cancer treatment. Ask your care team about resources and sexual health specialists in your area, and don't be afraid to use them.

"There are many more options than most people think," says Dr. Vencill. "We have excellent treatment options for people struggling with vulvovaginal dryness, sexual pain, erectile concerns, and so on. There are also amazing mental health providers who specialize in sexual health and sex therapy, as well as oncology care and cancer care. They help people work through the process of cancer treatment and cancer survivorship."

If you've been diagnosed with cancer, ask your health care provider what sexual side effects you might experience based on your specific type of cancer and treatment. Ask what body changes and common effects you can expect in the four sexual domains. Most important, ask what care is available if you have sexual difficulties related to cancer treatment.

"Many medical providers feel unprepared to counsel their patients about sexual side effects related to cancer treatment," says Dr. Vencill. "It's really important to be your own advocate, even if it feels uncomfortable."

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Cancer treatment is likely to affect your sexuality in some way. But with a positive approach and the right support, you can successfully renew sexual health after cancer treatment.

"What the new sexual normal looks like during and after cancer care could be worlds different than what you expected it to be," says Dr. Vencill. "But that doesn't always mean it's bad."

"Sometimes when I meet people for the first time, there's a grieving process that's happening," she says. "And through that grieving process, we need to recognize that the other side might not be a catastrophe or as bad as we think it's going to be. In fact, some cancer survivors I work with are having better sex lives than they did before cancer treatment."

Learn more

Watch Dr. Jennifer Vencill discuss sexual health after cancer treatment in this "Mayo Clinic Q&A" podcast video: