Navigating Cancer and Sex

You probably expected that a cancer diagnosis could upend everything. And while your sex life may not be the first thing you think of, you probably will eventually.

“Anytime there’s emotional or physical distress, we tend to put sexual health on the back burner,” says sexual health specialist Theresa Callard-Moore, PhD, LSW. “But maintaining sexual health and intimacy while living with cancer can help you feel less isolated, provide feel-good endorphins and be a natural pain reliever.”

Dr. Callard-Moore explains the impact cancer and cancer treatment can have on sex and intimacy — and how to find the path forward that works for you.

How cancer affects sex and intimacy

Cancer can impact both your desire and your ability to have sex.

Dr. Callard-Moore says that we all have “accelerators” that get us sexually aroused. But cancer can break or interrupt those accelerators and keep you from feeling in the mood. And often, people dealing with cancer find they “put their brakes on” when it comes to sexual activity.

“Brakes can be mental or physical,” Dr. Callard-Moore says. “It may be that you no longer feel sexual without your hair or breasts. Or it could be that your cancer treatment lowered your testosterone levels and it’s tougher to get or maintain an erection. The breaks in arousal caused by cancer are different for everyone. But once you identify them, you can begin to work around them.”

Sex after (and during) cancer treatment

Cancer symptoms can make you feel less like yourself. And when you don’t feel like your most confident and sexual self, your libido can take a back seat.

The impact on your sexuality can be more significant if you have cancer that affects your erogenous zones (the areas of your body that respond to sexual stimulation). That can be especially true if you’ve been diagnosed with:

• Breast cancer
• Cervical cancer
• Colorectal cancer
• Ovarian cancer
• Penile cancer
• Prostate cancer
• Testicular cancer

Here’s how cancer and cancer treatments can affect your sex life. And what to do about them.

Physical effects

It’s no secret that cancer itself, along with treatments like chemo, radiation and surgery, can leave you feeling less than your best. And when you’re feeling sick, sex can be off the table.

You might be dealing with issues like:

• Fatigue
• Nausea and vomiting
• Erectile dysfunction
• Jaw pain
• Joint pain
• Painful or burning skin
• Physical limitations from surgery
• Changes to nerve function that affect sexual performance or sensation

Adjusting to these physical impacts can take some time and patience.

For instance, for chemo side effects, you might consider keeping things PG when nausea or fatigue are highest. But you may still enjoy the intimacy and connection from a less-sexual touch, like snuggling, hugging or spooning.

For issues like sensitive skin after radiation treatment, you may find that other parts of your body are less affected.

“There may be times that you feel like you don’t want your partner to hug or even touch you. That’s OK and understandable,” Dr. Callard-Moore reassures. “Over time, though, that lack of affection can lead to disconnects in your relationship if you’re not both on the same page.”

You might find that the right touch to a different place could help build connections with your partner — and even fuel the fire. Dr. Callard-Moore recommends trying to avoid the area that received radiation. For example, if you had radiation therapy to the front of your body, consider side hugs, spooning or sex from behind.

Hormonal changes

Cancer and cancer treatments can also create hormonal changes that affect your sexual desires and performance.

Chemotherapy, for example, can destroy healthy cells in your reproductive organs. This may cause a hormonal imbalance that can stop menstruation and lead to early-onset menopause. Similar changes can occur if your ovaries are removed during cancer surgery.

“You may start having mood swings, hot flashes, hormone changes, foggy thinking, vaginal dryness and painful intercourse,” Dr. Callard-Moore notes. “It can all affect sexual functioning.”

What’s more, some cancers are best managed with hormonal treatments. But, as the name implies, they can disrupt your hormonal balance, causing troubles that affect your body image, sexual interest and sexual performance, like:

• Erectile dysfunction
• Hot flashes
• Lowered libido
• Reduced muscle mass
• Weight gain

“Your provider can help you with strategies to limit sexual issues during hormone therapy,” she adds. “There are many advances in hormone replacement therapy that may help.”

Emotional toll

Cancer and cancer treatments can do a number on your mental health and your body image. Both of which can make you feel less sexy.

Living with cancer can be one of life’s biggest stressors. Between the worries, the juggling of doctor’s appointments, treatment side effects and the toll on your body, it’s a lot to manage.

There’s a direct link between your mental health and your sexual health, so you may find that navigating cancer can take a hit on the emotional connection that can spur your sex life. And not just for the person who has cancer.

“Both the patient and their partner may experience mental health issues after a cancer diagnosis and during cancer treatment,” Dr. Callard-Moore says. “Working through both partners’ feelings can throw a relationship off balance — and make it hard to maintain sexual intimacy.”

And changes to your body can likewise put sex lower on your list of priorities. Hair loss, weight changes and an overall feeling of navigating the world as a “sick person” just might not give you those loving feelings.

If you’ve lost an erogenous body part to cancer surgery, such as having a mastectomy, it can feel extra un-sexy. But it’s possible to find other ways to be aroused.

Your mind and your skin are your most erogenous organs, and there are many places that can make you feel good. “After surgery, you and your partner may need to look beyond your typical toolbox and remap the way you find arousal,” Dr. Callard-Moore points out. “What else feels good? Maybe touching the nape of your neck, inner thighs or butt feels good. Explore to see what other areas of the body can get you warmed up.”

In other words, in time, you can make lemonade from those lemons — discovering new ways your body can bring you sexual pleasure.

Tips for navigating sex and cancer

Finding ways to be intimate and feel sexual while living with cancer can help you stay connected to your partner. If cancer and treatment are taking a toll on your sexual health, Dr. Callard-Moore recommends:

• Talking about it. Discuss your feelings with your provider and partner. Ask questions about how your treatment plan may be affecting your sex life.
• Taking a step back. If sex feels too challenging, go back to the basics. Start with hugging or cuddling before working your way up to more intimate touching.
• Looking beyond intercourse-focused sex. It’s easy to opt out of bedroom fun and games if your sexual organs aren’t functioning well. But expanding your list of sexual activity to include more foreplay and other pleasurable acts can help get the ball rolling again.

Bottom line? Sex may not be top of mind when you think about your cancer experience. But make no mistake, a healthy and fulfilling sex life matters to your well-being. And with help from your healthcare team and open communication with your partner, you’ll get there.

“Sexual connection can continue after a cancer diagnosis,” Dr. Callard-Moore says. “It just may take time to adjust to the new normal.”