Sexuality Issues and Cancer FAQs

Q: How soon after my surgery can I have sex?

A: You should wait about six weeks after a hysterectomy before having sex with your partner. Your doctor will tell you when it is okay to start having sex again. Your body needs to heal and lower your risk of infection. Some women are afraid of having sex after surgery. Starting slowly and gently will help your body to relax. Lubricants are sometimes needed for dryness. Finding a comfortable position may allow you better control of penetration. For instance, you might try side to side or woman on top. Your ability to have an orgasm should be no different than it was before surgery. You partner will not be able to tell if you had your uterus or ovaries removed.

Q: Will my partner catch cancer from me if we have sex?

A: No. Cancer is not contagious. It’s very normal and safe to have sex even with a cancer diagnosis. It’s also safe while going through treatment. There are treatments, though, that may increase your risk for infection. Chemotherapy, for instance, can increase your risk of lung or vaginal infections. Your health care team may instruct you on how to reduce infection risk.

Q: How will radiation affect my sexuality?

A: The effects from radiation depend on the dose and the area treated. Your doctor’s recommendation for radiation treatment is based on the type of disease. It’s also based on its stage or how far it’s spread. Treatment with radiation is specific to each woman. Radiation to the pelvis or abdomen can cause such side effects that include

  • fatigue
  • diarrhea
  • bladder swelling
  • vaginal swelling
  • discharge

These changes may interfere with sex and sexual desire, which is called libido. If you have whole abdominal radiation, you may have nausea. You may also vomit. These side effects happen because a larger area of the abdomen is being radiated. You can offset these side effects by using anti-nausea and anti-diarrhea agents before being intimate.

Delayed or long-term side effects may include:

  • diarrhea
  • vaginal discharge
  • swelling of the legs
  • vaginal narrowing

You may be able to prevent vaginal narrowing. Using a vaginal dilator with lubrication and/or frequent intercourse can help. A dilator is a cylinder that you insert into the vagina several times a day. Vaginal narrowing is often due to the forming of scar tissue after the radiation.

Radiation does not prevent you from having a sexual relationship. The side effects may affect how you see yourself, though. They may also change how you feel about your appearance. For instance, support-like stockings are recommended to reduce leg swelling. They can, though, be removed during times of intimacy. You can use medications that reduce swelling. Other medications can provide pain relief to the rectum or vagina. You do not have radiation inside you once you are done with your treatment. So you are not contagious. And it is safe to maintain a sexual relationship during or after radiation treatment. The vagina may be temporarily sensitive to touch as treatment progresses. It may feel like sunburn. Using lubricants and creams may be helpful. Tell your partner about the increased sensitivity. Ask your partner to use gentle strokes and touches. You should agree ahead of time to stop if there is pain. Then you can try other positions or styles that are more comfortable. The swelling and discomfort will slowly go away when the radiation is finished.

Q: How will chemotherapy affect my sexual functioning?

A: Chemotherapy does not cause sexual dysfunction. But it can change your libido or desire. Hair loss can affect your body image and self-esteem. Another name for hair loss is alopecia. Hair loss happens because chemotherapy attacks cells that divide rapidly. Not all chemotherapy causes total hair loss. Some agents only cause thinning. And some do not cause any hair loss. It’s possible you may lose eyelashes, eyebrows, underarm hair, and pubic hair. Hair loss is usually not uncomfortable. Some women, though, report scalp discomfort before and during hair shedding. On average hair loss occurs 2-3 weeks after the start of chemotherapy. But the hair comes back. On average, regrowth starts 6-8 weeks after the last chemotherapy.

If you are close to 40 and still have your ovaries, chemotherapy can cause ovarian failure. This will result in menopause. That could cause hot flashes and vaginal dryness. Talk to your health care team about ways to reduce the discomfort from hot flashes. For example, ask about estrogen-based products, and non-estrogen-based products.

White blood cells (WBCs) fight infection. With chemotherapy, they are decreased. This commonly happens about 7 to 10 days after each treatment. When your immune system is low, sexual practices and intimacy may increase the risk for infections. For instance, you may be at a higher risk for throat infection and vaginal infection. Hugging and touching is encouraged. But limited contact with a partner with a cold sore, sore throat, or a vaginal or penile infection will help reduce the spread of infection.

Anemia is a decreased number of red blood cells (RBCs) being or made. You are at risk if you’ve had surgery and are having chemotherapy or radiation. Anemia can begin over a gradual period of time. If it does, you may not know you have it. With anemia, you may have the following complaints:

  • fatigue
  • headache
  • a feeling of being lightheaded or dizzy
  • shortness of breath
  • a feeling of being winded with activities

Anemia and fatigue can interfere with your desire to have sex. Planning for sex when your energy is at it’s highest during the day can help. You might plan to nap prior to sex or together time. Sometimes when you’re tired, cuddling without having sex, can be a comfortable way for you and your partner to be intimate.

Many side effects, such as nausea, pain, and fatigue, can be treated with medications. Chemotherapy induced nausea and vomiting is called CINV. It can be mild, moderate, or severe. Not all chemotherapy causes nausea. Feeling queasy and unable to eat or drink, though, can be unpleasant. It can also lead to further physical problems. The goal is to prevent CINV before it occurs. It can affect your energy level. It can also affect your ability to perform daily activities. And it can interfere with your quality of life, intimacy, and socializing. Your doctor or nurse may instruct you to take prescribed anti-nausea medications for up to 4 days around the clock. Relaxation and visualization are non-medical techniques that may help ease nausea.

Feeling pain is very personal. It’s also different for each woman. You may have acute and short-lived pain from surgery. Different kinds of chemotherapy can cause joint and muscle aches. Chemotherapy can cause injury to your peripheral nerves. That’s called peripheral neuropathy. It can cause numbness, tingling, and burning in your hands and feet. When you feel it, getting relief from pain becomes more important than sex and intimacy. Massage may help with muscle aches and peripheral neuropathy. Massage, touching, and stroking can be a form of intimacy that brings couples together. There are two important things you can do to start managing your pain. The first is to talk with your doctor and nurse about your discomfort. The second is to work with them to find out what’s causing it. Talk to your health care team about medication that can ease your pain. Also, talk about non-medical treatments such as massage, acupressure, and visualization.

Q: Is there anything I can do to get in the mood for sex? I have no desire or libido?

A: Lack of desire or interest in sex is common for women being treated for gynecological cancer. Often the low interest in sex is temporary. The interest comes back when treatment ends. Sometimes, though, it can be long-lasting or permanent. Low estrogen levels can be one cause. If your partner is supportive and understanding during your treatment, chances are good you will get back to a satisfying sexual relationship. If you had a troubled relationship before the cancer, it may help to talk to a counselor. It may also help if your partner is not supportive. Sometimes partners understand but still have a hard time coping with the diagnosis of cancer. A referral to a therapist or couples therapy is an option.

Here are some tips for increasing desire in your relationship:

  • Schedule a “date” for sex or intimacy. Plan the time during the day when your energy is highest.
  • Set the “mood” for your scheduled date. Use things that increase your desire. That can be fantasies, candles, music, favorite lingerie, bubble bath, romantic environment, visual aids, and so on.
  • If you are having side effects such as nausea or pain, take proper medications. Allow about 60 minutes between the time you take them and having sex.
  • Talk to your health care team about medication to increase your libido. For example, they might suggest estrogen-based or testosterone-based products.
  • If uncertain about having sex, tease each other with light touch, massage, and kisses. But withhold intercourse.
  • Have fun. Use props, such as wigs, or blindfolds.