Sexual intimacy and cancer

Tiredness, pain, anxiety, hormone changes, and lower confidence can reduce your libido and make it harder to reach orgasm. For some people, libido may return to their usual levels after treatment ends, but for others, low libido continues. Ageing can also affect hormone levels and reduce libido. You might also feel anxious about how your partner/s will react to changes in your body.

Surgery or radiation therapy to the pelvic area or rectum may make sex painful. Pain may improve after treatment ends but it can continue. If you have ongoing discomfort during sex, talk to your doctor. They may suggest seeing a pain specialist or pelvic floor physiotherapist. Anxiety can also cause your pelvic floor muscles to become tense and worsen pain, so it may help to see a psychologist.

Cancer treatment for the prostate, bladder, bowel, uterus, vulva, vagina or penis may affect bladder or bowel control (urinary or faecal incontinence). This may be temporary or permanent. You may worry about leaking urine or faeces during sex. Some people find using a sex blanket, protective sheets, or having sex in the shower helpful.

Weak pelvic floor muscles can affect bladder and bowel control. A continence nurse or physiotherapist can show you exercises to help strengthen these muscles. For some exercise suggestions, see pelvic floor exercises. Start these exercises before treatment and keep doing them after treatment.

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. This can be managed the same way as incontinence (see above).

Surgery for some bowel, anal, ovarian or bladder cancers may create a stoma. A stoma is an opening in the abdomen that allows faeces and urine to be collected in a small plastic bag. You may have a stoma for a short time or permanently. If you feel self-conscious, wear clothing that covers the stoma and use tape to secure the bag. A stomal therapy nurse can suggest products such as smaller pouches or a stoma cap. Never use the stoma opening for sex – the surrounding tissue is delicate and can be easily damaged.

Cancer treatment may cause temporary or permanent changes to the vagina. Surgery may shorten the vagina. Pelvic radiation therapy can narrow the vagina and cause thinning of the vaginal walls and dryness. If you have a surgically created vagina (vaginoplasty), ask your doctor how radiation therapy may affect you.

Penetration with fingers, a penis or sex toys may be difficult, painful or cause bleeding. A narrower vagina will also make pelvic examinations uncomfortable. Talk to your cancer care team as soon as possible about ways to keep your vagina open and flexible. Treatment may be more effective if started early. Your team may recommend vaginal dilators to stretch the vagina. Using extra lubrication may make penetration more comfortable. Choose a water-based or silicone-based lubricant without perfumes or colouring. Ask your doctor if vaginal oestrogen is an option for you. It may also help to talk to a psychologist.

Cancer treatment to the vulva can change the appearance and texture of the labia, making the tissue feel harder (called fibrosis). This might also affect the clitoris and sexual enjoyment. Surgery for vulvar cancer may remove part or all of the labia and, in some cases, the clitoris.

Orgasms will still be possible but they may feel different because there is no uterine contraction.

Some cancer treatments can cause menopause symptoms or early menopause. Treatments 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, painful sex, hot flushes and mood changes, all of which can affect libido. Menopausal hormone therapy can help, but it’s not always suitable (e.g. for people with hormone-dependent cancers). Talk to your cancer care team about your options.

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. This can increase the sensitivity and pain of anal sex. You may need to use dilators and extra lubrication to make receptive anal sex more comfortable. Sensitivity to the anal area may improve after a few months, but some changes are permanent.

Pleasure experienced from stimulating the prostate during sex may change with certain prostate cancer treatments. After 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.

Surgery for prostate or penile cancer may shorten or shrink the penis. After prostate cancer surgery, the difference is often small, usually only about 1–2 cm. Changes in size may happen because of scar tissue or the nerves not working properly.

After surgery for prostate cancer or bowel cancer, getting and keeping a firm erection can be difficult (erectile dysfunction). How long the problem lasts depends on your age, your erections before treatment and whether erectile nerves were affected. 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 penetrative sex more difficult or painful, and you may find this makes you feel anxious and frustrated. Pelvic floor exercises can help improve erections. Using erection aids (e.g. a vacuum pump or constriction ring) or medicines can also help. Ask your doctor about these methods. They may suggest you see a sexual health physician.

Other ways to experience pleasure include masturbation or oral sex. Honest and open communication about what has changed, as well as non-sexual touching can help maintain intimacy in a relationship.

After some types of surgery and radiation therapy, such as for prostate cancer, you may ejaculate less semen or none at all (dry orgasm). Semen may also be a different colour. If this affects your sex life, talk to your partner/s.

Share any concerns about having sex or being intimate with your partner/s. Tell them when you are ready to have sex, what feels comfortable, what doesn’t and if they should do anything differently.

Show affection by cuddling, holding hands, lying together naked, kissing and massaging. Talking about change can help avoid misunderstandings and reduce pressure to go further.

If the way you used to have sex has changed, you could try different sexual positions; exploring other erogenous zones; manual sex, including fingering and fisting; mutual masturbation; oral sex; genital rubbing; personal lubricants (lube); vibrators and other sex toys; erotic images and stories; sexual fantasies and kink.

Using lubricants (lube) and erection devices, taking medicines, or managing incontinence or a stoma may mean you need to plan when to have sex. Some people say they miss spontaneity, others find that scheduling sexual activity gives them something to look forward to.

Many people in relationships do not see sex as important. How you feel about sex may also change as you get older. Spend time together doing things you both enjoy and that bring you closer. This helps make sure sex isn’t the only way you show affection or share intimacy.

Feeling relaxed can help with sexual pleasure. Use free apps and podcasts to guide you through relaxation and meditation techniques. Many treatment centres run meditation programs. Listen to Cancer Council's podcast series Finding Calm During Cancer.

Touch and masturbation can help you understand any changes in how you feel in a way that you have complete control over. You can work out what feels good to, or what feels sore or numb, without feeling self-conscious or pressure to “perform” or to keep going if you don’t want to. Once you feel comfortable exploring your body, you can show your partner/s what feels good and works best.

Ask your healthcare team how to manage any sexual changes. Your doctor can also refer you to a sexual health physician, sex therapist or psychosexual counsellor.