Healthy sexuality and cancer

Problems from cancer or its treatment can include lowered sexual desire, physical discomfort or a change in sexual functioning, body image issues, or extreme fatigue. Everyone reacts differently, however, and some effects will be temporary. Changes in the way you enjoy and carry out lovemaking may be needed. Communication with your partner is esssential.

What is sexuality?

Sexuality means different things to different people. It’s about who you are, how you see yourself, and how you connect with others. It is much more than sexual intercourse.

Cancer does not mean that you are no longer a sexual person or your sexuality will be destroyed. You can learn to feel good about yourself sexually despite the presence of cancer and the possible side effects brought about by the treatments.

How will cancer affect my sex life?

It is difficult to predict accurately how cancer and its treatment will affect you, but for most people there are changes which require them to adapt and develop new ways of giving and receiving sexual pleasure.

There are four main ways that cancer or its treatment can affect your sexuality. It can affect your:

• physical ability to give and receive sexual pleasure
• thoughts and body image (how you see yourself )
• feelings, such as fear, sadness, anger, and joy
• roles and relationships.

The links between these four areas are important. If there is a problem in one of them, it may have an impact on another. When someone becomes ill, it can affect their ability to feel good about themselves sexually, or their physical ability to give and receive sexual pleasure.

If this has happened to you or your partner, then it might be helpful to understand that some changes will only be temporary. Even if they are long-lasting, or permanent, you can learn to change or modify previous techniques that are no longer possible.

Lack of energy is common

Many people with cancer say they feel washed out and almost completely without energy over many months or even years. This may be to do with the cancer itself, or sometimes the treatment. In this situation you might not want to bother to do anything at all about sex. This tiredness can lead to loss of interest in sex during and after cancer treatment.

However, your desire to feel good about yourself or to reach out and connect with another person in your life rarely changes.

Aim for a flexible attitude

Communication is essential for healthy sexuality in a relationship. You and your partner, if you have one, can consider how to manage this aspect of your life. You can gather more information or resources to help you feel in control of maintaining good sexual self-esteem while undergoing treatment. Being open to change encourages healthy sexuality.

You may need to develop a whole new style of openness and flexibility in your relationship. It might be, for example, that one of you has always taken the lead in sex. This may have to change now. It could be that your favourite lovemaking positions are no longer comfortable, if only for a time. One or both of you may have seen sex as being entirely about intercourse. Clearly, if penetrative sex is impossible for some reason, you may want to start exploring other ways to experience sexual pleasure.

Acknowledging your own and your partner's needs is essential for healthy sexuality within couples. Remember that it's not just the person with the cancer that will be affected by the disease and its management. It can be more upsetting to watch someone we care for undergoing surgery and other treatments than to go through it all ourselves.

Sexual drive may undergo change

Sometimes it is the partner of the person with cancer who has a problem about sex. Your partner may feel afraid to touch you for fear of hurting you. Some people incorrectly believe they might catch the cancer through sexual contact. Your partner may lose desire as a direct result of the changes brought about in you. Your partner may also feel rejected if they do not realise that your reduction in sexual desire is due to the cancer or its emotional effects. 

It is also important to acknowledge that your partner's sexual drive may not be reduced. Sometimes it can even increase, if intimate touch helps to reassure them in times of stress. It may be important to talk through with your partner how they might increase their own self stimulation to reduce any frustration associated with reduced sexual contact. This may not be what you would ideally want but it can be a useful way for both of you to meet your needs and respect the fact that the mismatch is real and acceptable. 

Emotional intimacy may increase through greater communication, even when sexual intercourse is not possible.  Books and videos on sexual issues are available from shops and the internet - often they are not on display in shops so you may need to ask directly. Alternatively, your local library may have some useful books that you can borrow.

Starting again with sexual contact

Starting again and relearning about sensual bodily pleasures may be important for anyone who has a break in sexual contact. When rebuilding intimacy you may need to start very slowly and gently. Try caressing one another without a goal of orgasm or penetration.  Remember that there are many loving and erotic activities other than intercourse.

Early on, and perhaps even while your therapy is going on, you can keep love alive by cuddling and holding one another, perhaps learning to massage one another.

A person with cancer does not have to give up sexual contact completely.

Some people may find that they do not miss sexual contact and that not having sex is not a problem.

Common questions about sex and cancer

Can sexual activity actually cause cancer?

Not in the strictest sense of the word. In practical terms, the development of a few cancers may be influenced by a virus that is passed from one person to another during sex. Cancers of the cervix, vulva, rectum and penis may be linked to the human papilloma virus (HPV). But very, very few people who have one of these viral infections get cancer as a result.

There are many factors other than the virus at work, such as: the genes we inherit from our parents; whether or not we smoke; our age; our diet and our general health. These dictate whether or not an infection with a virus might affect the development of a cancer.

However, some people still see sex as bad or sinful and at some unconscious level fear that their cancer may be punishment for some past sexual disease or 'sin'. If you feel worried or guilty about your cancer having been given to you as a punishment, then it can be helpful to talk this through with a religious pastor, a counsellor or the Cancer Information Helpline (contact the Cancer Society - details at end of article under 'Further information and support').

Can I catch cancer from my partner?

No. If your partner has a cancer, you cannot catch it from any sexual activity. You cannot catch cancer from sex.

Could sex make my cancer worse?

No. On the contrary, sex and all the love and caring that goes with it can be helpful to those who have cancer. Many people feel depressed, unlovable, guilty or afraid when they have cancer or are having treatment, and their partner's affection and acceptance can make a big difference.

Are there times when sex should be avoided?

Yes, there are. First of all, it's safest either to avoid sex or to be sure to wear a condom or use some other form of barrier contraception during, and for a few months after, chemotherapy. We simply do not know enough about whether chemotherapy drugs can be present in semen or vaginal fluids.

Using barrier contraception removes any potential risks and avoids the stinging sensation some partners report.

For women who can still have children it is best to avoid becoming pregnant during treatment with chemotherapy. Vaginal intercourse is probably best avoided very soon after pelvic surgery in women.

The time to get back to sex will vary greatly according to the sort of operation you had and how quickly you are healing. You will be the best judge as to when you are ready.

Some types of cancer (of the cervix or bladder, for example) cause bleeding from the vagina or in the urine. If this sort of bleeding is made worse by intercourse then it is sensible to stop until treatment has controlled matters.

Are there any good positions for making love after cancer?

This will depend a lot on which part of the body is affected by the disease. If it is the pelvic area then it will take some gentle and patient experimenting to discover which lovemaking positions now suit you both. This can also be true after a mastectomy when some people say that they don't want their lover's weight resting on them. 

Maybe making love side by side, or swapping who is on top, will be better. Most couples find that with loving communication they can sort out what suits them best. And this will change with time, so be prepared to change what you do.

How can I overcome problems of tiredness?

Be flexible about the time of day you make love. Experiment with less demanding positions for lovemaking, and agree with your partner that lovemaking need not always mean a long session.

Make time to be together - book a babysitter or put the answer machine on.

I'm embarrassed about my scars but still want to make love. Any ideas?

It is a good idea to first talk things through with your partner. Most people find their lovers are much less concerned by their scars than they imagine, and once the subject has been discussed openly they can feel more relaxed about the changes in their bodies.

You could also consider making love in the semi-darkness to avoid being seen so clearly.

Some women also say that they find having sex with their bra on after a mastectomy makes them feel sexier. This both accommodates the false breast (prosthesis), if there is one, and helps to conceal scars. Crop tops or an all-in-one with gusset poppers can increase your comfort without you having to be completely hidden.

Men may also find it helpful to wear clothing such as vests or cummerbunds during sex if they are bothered by their scars.

Further information

The Cancer Society offers a Cancer Information Helpline where you can talk about your concerns and needs with specially trained nurses (contact details under 'Further information and support' below).

Related topics

 See Prostate cancer treatment and Prostate cancer issues after treatment

Original material provided by the Cancer Society of New Zealand, 2007. Reviewed by everybody, July 2010.