Sexuality Issues

Cancer and its treatment may affect how you feel about your sexuality. Sexuality refers to how you feel about yourself and your body and how you relate intimately to your spouse or significant other. Lack of sexual desire is the most common sexuality issue among both men and women with cancer. For younger women, other issues include symptoms of early menopause, such as hot flashes and vaginal dryness, and pain during intercourse. Among men, erectile dysfunction is a primary issue. Fertility is a related issue and is discussed on the chart with a summary of other side effects.
 

Treatment-related sexuality issues are most likely to occur in men and women who have had treatment directed at reproductive organs.
 

There are a wide range of reasons for changes in sexuality during cancer treatment, and the reasons relate to the treatments themselves as well as to other side effects of treatment.

Surgery has a variety of effects on sexuality. Removal of all or part of a reproductive organ decreases hormone levels, which can lead to overall loss of sexual desire. Such surgery can lead to premature menopause in younger women, and may make sexual intercourse painful or difficult for younger and older women. Surgery in the pelvic area in men can damage the nerves leading to the penis, causing erectile dysfunction. Lastly, surgery that changes body appearance, as with removal of a breast or a testicle, can affect how a person feels about his or her body image. A negative body image can change how you feel about your sexual desirability.

Chemotherapy or radiation therapy to the pelvis may damage the ovaries in women or the testicles in men, both of which can reduce the amount of hormones produced. This loss of hormones may cause a loss of sexual desire in men and women, premature menopause in younger women, and erectile dysfunction in men.

The side effects of cancer treatments also play an important role in sexuality. Side effects such as fatigue, nausea and vomiting, pain, diarrhea, and mouth sores can substantially reduce a person’s interest in sex and his or her feelings of desirability.
 

Changes in sexuality caused by cancer treatments may be short-term or long-term. The effects of chemotherapy or radiation therapy on the ovaries or testicles may be reversible, with function returning gradually over the few months after treatment has ended. In contrast, loss of function is permanent when these organs are surgically removed. Full recovery of erectile function after surgery may take 1 to 2 years. Resolution of sexual changes usually takes a while because both psychologic and physical factors are involved.
 

Some treatments are available for physical sexual issues. For example, vaginal dryness can be treated with vaginal moisturizers and lubricants. Several drugs are available for erectile dysfunction, including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs may not be appropriate for every man, and men should talk to their doctors about the risks and benefits. Hot flashes in both women and men have been relieved with low doses of antidepressants such as fluoxetine (Prozac), venlafaxine (Effexor), duloxetine (Cymbalta), and paroxetine (Paxil).
Management of side effects that interfere with intimacy can help you feel better overall, which may help you feel more desirable and more interested in sex.
Open communication with your spouse or significant other is key to maintaining a good intimate relationship. You and your partner should share concerns and fears. Talk about ways to be intimate other than with sexual intercourse. You should both understand that it is safe to have sex during cancer treatment (unless your doctor tells you otherwise). Counseling (individual, couples, and/or sex therapy) may be helpful.
If you are single during your cancer treatment, it is best to allow yourself some time to adjust to changes before you begin a sexual relationship.
 

You should talk with your doctor before treatment begins to find out what to expect in terms of sexuality issues. If there are treatment options, make sure to talk about the side effects of each option. Ask your doctor when it is safe to resume sexual activity after treatment. During and after treatment, talk to your doctor or nurse if you have symptoms that interfere with sexual desire or sexual performance. If you feel uncomfortable talking with your doctor or nurse about your sexual symptoms, ask for a referral to an appropriate health care professional or support group.
 

• American Cancer Society: www.cancer.org, Sexuality for Women and Their Partners
  Sexuality for Men and Their Partners
• M. D. Anderson Cancer Center: www.mdanderson.org, Sexuality, Fertility & Cancer
• Mayo Clinic: www.mayo.org, Sexuality after Cancer Treatment: What Women Can Expect, Sexuality after Cancer Treatment: What Men Can Expect
• Oncolink: www.oncolink.com, Coping with Cancer: Sexuality and Fertility

• Changes in Appearance and Sex Life After Breast Cancer Treatments
• Sex After Cancer Treatment Can Be an Issue, and You’re Not Alone
• Sexual Issues After Cancer: Helpful Advice for Women