cancer patient suffering of sexual dysfunction

Intimacy after Cancer: Navigating Sexual Health Post-Treatment

Cancer treatments can cause profound effects on sexual health and intimacy, depending on the type of cancer and the specific treatment received. Understanding the potential side effects on sexual function and how to address them can empower survivors to reclaim their intimate lives.

What you'll learn by reading this page:

Sexual side effects of cancer treatments and how they affect survivors
Sexual dysfunction in women and strategies on how to manage it
Sexual dysfunction in men and strategies on how to manage it

Understanding the sexual side effects of cancer treatment

Cancer treatments can bring about significant changes in many areas of life, and sexual health is no exception. For both men and women, treatments like chemotherapy, radiation, and surgery can lead to a range of sexual side effects, including reduced libido, vaginal dryness, erectile dysfunction, pain during intercourse, or emotional shifts that affect intimacy and relationships. These changes can be both physical and psychological, influencing how individuals feel about their bodies and their connection with their partners.

Understanding the sexual side effects of cancer treatments is an important part of maintaining your overall well-being during and after treatment. While these effects are common, they don’t have to define your sexual health or relationships. There are ways to manage these changes, communicate openly with partners, and find support to help rebuild intimacy and confidence.

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Sexual side effects of chemotherapy

Chemotherapy, which targets rapidly dividing cancer cells, can also affect the body’s normal cells, including those that regulate sexual health. Both men and women may experience a decline in sexual desire, physical discomfort, and emotional barriers to intimacy during chemotherapy.

How chemotherapy affects libido?

Chemotherapy can cause significant changes in libido due to its effect on hormone levels. For men, chemotherapy may lower testosterone, leading to a decreased sex drive. Women may experience disruptions in estrogen production, causing a loss of sexual desire. Fatigue, nausea, and emotional stress further contribute to these changes. These effects are often temporary, but they can be distressing during treatment.

Intimacy and sex during chemotherapy

In addition to reduced libido, chemotherapy can lead to physical side effects that impact sexual health. Men may experience erectile dysfunction, while women may face vaginal dryness, pain during intercourse, or changes in sensation. Fatigue and nausea can also diminish sexual interest, making intimacy challenging.

Many couples find intimacy difficult during chemotherapy due to physical discomfort and emotional exhaustion. However, intimacy doesn’t always have to involve sexual activity. Maintaining physical closeness, such as cuddling, holding hands, and sharing emotional support, can strengthen the connection between partners. Open communication about needs and limitations can help couples maintain a fulfilling relationship during this time.

"Vaginal dryness and discomfort are very common symptoms/concerns among many women of all ages. These symptoms are frequently due to hormonal changes that lead to lower estrogen levels - whether from natural menopause or cancer treatment-induced menopause."

Dr. Lisa Jervis,

Integrative medicine specialist at The After Cancer

Radiation therapy and its impact on sexuality

Radiation therapy can have a variety of effects on sexual health, depending on the area being treated. For those receiving radiation near the reproductive organs, such as pelvic radiation, there can be direct effects on sexual function. For men, this may manifest as erectile dysfunction, while women may experience vaginal dryness, discomfort during intercourse, or changes in sensation. Additionally, radiation can lead to fatigue and emotional stress, which can further reduce sexual desire. While it is generally safe to engage in sexual activity during radiation treatment, it’s important to be aware of any discomfort and to discuss concerns with your healthcare provider.

Sex after radiation therapy: what to expect?

After radiation therapy, patients may experience a range of changes in their sexual health. These can include physical symptoms like pain or discomfort during intercourse, changes in sensation, or a decrease in libido. For men, radiation to the pelvic region may cause erectile dysfunction, because of tissue scarring or reduced blood flow, which can occur immediately or develop over time. Women who receive pelvic radiation may experience vaginal narrowing or dryness, making intercourse uncomfortable. It's important to discuss these side effects with a doctor, as there are treatments available to manage discomfort and improve sexual function. Many of these side effects improve over time, but addressing them early can help maintain a healthy and fulfilling sex life.Treatments such as lubricants, erectile dysfunction medications, or pelvic floor therapy may help restore sexual function.

The impact of surgery on sexual health

Surgical treatments for cancer can profoundly affect sexual health, particularly when they involve organs related to reproduction or hormone production. Prostate surgery for men and breast surgery for women are two common procedures that can lead to significant changes in sexual function and intimacy. Addressing these challenges early can help patients regain confidence and intimacy post-surgery.

Prostate surgery and erectile dysfunction

Prostate surgery, particularly a radical prostatectomy, often results in erectile dysfunction due to the close proximity of nerves that control erections. The extent of erectile dysfunction varies, depending on whether nerve-sparing techniques were used during surgery and the patient's pre-treatment sexual health.

cancer survivor dealing with sexual dysfunction after cancer treatment

Breast cancer surgery and intimacy

Breast cancer surgeries, such as mastectomy or lumpectomy, can have a profound effect on a woman’s body image and sexual health. The physical loss or alteration of a breast can lead to emotional and psychological challenges that affect intimacy. Understanding these potential changes and seeking support can help women and their partners navigate this difficult transition.

Post-breast surgery, intimacy can become a sensitive subject for many women. The physical scars and changes in appearance may lead to a loss of confidence or feelings of unattractiveness. It’s essential for women and their partners to communicate openly about these challenges. Finding new ways to connect, such as focusing on emotional closeness and exploring new types of physical touch, can help maintain a fulfilling intimate relationship. Support from counselors or therapists who specialize in body image and intimacy after cancer may also be helpful.

"Due to pain or sickness, intimacy may have significantly decreased. One partner may have become more of a caregiver rather than a romantic partner and transitioning back to equal romantic partners can be challenging."

Dr. Tommy Bischoff

Therapist at The After Cancer

Relationship stress after cancer treatment

For many cancer survivors and their partners, adjusting to the post-treatment relationship dynamic can be challenging. After cancer treatment, couples often struggle to shift from the caregiver-patient dynamic back to a romantic and intimate relationship. During treatment, the focus is on survival, which can leave little room for intimacy. The fatigue, discomfort, and physical changes can make survivors feel less confident or “unsexy,” and transitioning back to a sexual relationship can be difficult for both partners.

It’s also common for the non-patient partner to experience sexual dysfunction or stress. Partners may be hesitant to initiate intimacy out of concern for hurting the survivor, or they may worry about causing discomfort. That’s why communication is key for both partners. It’s important to establish an open, respectful dialogue where both can express their needs and concerns.

For survivors who are single, entering the dating world again can be especially challenging. Discussing the impact of treatment on fertility, or even explaining the trauma of their cancer experience, can make dating feel overwhelming. Sharing a complex medical history with a new partner can create anxiety about how to disclose such personal details while building a connection.

Whether you're in a relationship or dating again, addressing these issues may require assertiveness training to improve communication and boost confidence. Role-playing these difficult conversations with a therapist can also help ease the discomfort.

Connecting with other cancer survivors is another great way to gain support and learn from shared experiences. It’s important to remember that support is available, and it’s okay to lean on others who truly understand what you’ve gone through.

Take it slow

It's important to understand that sexual dysfunction post-cancer is common, and there are many options available to help manage and overcome these challenges. By addressing the physical, emotional, and relational aspects of sexual health, cancer survivors can work towards restoring a fulfilling intimate life.

The after cancer period can be a time of feelings of loss and confusion, but the good news is that there is work to be done on changing your identity and feel like a sexual being again. It is important to know that especially with women who had internal radiation, medical trauma can certainly be relevant when it comes to sexual health, and this should be addressed as well. For many cancer survivors, their needs are not fully attended by medical teams, but it is a valid concern and you should absolutely work to address your sexual health and get help to do it.

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Sexual dysfunction in men

Sexual dysfunction is a common issue for many men undergoing or recovering from cancer treatment. Whether due to direct physical effects of treatment or psychological challenges, men diagnosed with cancer often face significant changes in their sexual health. Sexual dysfunction can manifest in several ways, including erectile dysfunction (ED), decreased libido, orgasmic difficulties, or even challenges with intimacy and sexual satisfaction.

An American Cancer Society research indicates that cancer treatments, such as surgery, radiation, chemotherapy, and hormonal therapy, can all affect sexual function. Many of these, especially those targeting hormone-sensitive cancers like prostate cancer, can reduce testosterone levels. Testosterone is a critical hormone for sexual desire, erections, and sperm production, and a drop in this hormone can result in low libido, fatigue, and erectile difficulties. Cancer treatments can lead to psychological issues such as depression, anxiety, and stress, all of which play a major role in sexual health. The fear of recurrence, body image issues, and changes in intimacy can negatively affect sexual desire and performance. Conditions such as hypertension, diabetes, and heart disease, all of which are common in older cancer survivors, can also contribute to sexual dysfunction. These health issues can exacerbate the physical effects of cancer treatment, making it more difficult for men to achieve or maintain an erection.

This issue can be distressing for men and their partners, affecting relationships, self-esteem, and overall quality of life.

It's essential to understand that sexual dysfunction is a manageable condition, and many men regain their sexual health through various medical, holistic, and psychological treatments.

Medical approaches

Medication

Common treatments for erectile dysfunction (ED) include phosphodiesterase type-5 (PDE5) inhibitors like Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). These medicines work by blocking an enzyme called PDE5, which usually breaks down a substance in the body called cyclic GMP. When cyclic GMP stays around longer, it helps the blood vessels in the penis relax and open up, letting more blood flow in, which helps with getting an erection.

These medications are typically the first-line treatment for ED because they are effective for many men, especially following treatments like prostate cancer surgery or radiation therapy.

However, it’s important to note that PDE5 inhibitors may not be effective for all men, particularly those who have extensive nerve damage from surgery or radiation. Additionally, these medications require sexual stimulation to work and do not create an automatic erection. Side effects such as headaches, flushing, or stomach discomfort can occur in some individuals. Always consult a healthcare provider before starting any medication to ensure it is safe, especially in those with underlying health conditions like heart disease or diabetes.

Penile rehabilitation

For men experiencing persistent ED after prostate cancer treatment, penile rehabilitation is another option. This approach combines various therapies like vacuum erection devices, penile injections (e.g., Alprostadil), and penile implants. These treatments aim to improve blood flow and preserve erectile tissue health after surgery or radiation.

Hormonal therapy

For men whose ED is linked to low testosterone levels, often as a result of cancer treatments, testosterone replacement therapy can help restore sexual function. However, testosterone therapy must be approached with caution, particularly for prostate cancer survivors, as high testosterone levels can encourage cancer growth.

Psychological approaches

Cognitive behavioral therapy

Based on the cognitive model, this approach explores how thoughts influence our behavior and mood, as those things can all interact with each other. It works to identify unhelpful thoughts and thinking patterns and restructure them to align with reality in a constructive and gentle way.

Mindfulness

The most researched coping strategy for sexual health issues is mindfulness practices. The act of being intentionally and non-judgmentally in the present. A lot of times, when going through treatment, women feel very disconnected with their bodies and sometimes that’s a survival behavior. However after treatment when you want to re-engage with your sexual being, mindfulness can be really helpful.

Lifestyle and holistic approaches

Physical activity

Regular exercise is a powerful tool for improving sexual function and overall quality of life. Physical activity enhances blood circulation, which is crucial for achieving and maintaining an erection. Exercise also helps reduce stress, one of the major psychological contributors to sexual dysfunction. Activities such as walking, swimming, or strength trainingcan not only improve heart health and stamina but also boost mood by releasing endorphins, the body's natural feel-good chemicals. This improvement in mood and energy can have a positive impact on intimacy and sexual desire. Even moderate physical activity, such as daily walking or yoga, has been shown to enhance overall well-being and aid in recovery from cancer treatments.

Diet and nutrition

What you eat plays a crucial role in supporting sexual health, particularly when it comes to circulation and hormone regulation. A balanced diet rich in omega-3 fatty acids (found in foods like salmon, walnuts, and flaxseeds), antioxidants (from berries, spinach, and green tea), and leafy greens can help improve circulation and protect blood vessels, which are essential for sexual function. A healthy diet can also help maintain an optimal weight, as obesity is linked to erectile dysfunction and other sexual health issues. Certain foods, like dark chocolate and pumpkin seeds, contain compounds that can enhance blood flow and increase libido. Maintaining a nutritious diet also supports hormonal balance, which is vital for sexual desire and function.

Support groups

Emotional health is just as important as physical health when it comes to managing sexual dysfunction. Support groupsoffer a safe space for cancer survivors to share their experiences, express concerns, and gain emotional support from others who understand their struggles. Whether in-person or online, connecting with others who have gone through similar experiences can reduce feelings of isolation and shame. Support groups also provide valuable coping strategies for managing anxiety, depression, and body image issues, all of which can negatively affect sexual health. Additionally, learning from the experiences of others can offer practical tips on navigating intimacy post-treatment. Talking openly in these settings can help normalize conversations about sexual health and allow men to feel more comfortable discussing their needs and desires with partners or healthcare providers.

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All in all...

Sexual dysfunction is a common issue faced by many men undergoing cancer treatment. It can stem from a combination of physical changes, hormonal shifts, psychological factors, and comorbidities. However, medical interventions, psychological support, and lifestyle changes can significantly improve sexual health post-treatment. Whether you’re managing erectile dysfunction or seeking to rebuild intimacy with a partner, there are effective treatments and support systems available. It’s important to work with healthcare providers to develop a comprehensive approach that addresses both the physical and emotional aspects of sexual health after cancer.

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Women and sexual dysfunction

Sexual health issues are some of the most common distressing concerns for cancer survivors. In fact, it's been estimated that 78 per cent of women treated for gynecologic cancer, experience some kind of sexual problem such as issues with lower or absent sexual desire or arousal, sexual pain, loss or change of sensation and loss of orgasm.

Sexual health can be impacted by biological, psychological, cultural and interpersonal factors. It's important to consider that there may be multiple factors related to sexual health.

The physical effects of all cancer treatments can compromised sexual function. Additionally, the psychological symptoms can compromise sexual health. For example, going through cancer treatment means a lot of bodily changes and the body can look a lot different, affecting body image - how we think and feel about ourselves is relevant to sexual health and willingness to be intimate with a partner, and it can also affect our sense of self-esteem and confidence. Anxiety and depression can also affect sexual desire. Medication treatment for depression and anxiety can decrease sexual desire as well. Women also find that they have a lot of fatigue and sleep issues during treatment and post-treatment periods, as the energy level can also affect the ability to function with sexual health. Stress in the relationship tends to also affect intimacy.

"Many GYN cancer survivors may experience short or long term side effects related to their cancer treatment. Surgery may cause changes in physical anatomy and nerve function which can lead to numbness or changes in sensation, loss of spontaneous sexual arousal, loss of orgasm and loss of sexual desire. "

Kelly Sherger

Therapist at The After Cancer

Psycho-education and therapies

Psycho-education

Psycho-education relates to learning about your cancer treatment, the cancer itself, your body, how specially how bodies respond to different sexual stimuli. For example, people think desire should be spontaneous, but for most people it is actually more responsive desire, and sometimes people need to have some kind of sexual stimulation.

Psychotherapy interventions

These interventions can follow 3 different settings:

1. Individual therapy

2. Couple therapy

3. Group therapy

With this in mind, the decision to go forward with one or more of these therapy modalities is entirely up to how comfortable you feel. Sometimes is just a matter of trial and error to figure out what works best for you!

Cognitive behavioral therapy

Exposure therapy

Also known as Systematic Desensitization, as the period post-cancer treatment can be very anxiety inducing, when it comes to engage in sexual activities or even just touch following cancer treatment, it may take some easing in and define coping strategies to relax the body. This approach helps take very slow step measures to work towards the anxiety inducing stimuli with learning some coping strategies.

Accepting and commitment therapy

This therapy works similarly to cognitive behavioral therapy, but instead of reframing the thoughts, we learn how to change our relationship and learn how to disconnect from those unhelpful thoughts.

Mindfulness

Sensei focus

Specific sex therapy which includes components of mindfulness and exposure of systematic desensitization, and you can go as an individual or couple. It includes touching exercises with the purpose of mindfulness.

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"One of the things that I have learned working with oncology patients is that the best tips and tricks are usually learned from other survivors. Use this platform, as much as you can, to get support from other people who've gone through what you have. It's essential and something that I really encourage doing."

Kelly Sherger,

Therapist at The After Cancer

Physical therapy

After cancer treatment, patients can experience Pelvic Floor Dysfunction. This encompasses a group of disorders that can occur whenever there are any ligaments or muscles inside of the pelvic floor that are not coordinated, and as a result they cause some type of urinary or bowel dysfunction (urinary incontinence, constipation, urinary urgency or frequency).Pelvic floor dysfunction can also impact the relaxation of the pelvic floor (relaxation or contraction) which is supposed to support your pelvic organs (bladder and rectum). For example, radiation and some type of chemotherapies, can sometimes cause the pelvic floor to lose estrogen and begin to thin out, causing pelvic pain or pelvic disorders. A lot of times it occurs because the muscular skeletal system doenst know to relax or contract when it needs to. Some tips from our experts include:

Teach your body how to relax your muscles

Learning how to breathe is one of the most important strategies to help your body relearn how to contract and relax your pelvic floor muscles. One simple and very helpful exercise is to try to activate the diaphragm - put your hands underneath your ribcage and breathe in and out. When you inhale the pelvic floor muscles drop down and when you exhale they rise up, this movement will help your body understand the dynamics of contraction and relaxation needed to improve pelvic floor dysfunctions

Oils or gels as lubricants

After radiation treatment, for example, pelvic floor muscles can become very dry and sometimes cause spasms, and discomfort during sexual activities, which can be very painful. Experts recommend coconut oil suppositories that allow the vaginal wall membrane to have some lubricant or use a water-based lubricant to help with sexual intercourse. Vaginal dilators are also recommended to help open the vaginal vault gradually, at the patient's pace.

"We want to make sure that you as a patient knows that there is help strategies for you. If you have problems with constipation, with intercourse or pelvic pain, make sure to see a pelvic floor therapist. We are here to help. My top tips are: learn how to breathe, lean how to use your diaphragm, learn how to relax your pelvic floor, and how to relax your body in general."

Dr Katrina Heath

Physical therapist at The After Cancer

Body image and sexual health after cancer

For many cancer survivors, adjusting to life after treatment involves not only physical recovery but also rebuilding their relationship with their bodies. Body image issues are incredibly common, affecting a significant percentage of cancer survivors. Research shows that anywhere from 40% to 80% of survivors experience some form of body image concerns following treatment. These concerns can range from visible changes like scarring, discoloration, and hair loss, to more internal shifts such as weight gain or loss, changes in anatomy, or sensory changes from surgery or treatment. For some, it’s a general discomfort with how the body looks or feels. It's important to acknowledge that many survivors may also have had pre-existing body image struggles that were exacerbated by cancer treatment.

One of the key challenges many survivors face is a disconnect between their mind and body. During cancer treatment, especially for gynaecological cancers, survivors may experience a shift in how they relate to their bodies due to invasive procedures, surgeries, and the medicalized nature of cancer care. Many report feeling as though their bodies have betrayed them or that they cannot trust their body’s signals, such as pain or discomfort, which can deeply affect their emotional and physical well-being. This disconnect can persist after treatment when survivors are faced with reintegrating into their bodies, especially in terms of sexual identity and self-esteem.

Rebuilding this mind-body connection is an important part of the survivorship process. Mindfulness practices can be especially powerful in helping survivors reconnect with their bodies. By focusing on the present moment and becoming more attuned to sensations like breathing or feeling textures in the body, mindfulness fosters a sense of reconnection and acceptance. This approach helps survivors move beyond the discomfort of negative body image and gradually reclaim a sense of ownership and appreciation of their bodies.

Additionally, survivors who struggle with negative body image or intrusive thoughts about how their body looks or feels can benefit from Cognitive Behavioral Therapy (CBT). This approach helps survivors reframe unhelpful thoughts and replace them with more realistic and compassionate perspectives, allowing them to foster a healthier relationship with their body. Instead of focusing on what’s changed or perceived as “flawed,” survivors learn to acknowledge and appreciate what their body has endured and accomplished.

For those who find it difficult to look at their body or experience discomfort with their body’s appearance, therapies like exposure therapy and Seisei focus can be very helpful. These therapies help individuals slowly and safely confront their body’s new reality. Sensey focus, for instance, encourages survivors to explore their body through touch and sensation, gradually helping them become more comfortable with their body’s changes and sensations. Over time, these practices help survivors regain a sense of empowerment, acceptance, and pleasure in their bodies, which can significantly improve sexual health and intimacy.

It’s important to remember that healing from cancer is not just about physical recovery, it’s also about emotional restoration. Rebuilding a positive body image can lead to a healthier relationship with sexuality, which is often a crucial part of overall well-being.