Sexual Health Q&A

What kinds of sexual problems might cancer patients face?

Much depends on the type of cancer a person has and the type of treatment he or she receives. In general, however, these are some of the more common sexual issues for cancer patients.

Diminished Sexual Interest or Desire

Some patients find that chemotherapy or medications have sexual side effects that decrease their libido. They may feel fatigued from treatment, too exhausted to even think about sex. And there can be emotional issues as well. Patients may feel anxious about having sex, with concerns about safety, pain, and body image. They may worry that a partner will not find them attractive if they have scars or if their body has changed, such as with a mastectomy. Depression can cause partners to distance themselves from each other.

Counseling, especially with a therapist that specializes in cancer, may help some patients overcome their anxieties and cope with depression. Couples with relationship issues can benefit from therapy as well. A qualified therapist can help partners learn to communicate more effectively and may suggest different strategies for restoring intimacy.

Vaginal Dryness

Cancer treatment causes vaginal dryness for many women. Some treatments induce surgical menopause, which decreases levels of estrogen, a hormone involved with vaginal lubrication. Without sufficient lubrication, sex may become uncomfortable or painful. Fortunately, a lubricant or vaginal moisturizer may help.

Pain

Changes in the genital area, such as from surgery, might make sex difficult or painful. Couples may need to make adjustments in their sexual activity. This may mean trying new positions or exploring other ways to be intimate, such as having oral sex, using sex toys, cuddling, kissing, or massaging.

In many cases, genital pain after cancer treatment improves significantly over time, as tissues heal.

Erectile Dysfunction (ED) and Ejaculation Difficulties

Some men are unable to get or maintain an erection suitable for sexual intercourse. This is common for prostate cancer patients, who may sustain nerve damage during treatment. It can also happen to men who are treated for penile, testicular, or colon/rectal cancer. Penile rehabilitation programs, which may include oral medications and vacuum erection devices, are helpful for some men with ED.

Men may also have trouble reaching orgasm or ejaculating. For example, retrograde ejaculation, in which semen travels backward into the bladder instead out of the penis, can occur.

Patients are encouraged to discuss the potential sexual side effects of cancer therapy with their doctors before treatment begins. Healthcare providers can address a wide range of issues, from the physical to the psychological and emotional. Patients may choose to include their partners in these discussions as well.