Suggestions that may help with sexual problems caused by cancer and its treatment

Help with body image problems

Body image is the mental picture you have of the way you look. This image may not be how your body actually looks, but rather how you think your body looks. Throughout life your body image is constantly changing. Your body image may alter regardless of whether or not a cancer, or its treatment, causes changes to the way you look.

Many people find that having a breast removed or a stoma affects how they feel about themselves. 

Physical changes in your body can affect how you feel about yourself and your sexuality. This may cause feelings of distress that go beyond the physical effects of cancer and its treatment. When there has been a change in your body, or how you think about your body, you may feel embarrassed, less confident or angry.

If your body image affects how you feel about yourself, it’s important to tell someone your fears rather than hiding them and letting them grow into something bigger. You may find it helpful to talk about this with your partner, a friend, your doctor or a counsellor/psychologist.

When having sex, changing the lighting level can help to build your confidence about how your body looks when giving and receiving sexual pleasure. You could try having sex in underwear or partly dressed rather than naked. It may help to lie on your side for sex to prevent pressure on scars or a stoma. Facing away from your partner, not towards, may also help.

If you are the partner of someone who has had changes in their real or perceived body image, it may also take you time to adjust to and accept the changes. You may need to reassure them that the changes to their body haven’t affected the way you feel about them. You may find it helpful to talk to a counsellor/psychologist about this.

Solutions for a mismatch in desire

It’s important to talk with your partner if you don’t feel interested in sex. It can be helpful to explain how you feel so they don’t feel hurt or rejected. You can also suggest what you are happy to offer as an alternative. 

Everyone’s sex drive is different and hormones are just one reason why you may not feel like being sexual. It’s common for people to have a changed sex drive – whether they have cancer or not - but if you start to be sexual, you may feel sexual.

If your partner is feeling frustrated it may be helpful for them to reduce the frustration through masturbation, either mutual or alone. If you are fatigued and don’t have much energy, it might help to have sex. Sexual positions where your weight is well supported can be more comfortable. Choose a time of the day when you have more energy. Make it a priority. Focus on sensuality and setting the scene. You may prefer quick sexual contact rather than long sessions. These are things you can talk about together. 

If the tension is building between you, you may find it helpful to get support from a counsellor/psychologist who specialises in offering help in these circumstances. Contact your local Cancer Society or phone the Cancer Information Helpline 0800 CANCER (226 237) for information on counselling.

Help for pain during sex

Pain during sex can occur after pelvic surgery or radiation to the area (click here for more information). The pain can take away sexual feelings and reduce desire. Often one experience of pain can lead to a fear of pain, which can lead to muscle tension. Increased muscle tension in the pelvic floor muscles can stop you achieving arousal, prevent lubrication, make penetration difficult and cause further pain. There are many reasons why pain can be felt. It may be helpful to see a pelvic health physiotherapist and learn relaxation techniques to stop the muscles tensing. It’s important to let your partner know what is painful during sex. Talk to your doctor about lubricants and moisturisers. Click here for a list of products and tips that may help you with dryness and improve sensation.

Solutions for loss of erection after cancer treatment

Some men say they have erection difficulties after cancer treatment. Generally, you may find it helpful to increase your range of sexual activity to include oral sex, mutual touching, masturbation or the use of a vibrator to help your arousal or that of your partner. For some this provides a whole new opportunity to explore sensual experiences without the pressure of ending in intercourse. If you are interested in using a vibrator or sex toy, adult shops and online services may be helpful.

With time, some men find they can recover full erections. You don’t need to have an erection to give your partner pleasure and you can still experience orgasm without an erection. Many find that a half-erect penis can still be effective for sex. The positioning for this is better with the partner on top guiding the penis inside. If you have had an operation that has damaged your erection-producing nerves, this need not be the end of your sexual activity.

There are practical ways to help overcome impotence, including:
  • physical devices such as vacuum pumps and constriction rings that can help you to achieve and maintain an erection
  • oral drugs such as Avigra, Viagra, Cialis and Levitra, which are options to discuss with your cancer doctor. These drugs cannot be used by men who take nitrate-based medicine for heart problems 
  • injections given straight into the penis
  • a penile implant – a device that achieves an erection through the use of a small pump within the scrotum
  • pelvic floor exercises.

Regular pelvic floor exercises, which involve exercising the muscles of the pelvic floor, help many men with bladder control and help with sexual sensations after prostate surgery. It’s advisable to start these exercises before treatment as sensations are affected for several weeks afterwards. Ask your doctor, a nurse or a pelvic health physiotherapist for information about pelvic floor exercises.

Vaginal changes after cancer treatment

Cancer treatments such as chemotherapy, hormonal therapy and radiation treatment to the pelvic area and pelvic surgery may cause a variety of vaginal changes. These might lead to vaginal dryness, narrowing or shortening, ulcers and infection. These changes may lead to pain during intercourse. Try experimenting with different positions when having sex. You may want to look into the options of using a vibrator or sex toy. Adult shops and online services may be helpful.

Vaginal dryness

There are a number of lubricants and moisturisers that can be put directly into the vagina to help prevent vaginal dryness. Lubricants are used as part of intercourse and moisturisers can be used regularly to prevent dryness. Water-based lubricants (such as Sylk) can be bought at a chemist or supermarket.

Replens is an example of a non-hormonal vaginal moisturiser, which you insert into your vagina three times a week. This is available at your chemist and you don’t need a doctor’s prescription – but this does not replace a vaginal lubricant and for your comfort you may need to use both. Ask your local chemist or doctor for other options, or phone the Cancer Society information staff on the Cancer Information Helpline 0800 CANCER (226 237) about this product.

To prevent dryness, wash the vaginal area gently with water only or use a fragrance-free soap substitute. Oilbased creams such as Vaseline and hand cream should not be used as they can cause infection.

Ovestin cream (oestriol) is available on prescription from your doctor. It contains a very small amount of oestrogen, and you put it into your vagina. This relieves dryness temporarily. Talk to your doctor about whether this is suitable for you. Vagifem (oestradiol) is also available on prescription, and is a tablet that you place into the vagina. It also contains a small amount of oestrogen. You may find you need to use a vaginal lubricant as well as the vaginal oestrogen.

Vaginal narrowing

This may happen after radiation treatment to the pelvis, and sometimes after surgery. After your treatment you may be advised to use vaginal dilators. These dilators prevent the two side walls of the vagina sticking together. The dilators are plastic tubes of varying sizes, which you insert three times a week for a few minutes. Ask your radiation therapist, doctor or nurse about where you can get a set of dilators and how to use them. You may use the dilators with your partner, and alternative ways to achieve vaginal dilatation (stretching) are to have regular intercourse, use a vibrator or use fingers. If you have problems using your vaginal dilators, ask your nurse specialist or doctor for a referral to a pelvic health physiotherapist.

Vaginal ulceration

Radiation treatment can also cause vaginal ulcers, which may produce a little bleeding. These can take weeks, or even months, to heal. If you have any unusual bleeding after sexual activity, you need to tell your doctor.

Vaginal infection

Some women find that they get vaginal thrush while having radiation treatment or chemotherapy. This is because there are changes in the acidity of the vaginal area that allow the normal organisms in the vagina to overgrow. If you notice a creamy white discharge, or itchiness, you may have thrush. This is easily treated and can be quickly resolved. You can purchase medication for the treatment of thrush from your chemist or with a prescription from your doctor. The medication comes in the form of a cream or pessary, for example Canestan. If you have had sexual contact, your partner may also need treatment.

Sex and head and neck cancer

Cancer in the head or neck area (eg mouth, tongue, throat or voice-box) may be tough on your sex life. You may have to cope with many changes, such as changes in your appearance after surgery, dry mouth after treatment, and changes to your speech or breathing. This can affect the way you feel about yourself and how you think others see you. You may feel less confident about sex. You may have ongoing pain and dry mouth, which makes kissing and oral sex uncomfortable. 

Try talking to your partner about how you are feeling. If talking is difficult, eye contact and touch are very powerful ways of showing how you feel. This can help you both to get used to the situation gradually.

Talking to a counsellor/psychologist or your nurse about ways to cope with changes to your appearance can be helpful. Some people find using make-up to hide scars is helpful. For more information, visit: www.dermnetnz.org/topics/cosmetic-camouflage/ If you feel very self-conscious, try having the lighting low when you have sex.

Talk to your doctor, dentist or nurse about managing pain and dry mouth problems. 

The Cancer Society has a booklet, Living with Dry Mouth/Te Noho me te Waha Maroke that you may find helpful. 

Some people with HPV-related head and neck cancers worry about spreading cancer to their partners.

Sex after treatment for bowel cancer

Most people are able to have satisfying sex lives after bowel cancer, but you will need time to get over surgery or other treatment. You should not have penetrative sex for at least six weeks after major surgery. This allows that area time to heal and gives your stomach muscles time to recover. If you have had surgery involving the anus, you are advised to wait 10 to 12 weeks before having sex. But there is no reason why chemotherapy or radiation treatment should stop you having sex if you feel like it.

Many people don’t feel like sex while they are having treatment. Side effects and general tiredness can get in the way. Surgery to the bowel or anus can affect the nerves to the sex organs. 

Maintaining or keeping an erection may be difficult and the orgasm may be dry. The ability to have an erection depends on whether there is nerve damage. If you have any problems with sex after your treatment you can discuss this with a health professional. There are a number of treatments available for erectile problems. You can find out more about them here

Anal sex can resume or may start when it’s comfortable for patients and partners. For those who have had surgery to close the anus, this will not be possible.