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Intimacy and Sex

A guide for people with cancer and their partners.
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Sex and intimacy may change when you have cancer

You may be used to thinking about sex as just intercourse. Sex can be any type of touching or intimate activity that makes you and your partner feel good and connected. Cancer treatments will change your body. Your sex life will probably be different after having cancer. With time and effort, you can have a good sex life again.

Coping with changes in your sex life

When your body goes through changes from cancer and its treatment, you may feel grief or a sense of loss.

The following changes could affect your sex life:

  • Loss of a body part, like a breast or prostate
  • Problems with erectile function (getting or keeping erections)
  • Pain or discomfort during sex
  • Needing to use things like erection pills or vaginal lubricants
  • Dry mouth and sores

Give yourself time to adjust if you need to grieve any changes to your body and your sex life.

Talking about sex

Talking to your partner and health-care team about sex is an important first step in making things better.

Talking about sex may not be easy or comfortable for you. Many people do not like to talk about sex.

Tips for talking to your partner about sex

If you are nervous or uncomfortable, try writing down your thoughts first. Speak openly with your partner. It might be scary at first, but if you share what you are feeling, you can work through any issues together. Tell your partner what you want and what feels good or does not feel good.

Tips for talking to your health-care providers about sex

You can feel comfortable talking to your health-care providers about sexual concerns. They are used to talking about how our bodies work. Make a list of questions or concerns before your appointment so you do not forget them. If you prefer, you can even give your health-care team the list instead of saying the words.

Counselling can help

A counsellor can help you understand and cope with changes in:

  • How you feel sexual pleasure
  • How your body functions during sex
  • How your body looks and feels
  • Your relationships

If you have a partner, getting counselling together can help you work through sex and relationship concerns as a team.

Sex and your treatment choices

Different treatment options can affect your sexual function in different ways. There may not be a lot of treatment choices for the cancer you have. For some types of cancer, there may be more than one treatment option. Before your treatment starts, ask how it may affect sexual function so you will know what to expect.

Body image

Body image is how you see your body and how you feel about the way you look. When cancer changes your body, you may feel unhappy and worry about how others see you.

Stay positive about your body

Remember that your body is only a small part of what makes you who you are. Be kind to yourself. You are likely harder on yourself than others ever will be. Some changes to your body will not last forever and will get better over time. For everything you find wrong with your body, look for something good.

Caregivers and sex

When your sexual partner has cancer, your role as a caregiver can be confusing and conflicted. Some partners find that cancer brings them closer together, while others find it can drive them apart.

What to do when your sexual partner has cancer

Be open with your partner about your feelings, and be patient with them. They may need time to heal or rest before sex feels good again. Talk about your sexual wants and needs with your partner. It is okay for you to have wants and needs, even if your partner is sick. Take care of your own health. Eat well, take breaks, get help with things like cooking and make sure you get enough sleep.

Having sex cannot make your partner’s cancer worse. For most people with cancer, sex can be safe and enjoyable.

Physical problems that can affect sex

Problems with the penis

Erectile dysfunction

Erectile dysfunction is when you have trouble getting or keeping an erection.

How to manage erectile dysfunction:

  • Keep trying to get an erection; any type of blood flow to the penis is helpful
  • Keep up any kind of touching, either by yourself or with your partner
  • Talk to your physician about therapies to help you get an erection
  • Things like erection pills or vacuum erection devices may help
  • Try having fun with sexual activity that does not focus on intercourse
  • Remember that you can probably climax or orgasm even if your penis is not firm

Changes in size and shape

Some cancer treatments can cause your penis to get shorter and smaller. You may feel upset by this change. Changes in size and shape may or may not happen with erectile dysfunction.

How to manage changes in size and shape:

  • Keep trying to get erections, either with or without a partner
  • Blood flow to the penis can help to prevent the penis from getting smaller
  • Talk to your health-care provider about using medications or devices to help with changes in shape and size

Problems with the vagina

Narrowing of the vagina (vaginal stenosis)

Narrowing can make it hard or impossible to put things into the vagina. It can be caused by:

  • Spasms of the muscles in the walls of the vagina (vaginismus)
  • Radiation therapy to the pelvis
  • Surgery to the pelvis

How to manage narrowing of the vagina:

  • Use a vaginal dilator, which is a device or set of devices that you put inside the vagina to keep it open for a period of time
  • Use the dilator several times each week until about six months after treatment ends
  • Ask your health-care team how often to use your dilator and what type to buy

Dryness

Cancer treatments like chemotherapy, radiation therapy and surgery to the pelvis can cause vaginal dryness. Dryness can make it painful to get pelvic exams or have sex. It can also make you more prone to vaginal infections.

Vaginal moisturizers can help keep your vagina moist on a daily basis. They are usually put into your vagina every couple of days. They can be:

  • Creams or gels
  • Suppositories

Vaginal lubricants are put on or into the vagina just before having sex or inserting a tampon or vaginal dilator. They give your vagina extra moisture to help make sex feel better or to make it easier to insert things into the vagina.

Do not use these products inside the vagina:

  • Petroleum-based products like Vaseline
  • Hand or body lotions
  • Massage oils

Hot flashes

Hot flashes make you suddenly get very warm, flushed and sweaty. The flushing may appear on your chest, neck and face. After the hot flash, you may feel cold. Hot flashes can happen to people of any gender during cancer treatment.

How to manage hot flashes:

  • Dress in cool layers and avoid hot drinks
  • Breathe deeply and slowly when you are having a hot flash
  • For women, hormone treatment may also help, as long as you do not have hormone-sensitive cancer
  • For men, there are other medications that can help

Low sex drive

A low sex drive can be caused by cancer treatment, the cancer itself, or treatment side effects like fatigue, nausea or painful intercourse. The effects of your low sex drive may be short term or long term.

How to manage low sex drive:

  • In the short term, you and your partner may be satisfied with affection like holding hands, hugs, massages and cuddling
  • In the long term, you and your partner may need a plan to handle your low sex drive; a sexual health specialist can help

Incontinence

Cancer and treatments can sometimes cause incontinence, which is a loss of control of your bladder or bowel functions. Incontinence can make you feel awkward, embarrassed or anxious about sex.

How to manage sex and incontinence:

  • Plan to have sex at a time of day when you feel the least tired
    • The muscles that control your bladder and bowels may work best when you feel most awake
  • Go to the bathroom to empty your bladder and bowels before you have sex
  • Do Kegel exercises to strengthen the muscles that control your bladder and bowels.

Safe sex during cancer treatment

During cancer treatment, you and your partner may have to do things differently or not have sex for a short period of time.

Safety tips:

  • Use birth control if there is any chance you or your partner may become pregnant
    • Ask your health-care team if your treatment may harm an unborn baby
  • If you have had surgery on your pelvis, wait until your physician says you have healed enough before you have sex
  • If you have anal sex, use a condom, try gentle positions with your partner and ask your health-care provider if there are any other safety concerns you should think about
  • If you have oral sex, use a condom or a dental dam

All of the general rules for safe sex still apply when you have cancer:

  • Use condoms to prevent sexually transmitted infections
  • Use effective birth control if you do not want to become pregnant
  • Choose sexual partners who make you feel safe

Key points

  • Your health-care team can help with any concerns you have about your sexual well-being
  • Counselling can help you feel better about changes to your body and your sex life
  • Be open and honest when talking to your partner and your health-care team
    There are solutions to many of the sexual problems you may be having

Where to get more information

Visit the websites below for more information and support.

If you need this information in an accessible format, contact 1-855-460-2647, TTY: 416-217-1815 or [email protected].

Special thanks to the Patient and Family Advisors and the Clinical Advisory Group who worked on this guide and the University Health Network for sharing patient education content.

This patient guide was created by Cancer Care Ontario to provide you and your partner with information about intimacy and sex when you have cancer. It should be used for information only and does not replace medical advice. This guide does not include all information about intimacy and sex when you have cancer. Always ask your health-care team if you have questions or concerns. The information in this guide does not create a physician-patient relationship between Cancer Care Ontario and you.

About this guide

Ontario Health’s patient guides provide Information on managing health-related symptoms (“Information”). The patient guides are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, treatment, or care. The information does not establish a physician-patient relationship between you and Ontario Health. Always seek the advice of a qualified health-care provider.

The patient guides may be amended, reproduced, and distributed without prior permission of Ontario Health for limited use in healthcare settings where patients may benefit from the information. Ontario Health must be cited as the source only when the patient guides are reproduced in their original form. Ontario Health is not responsible for any copyright reproduction of materials.