Intimacy, Sex and Fertility Issues

Little baby shoes

Sometimes, side effects from cancer treatments and the stress of having cancer can lead to sexuality and intimacy issues with a partner. These may include:

  • Loss of fertility or fertility problems in men and women
  • Loss of sexual desire
  • Problems getting or keeping an erection
  • Color changes of sperm or ejaculate after treatment with chemotherapy (short term)
  • Pain associated with sex for women
  • Vaginal dryness
  • Muscle weakness in women
  • Early menopause or changes in regularity of menstrual cycle

A cancer diagnosis can change the way you feel about yourself and how you relate to others. Your physical appearance may change because of your treatment. You may have short-term and long-term changes in your body. You may feel grief and loss, anxiety, and depression.

There are steps you can take to address both intimacy and fertility concerns. Talk with your healthcare provider about these issues. They can offer resources and support. A referral to a sexual health specialist may be helpful.


Changes in Intimacy

Physical closeness with your partner is a part of intimate relationships. The simple act of a touch, holding hands, or a hug can make you feel connected. Physical contact can make you feel less alone and improve your sense of well-being. Cancer, its side effects, and its emotional effects can affect sex and intimacy. Both partners may feel anxious about their sexual relationship. Factors like concern about physical appearance, depression, pain, or fatigue can lower sex drive or make intercourse difficult or impossible. Medical appliances (like pumps and ostomies) can also have an impact. Sometimes, there is a break in intimacy during treatment. After treatment, it may be hard to become intimate again. All these things can be upsetting and stressful. However, there are solutions available.


Communication Is Key

Couples may experience many changes in their relationships as a result of a cancer diagnosis. Talk to your partner about how you are feeling. You can maintain intimacy without having sex. You can do this through gentle touching, kissing, and physical closeness. Planning dates and times for intimacy can help you both feel more comfortable.

Sharing your concerns with your healthcare team can also help. They can offer solutions and support. You can ask for a referral to a gynecologist, urologist, or a counselor who specializes in intimacy, sexuality, or fertility after cancer. They can help with physical and emotional concerns. Treatments include medications, tips to increase physical comfort, talk therapy, stress management, changing routines, and support in talking with your partner. Know that you are not alone in coping with changes in your sexual or intimate relationships.


Tips to Cope With Intimacy and Sex Issues

  • During active treatment, and when you have a low white blood cell count (called neutropenia), you are at increased risk of infection. Ask your healthcare team if you can engage in sexual activity during this time.
  • Discuss the use of birth control. Many providers will advise women to stop using the pill during treatment.
  • Talk about using contraceptives during active treatment. Doctors usually advise using condoms or other contraceptives during this time. This prevents infections such as urinary track infections (UTIs) and yeast infections. It also prevents pregnancy. Some anticancer drugs can be excreted into the semen and vaginal fluid. Using condoms can also prevent exposing the patient's partner to the drug.
  • Vaginal dryness is a common side effect. Your healthcare team can prescribe medications to help with this.
  • Your healthcare team may be able to refer you to sexual health and fertility specialists.
  • Be open to discovering new ways you and your partner can connect and feel close.


Tips to Cope With Fertility Issues

Sometimes, cancer treatments can affect people’s ability to have children. These treatments include radiation, chemotherapy, or surgery. If you are thinking of having children, let your doctor know as soon as possible, even before you have started treatment. Some options such as tissue freezing or sperm or egg banking may need to begin before treatment starts.

Before you begin any of these procedures, check with your insurance company to see if they will cover them. If banking or tissue freezing is not an option for you, you may want to talk to your healthcare team about alternatives such as adoption, surrogacy, or a donor.


Tips to Cope With Hot Flashes

  • Avoid spicy foods, alcohol, and smoking.
  • Avoid saunas and hot baths or showers.
  • Wear layered clothing, preferably cotton.
  • Exercise.
  • Use deep, slow abdominal breathing techniques.
  • Try acupuncture — some people find that this can help relieve a number of their symptoms. Talk to your healthcare team first. It isn’t always covered by insurance.