How do I maintain a healthy sex life?

How will treatment affect my sex life?

Chemotherapy

If you are receiving chemotherapy, speak to your doctor about precautions to protect your partner. Chemotherapy drugs may be secreted from your body for a few days following infusion. It’s a good idea to use a condom during this time. Although fertility issues are common during treatment, it is still possible for women to become pregnant while on treatment. This should be avoided, as chemo drugs are very dangerous to an unborn baby. Speak to your oncologist about the right kind of birth control for you.

Women

Many women receiving chemo report a loss of libido at some point during their treatment. Women often experience a drop in estrogen production, which leads to early symptoms of menopause. This can include vaginal dryness, and a lack of a period. Chemotherapy drugs attack the fast-growing cells in mucous membranes (including those in the vaginal lining) which can cause the vagina to become irritated. If you are taking steroids or antibiotics, you may be at increased risk of yeast infections. If you have experienced genital warts or herpes in the past, chemo can cause these to flare up.

Symptoms such as vaginal inflammation will likely be temporary. Other symptoms such as menopause and vaginal dryness may resolve after you stop treatment, or they may become permanent.

Men

Chemo can reduce testosterone production, or cause it to slow down. This can lead to a loss of libido. It can also cause difficulty getting and maintaining erections. However, many men report that their libido and ability to have erections eventually return after treatment has finished.

Radiation

If you are receiving radiation therapy, and aren’t experiencing significant pain or bleeding. It should be safe to have sex with your partner. It’s important to take precautions to avoid pregnancy during this time.

Women

Pelvic radiation can cause scarring and damage to the vaginal walls. The most common symptoms women report are loss of libido, vaginal dryness, pain during penetration, and a narrowing or shortening of the vagina (vaginal stenosis). Pelvic radiation is likely to cause infertility in women, and may induce menopause symptoms.

Men

Pelvic radiation can cause a drop in testosterone, block blood flow to the penis, and damage nerves in the pelvic area. As the area that was treated begins to heal, scar tissue around the blood vessels can make them less stretchy, and make it difficult to produce erections. This problem tends to affect older men more. Radiation treatments can also cause men to feel pain when ejaculating, due to irritation and inflammation of the urethra. This pain should reduce after radiation treatment ends.

Surgery

First of all, speak to your surgeon about how soon after surgery you will be able to resume sexual activity. Ask if you will need to take any additional precautions.

Women

Sometimes the uterus and ovaries are removed during surgery, either due to the presence of metastases or to allow for the safe removal of other organs or tissue. A hysterectomy (removal of the uterus) will cause the vagina to become shorter, and may cause some numbness in the genital area.

Abdominoperineal resection (APR) surgery involves the removal of the lower colon and rectum. In some cases, the uterus, ovaries, and possibly the rear wall of the vagina are removed as well. If your vagina is affected, your surgeon will reconstruct it using skin grafts or a flap of skin and muscle. This type of surgery should not affect the nerves in your clitoris. However, it can cause vaginal shortening and dryness, especially if the ovaries are removed. The removal of the rectum can also affect sensation in that area, meaning that you and your partner may have to experiment with different sexual positions to find one that is comfortable. 

It is important to talk to your doctor about what to expect in terms of sexual function after surgery.

Men

Some commonly performed surgeries can cause nerve damage, which can lead to issues with erectile dysfunction. Abdominoperineal resection (APR), total mesorectal excision (TME), and total pelvic exentreration (TPE) surgeries can damage the nerves that cause erections. Whenever possible, surgeons will try to spare these nerves from damage, but depending on the size and location of the tumors, this is more difficult in some cases than others. Even if nerves are not disturbed, the healing process can take up to two years. Older men and those who had issues with erectile dysfunction prior to surgery are most likely to be affected.

If the prostate and/or seminal vesicles are removed, a person can no longer produce semen. Other surgeries and treatments can also cause a drop in semen production, which can lead to dry orgasms. This may be temporary or permanent.