The Chemotherapy Guide to Sex

While sex and chemotherapy aren’t necessarily two thoughts you want to be having in conjunction, sexuality is a crucial aspect of health, and as such you should never hesitate to ask your doctor about the impact of chemo treatments on your sex life.

Generally speaking, it's usually okay to have sex while treating cancer—as long as interest, energy, and comfort levels allow, of course.

While talking to one’s doctor is all hunky dory if your doctor is receptive and respectful, if you feel that any member of your treatment team isn’t listening to your needs or concerns—because, for instance, you identify as LGBTQIA+—or for any other reason—there are resources like this “find a provider” tool by the Health Professionals Advancing LGBTQ Equality.

But back to basics. The fact is, even if you’re physically cleared to have sex, you may not feel like getting sexy for a while—and the same may be true of your partner(s). This may change the way you relate to your sexuality—which can be destabilizing—but it’s important to understand that you’re perfectly justified in feeling however you happen to feel, and that everyone is different, so what’s true for someone else dealing with cancer may not be true for you.

There are many factors that might influence your decision about when and how to express your sexuality while undergoing chemo. Here are a few things to consider:

The way you feel

Some people dealing with cancer and receiving chemo treatments struggle with body image, reduced sexual pleasure, an inability to orgasm, and/or dyspareunia, recurring pain during penetrative sex—sometimes due in part to vaginal dryness. Be sure to discuss your treatment options with a health professional and clarify how long the pain typically lasts. Additionally, chemo can cause fatigue, nausea, and changes to your hormone levels, which can reduce your libido and affect your desire for intimacy. Be kind to yourself, go slow, and don’t force anything. You’ll get there when you’re ready.

Sexual pleasure and intimacy come in many forms

When it comes to sexual contact, it might be worth thinking outside the usual box. Even on a good day, sex does not have to include penetration, oral, or any given act. Consider kissing, touching, caressing, external stimulation with hands. You might even consider exploring some new sex toys to satisfy each other. And if sex in general is not where you’re at, explore other ways to show affection, like cuddling, a tantric melting hug, or other shared activities.

Type of cancer

Not all cancers are created equal, and they won't all affect your sex life the same way. For instance, cancers of the genital tract, urinary tract, anus or rectum might require extra care. After a procedure which affects these areas, your doctor might recommend abstaining from sexual activity involving the pelvic region until you’re fully healed. And, it probably goes without saying, but avoid sexual contact with any open sores, bleeding, or tears in the genital, rectal, or oral areas. If none of this applies to you, you may still experience altered sensations while having sex. If a particular position is painful, try exploring some new ones.

Type of chemotherapy

There are different types of chemotherapy out there with different side effects, some milder than others. Your doctor can clarify which type you’re getting. If, in your case, chemo happens to reduce your white blood cell count, your protection against the usual bacteria introduced during sex is reduced, increasing your chance of infection. Chemo might also cause a low platelet count, which could lead to bleeding during sex. In either case, your doctor may recommend avoiding vaginal, anal or oral sex until you’re back up to healthy levels again.

Partner safety

Chemotherapy drugs (including IV and oral chemo) can be excreted in saliva and vaginal secretions for 48-72 hours post treatment. As such, the recommendation is to use a condom for vaginal or anal sex and a dental dam for oral sex during this period—as well as avoiding open-mouth kissing—to prevent your partner from being exposed.

Avoiding pregnancy

According to the National Cancer Institute, chemotherapy can cause changes in eggs and sperm which could lead to birth defects, particularly in the first trimester. It’s strongly recommended that you avoid getting pregnant while being treated and for a specific amount of time afterwards as well. If you or your partner are at risk of getting pregnant during your chemo, it’s important to choose a reliable form of birth control—even if your periods have stopped or your fertility has been reduced. Since hormonal birth control options are associated with an increased risk of cancer, you might consider exploring non-hormonal options.

Tips for a better sex life during chemo

Since everyone’s experience of cancer and chemo are different, take the following tips or leave ‘em!

- Use a water-based vaginal lubricant during sex, applying it both inside your vagina and on your partner's penis, fingers, or a sex toy, just before penetration.

- Use a vaginal moisturizer 2-3 times a week, whether you’re having sex or not. This can help your vaginal tissue regain its natural moisture.

- Some women may experience vaginal atrophy (inflammation, shrinking, and thinning of the vaginal tissue) as the result of diminished estrogen. In such cases, vaginal estrogens (In the form of creams, tablets, or rings) may be effective. If you have a history of hormonally based tumors, however, your doctor may advise against this.

- Prioritize communication—always. Be honest with yourself about what feels good and what doesn’t. Be honest with your partner if you’re tired, uncomfortable, or in pain—be it physical or emotional. Discuss any changes in your body image and sexual health with your healthcare team. Consider joining a support group made up of people going through similar experiences. Consider individual counseling. Consider couple counseling. The latter may really help with communication and break down barriers preventing you from being more intimate with one other.

Bottom line: chemotherapy treatments may or may not temporarily interrupt or alter your sex life. With a few precautions, some new ways of expressing intimacy, and guidance from your health professional, you’ll be able to pick up where you left off—whenever you’re feeling good and ready.