Most sexual problems caused by cancer are temporary. With patience, practice and time, many of these problems can be overcome. The practical tips in this chapter may also help.
Fatigue
During and after cancer treatment, many women feel tired and have no energy (fatigue). Fatigue can include feeling exhausted, sleepy, drowsy, confused or impatient. You may also have trouble concentrating and lose your appetite. You may feel like this for a long time. This fatigue, which is often not relieved by rest, may mean you have no interest in sex.
Tips
- Plan your day so you have time to rest.
- Save your energy. Don’t do more than you can comfortably do.
- Take short naps or breaks.
- Eat well and drink plenty of fluids.
- Take short walks or do light exercise.
- Let other people help you.
- Try different times of the day to be intimate.
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Losing interest in sex
Lack of interest or loss of desire for sex -- low libido -- is common during cancer treatment. Libido usually returns after treatment is over.
Tips
- Talk with your partner about how you are feeling. They need to know when you feel ready for sex and ways to help you get in the mood.
- Explore other ways of sharing intimacy and showing affection for each other such as touching, holding, hugging and massaging.
- Stimulate and help your partner reach orgasm.
- Try different sexual positions if your usual ones are uncomfortable. Use cushions or pillows to support your weight.
- Suggest a quick lovemaking session rather than a long session.
More information
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Trouble reaching orgasm
A woman’s ability to reach orgasm is usually unchanged after cancer treatment. However, women who have had their clitoris or other sensitive areas of the vulva removed will experience some difficulties.
The touching and kissing that often happens before penetration (foreplay), as well as oral sex and masturbation, can help a woman reach orgasm. You may feel these activities are not real sex, but if they provide sexual pleasure and you are happy with your sex life, there is no need to think they are inferior to intercourse.
Tips
- Try different ways of getting in the mood for intimacy -- shower or bath together, go away together -- whatever makes you feel sexy, relaxed and good about yourself.
- Set the mood or atmosphere with soft lighting, candles or soothing music.
- Use stroking, caressing or massage, or guide your partner’s hands or fingers to areas that arouse and excite you.
- Think about a past pleasurable sexual experience or imagine a strong sexual thought. The mind plays an important role in arousal.
- Consider using an electric vibrator -- this may give you the extra stimulation you need to reach orgasm.
- Explore reaching orgasm without penetration. Try activities such as oral sex, masturbation or all-over touching.
- Focus on your breathing. Tighten and relax your vaginal muscles in time with your breathing during intercourse or while your clitoris is being stroked.
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Vaginal dryness
Vaginal dryness is common after cancer treatment. It can make you more prone to vaginal infections, such as thrush, because the natural lubricating and cleaning process is not working.
Tips
- Treat thrush with prescription creams or home remedies such as yoghurt.
- Wear loose, cotton clothes if you develop thrush. Avoid nylon pantyhose and tights, tight jeans or trousers.
- Avoid use of soap, bubble baths or oils, and creams that might irritate the genital area.
- Consider alternative contraception if your usual contraceptive device irritates the genital area.
- Try lubricants that are non-perfumed and water-based to relieve vaginal dryness. Many different types are available from chemists and supermarkets.
- Avoid Vaseline or oil-based lubricants; they may cause thrush. You can use natural oils that are not petroleum-based.
- Treat the application of the lubricant as foreplay. Spread the lubricant on your partner’s genitals and ask them to spread it around and inside the entrance of your vagina.
- Take more time over foreplay to help the vagina relax and become well lubricated. This will make penetration or intercourse less painful.
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Reduced vaginal size
Vaginal narrowing from radiotherapy may make penetration or intercourse uncomfortable but it will not affect your ability to reach orgasm.
Tips
- Widen the entrance to the vagina by using a device called a dilator, which is shaped like a tube and made from plastic or rubber. It comes in different sizes and helps increase the vagina’s size over time. A dilator is different from a vibrator. A dilator is used to maintain the shape of your vagina, while a vibrator is used to give you sexual pleasure. For information on using a dilator talk to your doctor or nurse.
- Use a lubricant to relieve painful irritation.
- Regular gentle sex will help widen the vagina.
- Talk to your doctor about further treatment, such as skin grafts to widen the entrance.
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Painful penetration or intercourse
Sexual positions that you enjoyed in the past may now be painful after cancer treatment. Pain in the vulva area is called vulvodynia. Even if the pain is not in the genitals, it can distract you from feeling pleasure during sex.
Sometimes the pain causes the muscles around the vagina to become tight. This is called vaginismus. It is often caused by fear that you’ll be hurt during intercourse and can make penetration difficult and, sometimes, impossible.
Tips
- Plan sexual activity for the time of day when your pain is lowest.If you are using pain medication, take it shortly before sex so it will be in full effect during foreplay or intercourse.
- Use a position for touching or penetration that puts minimal pressure on the painful areas of your body.
- Find a new position to control the depth of penetration.
- Focus on your feelings of pleasure and excitement rather than the pain.
- Learn relaxation techniques to help stop the muscles tensing up.
- Talk to a doctor or counsellor if these methods don’t work.
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Losing a body part
Losing a breast, nipple, part of the genitals or a limb due to cancer treatment may affect your self-esteem. You may feel less feminine. It will take time to get used to how your body has changed.
After a mastectomy, you may choose to use a breast form (prosthesis). This can either be a piece of specially made foam or a liquid-filled sac worn in your bra. If you find the breast form uncomfortable or a nuisance, you may consider having your breast surgically reconstructed.
A breast reconstruction can help improve your body image and can help you enjoy sex if it makes you feel more attractive. It can also give you confidence to wear different types of clothes. However, a breast reconstruction may not fully restore the pleasure you used to feel from breast touching. Your partner may also receive no pleasure or feel uncomfortable touching your reconstructed breast – talk to them about how they feel so you don’t mistake their behaviour for rejection.
Tips
- Ask your partner to stroke, touch or kiss other parts of your body -- the neck and inner thigh are very sensitive and can lead to orgasm.
- Touch your genitals to find out how your sexual response has changed. Explore other areas of your body that are sensitive to touch.
- Take time to get used to your body changes. Look at yourself naked in the mirror and remind yourself that what makes you unique is much more than your body.
- Wear a nightie, pyjamas or lingerie, or use soft lightening if you feel uncomfortable or self-conscious revealing your body and want to be ‘less visible’.
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Adapting to life with a stoma
Sexual activity with a stoma can be satisfying but may need a little more planning.
Tips
- Change the appliance before having sex.
- Cover your appliance if you don’t like the feel of plastic on your skin with a ready-made cover or make one from soft material such as cotton or satin.
- Wear a mini-slip, nightgown or crutchless underwear during sex if you feel uncomfortable. Many people are happy wearing nothing.
- Choose a position that keeps your partner’s weight off the stoma, or place a small pillow over the stoma so your partner is lying on the pillow rather than on the appliance. You can lie on top or underneath your partner – you will not hurt the stoma.
- Have sex in the bath or shower.
- Let your partner see or feel the stoma, if they want to.
- Seek help if you are having trouble coping. Speak to your stomal therapy nurse or contact your local continence or ostomy association.
More information
- See Stoma section for contact details.
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Fertility problems
Chemotherapy may have a temporary or permanent effect on your ability to have children (fertility).
Your gynaecologist and radiation oncologist will work together to try to keep radiation away from the ovaries. But they are difficult to protect from radiation because their position is uncertain and they are often in the area that needs treating. If fertility is an important issue for you, talk to your doctor before treatment about ways to preserve it. New ways of dealing with infertility are being developed. One option may be to store eggs before treatment for use in the future.
You may feel very upset if you are unable to have children and worry about the impact of your fertility on your relationship. These feelings are natural. Share these feelings with your partner, who may also be grieving for the family they can no longer have.
Even if you have finished having a family, you may feel the removal of your uterus makes you feel less feminine.
Having a stoma doesn’t prevent you from becoming pregnant. You will probably be advised to wait one or two years after surgery before becoming pregnant, this gives everything inside you time to settle down.
Contraception
Although chemotherapy and radiotherapy reduce fertility, it is possible for some women to become pregnant.
A woman receiving chemotherapy or radiotherapy should not become pregnant. Both treatments can affect her eggs. Your doctor may suggest you wait two years after chemotherapy before becoming pregnant. Talk to your doctor immediately if you become pregnant. Contraception must be used. Ask your doctor about your contraceptive options.
If you have a stoma, the effect of the contraceptive pill may change depending on surgery and type of stoma you have. Discuss what contraception is suitable for you with your surgeon, stomal therapy nurse or gastroenterologist.
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Premature menopause
The average age for menopause is 52. The loss of menstruation and fertility at a younger age can lead to feelings of sadness, grief and low self-esteem. You may feel old before your time or less feminine. You may worry that your partner finds you less attractive or less sexually appealing.
The sudden start of menopause can cause more severe symptoms than a natural menopause because the body hasn’t had time to get used to the loss of the hormones.
Oestrogen loss can cause hot flushes, mood swings, trouble sleeping and tiredness. The vagina may also become dry because it depends on oestrogen to keep it moist.
Premature menopause may cause bones to weaken and break more easily. This is called osteoporosis.
Tips to help prevent osteoporosis
- Eat low-fat dairy food and high-calcium food.
- Exercise regularly. Walking, dancing and weight training all help reduce the rate of bone loss.
- Talk to your doctor about medication for osteoporosis.
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