Side effects will vary from person to person, and depend on the type of treatment and medicines you have. Some people have no side effects, while others have many.
Talk to your cancer care team about ways to manage side effects and click below to learn about the impact of cancer treatment side effects on sexual intimacy within the LGBTIQA+ community.
Tiredness, pain, anxiety, hormone changes, and lower confidence can reduce your libido and make it harder to reach orgasm. For some people, libido may return to their usual levels after treatment ends, but for others, low libido continues. Ageing can also affect hormone levels and reduce libido. You might also feel anxious about how your partner/s will react to changes in your body.
Surgery or radiation therapy to the pelvic area or rectum may make sex painful. Pain may improve after treatment ends but it can continue. If you have ongoing discomfort during sex, talk to your doctor. They may suggest seeing a pain specialist or pelvic floor physiotherapist. Anxiety can also cause your pelvic floor muscles to become tense and worsen pain, so it may help to see a psychologist.
Cancer treatment for the prostate, bladder, bowel, uterus, vulva, vagina or penis may affect bladder or bowel control (urinary or faecal incontinence). This may be temporary or permanent. You may worry about leaking urine or faeces during sex. Some people find using a sex blanket, protective sheets, or having sex in the shower helpful.
Weak pelvic floor muscles can affect bladder and bowel control. A continence nurse or physiotherapist can show you exercises to help strengthen these muscles. Cancer Council’s Exercise for People Living with Cancer section also outlines how to do these exercises. Start these exercises before treatment and keep doing them after treatment.
After surgery for prostate or vulvar cancer, you might leak a small amount of urine when having an orgasm. This is usually temporary but is sometimes ongoing. You may feel embarrassed and nervous at the thought of leaking urine during oral sex and/or masturbation. This can be managed the same way as incontinence.
Surgery for some bowel, anal, ovarian or bladder cancers may create a stoma. A stoma is an opening in the abdomen that allows faeces and urine to be collected in a small plastic bag. You may have a stoma for a short time or permanently.
If you feel self-conscious, wear clothing that covers the stoma and use tape to secure the bag. A stomal therapy nurse can suggest products such as smaller pouches or a stoma cap. Never use the stoma opening for sex – the surrounding tissue is delicate and can be easily damaged.
Cancer treatment may cause temporary or permanent changes to the vagina. Surgery may shorten the vagina. Pelvic radiation therapy can narrow the vagina and cause thinning of the vaginal walls and dryness. If you have a surgically created vagina (vaginoplasty), ask your doctor how radiation therapy may affect you.
Penetration with fingers, a penis or sex toys may be difficult, painful or cause bleeding. A narrower vagina will also make pelvic examinations uncomfortable. Talk to your cancer care team as soon as possible about ways to keep your vagina open and flexible. Treatment may be more effective if started early. Your team may recommend vaginal dilators to stretch the vagina.
Using extra lubrication may make penetration more comfortable. Choose a water-based or silicone-based lubricant without perfumes or colouring. Ask your doctor if vaginal oestrogen is an option for you. It may also help to talk to a psychologist.
Cancer treatment to the vulva can change the appearance and texture of the labia, making the tissue feel harder (called fibrosis). This might also affect the clitoris and sexual enjoyment. Surgery for vulvar cancer may remove part or all of the labia and, in some cases, the clitoris.
Orgasms will still be possible but they may feel different because there is no uterine contraction.
Some cancer treatments can cause menopause symptoms or early menopause. Treatments include surgery to remove both ovaries; hormone therapy to block oestrogen; and radiation therapy and chemotherapy, which can damage the ovaries.
Menopause symptoms can include a dry vagina, painful sex, hot flushes and mood changes, all of which can affect libido. Menopausal hormone therapy can help, but it’s not always suitable (e.g. for people with hormone-dependent cancers).
Talk to your cancer care team about your options.
Radiation therapy to the abdomen or pelvic area may irritate the lining of the bowel and rectum. This can cause bowel problems, and the skin inside the anus may be more sensitive. This can increase the sensitivity and pain of anal sex.
You may need to use dilators and extra lubrication to make receptive anal sex more comfortable. Sensitivity to the anal area may improve after a few months, but some changes are permanent.
Pleasure experienced from stimulating the prostate during sex may change with certain prostate cancer treatments. After radiation therapy, the prostate may feel less sensitive. You won’t feel the same pleasure if the prostate is removed with surgery (radical prostatectomy).
It may take time to adjust to this change and for you to become more aware of other pleasurable sensations.
Surgery for prostate or penile cancer may shorten or shrink the penis. After prostate cancer surgery, the difference is often small, usually only about 1–2 cm. Changes in size may happen because of scar tissue or the nerves not working properly.
After surgery for prostate cancer or bowel cancer, getting and keeping a firm erection can be difficult (erectile dysfunction).
How long the problem lasts depends on your age, your erections before treatment and whether erectile nerves were affected. Radiation therapy or taking androgen deprivation therapy can also cause erection problems.
The impact on sexual activity
You don’t need an erect penis to have an orgasm. However, firmer erections are needed for penetrative sex. Erection problems can make penetrative sex more difficult or painful, and you may find this makes you feel anxious and frustrated. Pelvic floor exercises can help improve erections. Using erection aids (e.g. a vacuum pump or constriction ring) or medicines can also help. Ask your doctor about these methods. They may suggest you see a sexual health physician.
Exploring other forms of intimacy
Other ways to experience pleasure include masturbation or oral sex. Honest and open communication about what has changed, as well as non-sexual touching can help maintain intimacy in a relationship.
After some types of surgery and radiation therapy, such as for prostate cancer, you may ejaculate less semen or none at all (dry orgasm). Semen may also be a different colour. If this affects your sex life, talk to your partner/s.
Safety concerns for partners
Your doctor may advise you to use barrier protection during specific sexual activities to reduce any risk to your partner from cancer treatment and to avoid pregnancy.
Chemotherapy – The drugs may be released into your body fluids. For penetration, use condoms or internal condoms. For oral sex, use condoms, internal condoms or dental dams (latex squares). Wear latex gloves if using hands for penetration. If you have anal sex, use condoms. Clean sex toys after each use, and do not share between partners without using a new condom. Ask your doctor or nurse how long you need to use protection.
Internal radiation therapy (brachytherapy) – If you have radioactive seeds inserted to treat prostate cancer, you will usually be advised to avoid anal sex or use barrier protection (such as condoms) during treatment. Ask your doctor how long to wait before having sex.
→ READ MORE: Adapting to changes in your sex life
As far as I can see, gay men pick each other up on Grindr. And that is a much more explicit sexual thing – come over and I’ll perform or you perform or whatever. And I’m not up for that. I don’t take the risk that things won’t work properly.
TROY (GAY MAN, PROSTATE CANCER)
Key resource
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We thank the chief investigators from the Out with Cancer research project: Prof Jane Ussher, Prof Janette Perz, Prof Martha Hickey, Prof Suzanne Chambers, Prof Gary Dowsett, Prof Ian Davis, Prof Katherine Boydell, Prof Kerry Robinson and Dr Chloe Parton. Partner investigators were Dr Fiona McDonald and A/Prof Antoinette Anazodo. Research Associates were Dr Rosalie Power, Dr Kimberley Allison and Dr Alexandra J. Hawkey.
We thank the reviewers of our LGBTQI+ People and Cancer booklet: Prof Jane Ussher, Chair, Women’s Heath Psychology and Chief Investigator, Out with Cancer study, Western Sydney University, NSW; ACON; Dr Kimberley Allison, Out with Cancer study, Western Sydney University, NSW; Dr Katherine Allsopp, Supportive and Palliative Care Specialist, Westmead Hospital, NSW; A/Prof Antoinette Anazodo OAM, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital, NSW; Megan Bathgate, Consumer; Gregory Bock, Clinical Nurse Consultant–Oncology Coordinator, Urology Cancer Nurse Coordination Service, WA Cancer & Palliative Care Network, WA; Morgan Carpenter, Executive Director, Intersex Human Rights Australia (formerly OII Australia); Prof Lorraine Chantrill, Medical Co-Director Cancer Services, Illawarra Shoalhaven Local Health District, NSW; A/Prof Ada Cheung, Endocrinologist, Head, Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC; Bonney Corbin, Australian Women’s Health Network; Cristyn Davies, Research Fellow, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney and Children’s Hospital Westmead Clinical School, NSW; Prof Ian Davis, Professor of Medicine, Monash University and Eastern Health, Medical Oncologist, Eastern Health, Chair, ANZUP Cancer Trials Group, VIC; Rebecca Dominguez, President, Bisexual Alliance Victoria; Liz Duck-Chong, Projects Coordinator, TransHub and Trans Health Equity, ACON, NSW; Lauren Giordano, 13 11 20 Consultant, Cancer Council NSW; Hall & Wilcox (law firm); Natalie Halse, BCNA Consumer Representative; Jem Hensley, Consumer; Prof Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne, and Director of the Gynaecology Research Centre, The Women’s Hospital, VIC; Kim Hobbs, Clinical Specialist Social Worker – Gynaecological Cancer, Westmead Hospital, NSW; Dr Laura Kirsten, Principal Clinical Psychologist, Nepean Cancer Care Centre, NSW; Amber Loomis, Policy and Research Coordinator, LGBTIQ+ Health Australia; Julie McCrossin and Melissa Gibson, Consumers; Dr Fiona McDonald, Research Manager, Canteen, NSW; Dr Gary Morrison, Shine a Light (LGBTQIA+ Cancer Support Group); Penelope Murphy, Cancer Council NSW Liaison, Prince of Wales Hospital, NSW; Dr Rosalie Power, Out with Cancer study, Western Sydney University, NSW; Jan Priaulx, 13 11 20 Consultant, Cancer Council NSW; Paul Scott-Williams, Consumer; Simone Sheridan, Sexual Health Nurse Consultant, Sexual Health Services, Austin Health, VIC; Cheryl Waller and Rhonda Beach, Consumers.
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