- Cancer Information
- LGBTQI+ People and Cancer
- Sexual intimacy and cancer
- Treatment side effects and sexual intimacy
Treatment side effects and sexual intimacy
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.
Learn more about:
- Changes to sex drive or desire
- Pain during sex
- Leaking urine at orgasm
- Changes to the anus
- Sex with a stoma
- Early menopause
- Changes to the vagina
- Changes to the prostate
- Changes to the penis
- Erection problems
- Changes in ejaculation
- Safety concerns for partners
Changes to sex drive or desire
Your libido might change because of tiredness, pain, anxiety, changes in hormone levels, and loss of confidence and self-esteem. For some people, libido may return to your usual levels after treatment ends, but for others, low libido may continue. Hormones can also change with age, and it’s common for libido to decrease as you get older. Even if you feel like having sex, you might feel anxious about your partner/s seeing how your body has changed.
Pain during sex
Radiation therapy to the pelvic area or rectum may make sex painful. This usually improves after treatment ends.
Trouble controlling the flow of urine (urinary incontinence) or flow of faeces (faecal incontinence) is a common side effect of treatment for cancer of the prostate, bladder, bowel, uterus, vulva, vagina and penis. This may be temporary or permanent.
Having bladder or bowel issues can be embarrassing and you may worry about having accidents or leaking during sexual activity. You can use a sex blanket, cover sheets or have sex in wet areas like a shower.
Weak pelvic floor muscles can affect bladder and bowel control. The hospital continence nurse or physiotherapist can suggest exercises to strengthen the pelvic floor muscles and manage urinary symptoms. Start these exercises before treatment and continue to do them regularly after treatment.
Leaking urine at orgasm
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. Reassure your partner/s that urine is sterile.
Changes to the anus
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.
If the anus area is sensitive after radiation therapy, take it slow and work up to full penetration. Fingering, rimming, using small dildos and picking positions where you control the speed and angle of penetration may help. Although sensitivity to the anal area may improve after a few months, some changes are permanent.
Sex with a stoma
Some types of surgery for bowel, anal, ovarian or bladder cancer create a stoma. This is an opening in the abdomen that allows faeces and urine to be collected in a small plastic bag.
Sometimes a stoma is needed for only a short time, but sometimes it is permanent. Planning can help make sexual intimacy for people with a stoma satisfying and fulfilling. Consider wearing clothing like a slip or cummerbund to cover the stoma. You could secure the bag with tape to stop it moving. Talk to a stomal therapy nurse about products such as smaller pouches or a stoma cap. Do not use the stoma for sex.
Some cancer treatments can cause menopause symptoms or early menopause. These 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 and mood changes, both of which can affect libido.
Changes to the vagina
Cancer treatment may cause temporary or permanent changes to the vagina. Surgery may shorten the vagina, and pelvic radiation therapy can narrow the vagina, causing thinning of the walls and dryness. If you have a surgically created vagina (vaginoplasty), speak to your doctor about the effects of radiation therapy.
Penetration with fingers, a penis and/or sex toys such as dildos or other objects may be difficult and painful. A narrower vagina will also make cervical screening uncomfortable. Talk to your doctor about the options for keeping the vagina open. They may suggest using dilators in different sizes to dilate and extend the vagina. Using extra lubrication may make sexual intercourse more comfortable. Choose a water-based or silicone-based gel without perfumes or colouring.
Changes to the prostate
Pleasure experienced from rubbing or stimulating the prostate during sex may change with certain prostate cancer treatments. If you have 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.
Changes to the penis
Surgery for prostate or penile cancer may shorten or shrink the penis. After prostate cancer surgery, the difference is often small, usually about 1 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. This is known as erectile dysfunction or impotence. How long the problem lasts will depend on your age, how easily you got an erection before surgery and how much the erectile nerves were damaged. Having radiation therapy or taking androgen deprivation therapy can also cause erection problems.
You don’t need an erect penis to have an orgasm. However, firmer erections are needed for penetrative sex. Erection problems can make having penetrative sex more difficult or painful, and you may find this makes you feel anxious and frustrated.
Ways to improve erections, include:
- doing pelvic floor exercises
- using erection aids such as a vacuum pump, constriction ring around the base of your penis
- taking medicines.
Ask your doctor for more details about these methods.
Other ways to experience pleasure include masturbation or oral sex, but you may be worried about how your sexual partner/s may feel. Open and honest communication about what has changed and non- sexual touching can help maintain intimacy in a relationship.
Changes in ejaculation
After some types of surgery and radiation therapy (e.g. for prostate cancer), you won’t be able to ejaculate semen. This is known as dry orgasm. This is because semen is no longer produced. If ejaculating semen was an important part of enjoying sex for you or your partner/s, you might want to discuss this change with them.
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.
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)
Podcast: Sex and Cancer
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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.
View the Cancer Council NSW editorial policy.