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Cancer and its treatments may lead to changes in the appearance of your body or sex organs or the way your body works. In addition to these physical changes, you might have emotional and practical changes that also impact your sex life.

Sexuality is so much more than sexual intercourse and means different things to different people. Touching, caressing and warmth is an important part of intimacy.

Cancer and cancer treatments can potentially affect sexual wellbeing in many different ways.

The information below includes some of the things people can experience including; low sexual desire, vaginal dryness, pelvic or genital pain, difficulties with erections or changes to ejaculation or orgasm.

These are just some examples of difficulties with sex and intimacy people may experience as a result of a cancer diagnosis or treatment, these difficulties are not experienced by everybody undergoing these treatments.

If you are concerned about any aspect of your sex life or intimacy, please speak to a healthcare professional.

The resources LINK will signpost you to further information and support.

There are common misconceptions about sex and cancer, but we know the following facts:

How to ask for help

Conversations about sex can feel uncomfortable for some people, if it feels awkward at first, don’t let that discourage you. You might need to raise the topic more than once or speak with another member of your care team

General advice

It is ok and safe to have sex, and for many people is a normal part of their lives but there may be times during your treatment that you need to be more cautious with your day-to-day activities, including your sex life. Follow medical advice regarding this.

To minimise causing an infection during masturbation ensure your hands and fingernails are clean. A good standard of hygiene for sex toys is also advised to minimise risk of infection.

If you have low platelets, you will be more at risk of bruising, at this time receiving a love bite is not advisable. Ensure platelets are above 50 before engaging in any BDSM or vigorous sexual intercourse.

Avoid oral sex if there are cuts or sores in the mouth.

Never use the same condom for anal and then oral or vaginal sex.

Further information can be found at Sex and Cancer: General impacts – OUTpatients

Low sexual desire (low libido)

When a person has lost desire, they do not feel like having sex or being intimate. This can be common when going through a cancer diagnosis, as this can be a very emotional time. This can also be impacted by cancer treatments, for example hormone therapies. LINK TO LOW LIBIDO

Vaginal dryness

Vaginal dryness can cause difficulties such as irritation, burning or painful sex. People may feel frustrated by this, or the impacts it can have on day-to-day life, as well as intimacy and sex. Vaginal dryness

Erection difficulties

Some people during and after cancer treatments can notice problems with gaining or maintaining an erection, which can be either temporary or permanent. People may feel frustrated by this, and it can impact on their intimacy and sex life.

For more information on erectile dysfunction and what can help see Erection difficulties.

Changes to ejaculation or orgasm

Some treatments such as radiotherapy and surgery can change the sensation and sensitivity of skin around the penis, vulva and clitoris which may mean orgasms feel different. It may be that you need to experiment with what feels good now, trying different sex positions or types of stimulation.

Following some cancer treatments people can notice a change in their ejaculation, including dry ejaculation (less or no fluid coming out), painful ejaculation, retrograde ejaculation (ejaculating into the bladder). If this happens to you it can take time to adjust to this change.

For more information on this see:

Erectile dysfunction, sex life and cancer treatment | Macmillan Cancer Support

Vaginal changes and sexual well-being with cancer | Macmillan Cancer Support

Pelvic and genital Pain

Some cancer treatments can lead to people experiencing pelvic pain either temporarily or permanently.

If you are experiencing pain, please speak with your cancer team or GP to think about pain management strategies.

If pain is impacting your sex life it may be helpful to consider:

  • Using lubricants to help with dryness
  • Using vaginal dilators to improve comfort and sensation around and within the vaginal tissues
  • Using sex toys such as the Ohnut to help with pain on deep penetration, as this includes rings that sit at the base of the penis or dilator to prevent deep penetration
  • Engage in relaxation techniques before sex
  • Try different sex positions
  • Only start penetrative vaginal sex when you or your partner are close to orgasm

Incontinence/leaking during sex

Having difficulty controlling your bladder or bowels may change the way people feel about having sex or being intimate.

For further information on incontinence and cancer please follow this Continence Tips.

Some cancer treatments can cause people to leak when they are sexually aroused or at the point of climax/orgasm (this is called climacturia). For some people this is a temporary issue, but it can be a long-term issue. Leakage of urine is not harmful to your partner.

You may find these following tips helpful

  • Consider where you have sex.

Would the shower be appropriate? Would it help to lay down a towel first?

  • Pass urine before you have sex.
  • You could use a condom/barrier method.
  • Try different positions that don’t put pressure on your bladder.

How you feel about your body, body image difficulties

Our body image is the way we see ourselves and the feelings that we have about our bodies. Some cancer treatments, such as surgery and radiotherapy, can change the way the body looks. Adjusting to changes to our body can be difficult and may impact how comfortable and confident people feel about being intimate with others. It is natural to feel sadness and grief while you are adapting to the changes in your body.

Hair loss, weight gain/loss LINK to HAIR section

You may find the following tips helpful:

  • Allow yourself time to adjust to the changes in your body and remember it is normal for this to take time
  • If you are avoiding looking at the part of your body that has changed, gradually work towards looking at it by first looking at it covered up and then slowly uncovering parts of it and looking at the area. You can then move on to touching that part of your body. You can also involve a partner in this if helpful
  • If you are worried about your appearance spend time thinking about other parts of your body that you like or are grateful for. You can do this by thinking about it, or by looking at a mirror and working downwards from your head and saying what you like and appreciate out loud
  • Thinking about the positives alongside the difficulties of changes to your body, for example “it saved my life”
  • It can be helpful to recognise and challenge negative thoughts as they arise by using a technique from Cognitive Behavioural Therapy (CBT) called ‘thought challenging’.

    Often we make assumptions and jump to conclusions that may not be true, so by recognising and taking a step back from our thoughts and challenging them we may be able to see things differently. For more information on this the Macmillan page has a helpful section called ‘Challenging Negative Thoughts’ at Managing your feelings about body changes | Macmillan Cancer Support

  • If you are feeling that the changes to your body have made you less feminine or masculine, it may be helpful to think about other ways in which you still are feminine or masculine
  • If you are transgender or non-binary it may be that body changes have impacted your sense of identity. If you are struggling with this, you may benefit from seeking further support from the UK Cancer and Transition Service (link)

Anxiety

People can often feel very anxious after a cancer diagnosis, during treatment or post treatment.

Some people can feel particularly anxious about their sex life which may mean they stop having sex or feel uncomfortable during it.

Common worries include feeling insecure about changes to their body, worries about getting an erection, worries about leakage due to incontinence or a stoma, worries about not reaching orgasm or worries about feeling pain.

People may also worry about not being able to have sex in the same way or pleasuring their partner, and the impact this may have on their relationship. People may also worry about hurting each other during sex.

When we feel anxious we are often focused on our worry and not as present in the moment. If we feel this way before, during or after sex we may not be able to reach the same level of arousal and therefore do not enjoy sex as much.

If this happens a few times, people can then find themselves worrying even more which creates a vicious cycle.

It is very natural to feel anxious about cancer and about sex, especially if you are trying something new or re-engaging with sex after a break.

It is important to talk to your partner about your worries if you can, to take things slowly and remember you can reach out for professional support if you are struggling.

Fatigue

The exhaustion that people can experience due to cancer or cancer treatments can also impact upon sex and intimacy. Consider trying different positions that don’t use as much energy. Or try sex toys with longer handles so that you can reach with less effort.

Sex during systemic anti-cancer therapies (SACT)

Systemic Anti-Cancer Therapies (SACT) is a term that’s used to describe anti-cancer medications that treat the whole body. In general, it is advised to use barrier methods of contraception whilst on SACT.

Many drugs and cancer treatments can damage sperm and eggs and some can affect the development of an embryo, therefore people are not advised to try to get pregnant during chemotherapy. Some hormone contraceptives do not work or are not advised with specific types of cancer or cancer treatments.

If you are having oral, vaginal and/or anal sex, you will be advised to use barrier methods to protect your sexual partner from the risk associated with small amounts of anti-cancer medications that can remain in bodily fluids for a number of days after having chemotherapy.

Barrier methods will also reduce the risk of infection, which you may be more prone to if your blood count is low. Please note it is not necessary to sleep in a different bed from your partner for risk of contamination and kissing is safe.

Access free condoms via the NHS

Many chemotherapy drugs can also affect fertility. Please see LINK for further information on fertility.

Sex following stoma surgery

After stoma surgery, you may find that your sex life is temporarily put on hold whilst you are recovering. Most surgeons suggest a six-week recovery period. When you feel ready to explore your sexuality again, you may find these tips and resources helpful.

It is generally more comfortable to empty your pouch (stoma bag) before intercourse.

Some people prefer to wear a cover over their pouch, this can help to prevent the plastic from rubbing on you and sticking to your partner’s skin.

Special underwear or accessories (belly bands, cummerbunds and crotchless underwear) can help you to feel more confident whilst supporting and disguising your pouch.

There are companies that make underwear and lingerie for people following stoma surgery, including high street stores and specialist stores that you can explore. Please ask your CNS for recommendations.

Sex will not harm the stoma, as long as you have attached your pouch securely, the positions you choose should not affect the stoma. You can lie underneath, or on top of your partner you will not hurt the stoma.

If your surgery has involved the removal of your rectum:

  • The position of the vagina may now be different. This might make missionary position uncomfortable. This might also affect the use of sex aids, it can help to try different positions to find what is comfortable for you.
  • If anal penetration has been an important part of your sex life, closure of the anus may create an additional challenge for you. Intercourse of the stoma is not advised, you should not push anything into the stoma as you can cause damage.

    Even when the rectum is still intact or disconnected, caution is recommended with anal sex due to the increased risk of tears and bleeding.

We encourage people to have frank and open conversations with their partner beforehand, this can help both parties feel more comfortable that they won’t cause any pain, harm or embarrassment and hopefully make the experience more enjoyable.

See your sexual self after stoma surgery

Sex following bladder cancer treatments

Bladder cancer treatments can affect sex and intimacy in different ways.

Surgery may make your vagina shorter or might affect nerves which can change the sensation of your vagina or clitoris. Some treatments, such as radiotherapy, also can cause vaginal dryness.

Some of the surgical procedures to remove the bladder (cystectomy) also require the removal of the prostate.

If you have this procedure it will affect the ability to be able to ejaculate, your orgasms will be ‘dry’. Also, some of the surgical procedures or radiotherapy can affect the ability to get an erection.

Sex and relationships after bladder cancer treatment | Cancer Research UK

Sex following prostate cancer treatments

Prostate cancer can impact upon sex and intimacy in many different ways.

Everyone is different, some people will have temporary problems that affect their sex life, for other people these issues may not recover. The following resources provide more detailed information about this.

Sex and relationships | Prostate Cancer UK

Prostate cancer and your sex life | Prostate Cancer UK Shop

Prostate UK specialist nurses offer a sexual support service. Call 0800 074 8383 and ask for the Sexual support service nurses

Sexual support | Prostate Cancer UK

Sex following colorectal cancer treatments

You should wait at least 6 weeks after major bowel surgery to resume sexual intercourse. If you have cancer in the rectum and have had part, or all of your rectum removed, you will no longer be able to have receptive anal sex. There may be other ways for you to enjoy being intimate though.

Some procedures can affect the nerve supply to the sexual organs which affects arousal and sensation. Some treatments can cause shortening or narrowing of the vaginal canal.

Radiotherapy can make tissues feel more fragile and uncomfortable. Until the tissues have recovered, be careful with receptive anal sex and anal play.

Body image & sex | Life with & after bowel cancer | Bowel Cancer UK

Sex following gynaecological cancer treatments

You can return to sexual intercourse after 8 weeks, however, make sure the bleeding has stopped, and wait until you feel ready to be intimate. Using adequate lubrication is helpful

Ovarian Cancer And Sex | Ovacome

Stress management

It is natural to experience stress during cancer due to worries about the cancer and treatment, but also other practical life factors such as money, relationships and work. When we feel stressed this can impact on our desire to have sex, impact relationships, lead to feelings of anxiety or low mood, and impacts hormonal levels which in turn can impact our sexual organs.

Psychosexual therapy

If you are struggling with your sex life and feelings around this, you may benefit from considering psychosexual therapy. This is a talking-based treatment, nobody will be touching you, and it offers a chance for individuals or couples to explore the psychological, emotional and physical factors that may be contributing to difficulties with their sex life with the hope of improving this.

If you speak with your cancer team you may be able to access this type of therapy within the hospital, or you can find further information about how to access this type of support from the websites below.

  • Here are some psychosexual tips you may find useful: Sex and intimacy can mean many different things. There are lots of ways to be intimate from conversation, touch, kissing, mutual masturbation, non-penetrative sex, penetrative sex and so many more. Sometimes during treatment people lose interest in some aspects of sex but can find other forms of intimacy beneficial.
  • Take time to explore and touch your body alone or with a sexual partner. It may be that things feel different after cancer treatment.
  • Try different sexual activities or positions that feel comfortable for you and your sexual partner. This is particularly important if there have been physical changes to your body due to cancer, such as shortening of or losing your penis or vagina, or your vaginal or anal passage being closed.
  • Remember, it takes time to adjust to changes during and after cancer treatment (both physically and emotionally). Take things slowly and at your own pace.
  • Speak openly with your partner about your feelings, worries and desires regarding intimacy and sex. We often worry about and make assumptions about what others are thinking, but we won’t know until we ask.
  • Sex toys can be helpful when you are having difficulties with sex due to pain, want to have penetrative sex but cannot use a penis, as something new and different or to increase stimulation.
  • Your sexual self is one part of your identity and relationship, but there are lots of other aspects to both yourself and your relationship. It can be helpful to identify and remember these if you are being harsh on yourself for what you can or cannot do.
  • If you are struggling, reach out for help from a professional. You are not alone.

Further information can be found at these sites:

The College of Sexual and Relationship Therapists (COSRT)

The Institute of Psychosexual Medicine 

Relate offers online, face-to-face or phone services to help with relationships and support sex therapy. Visit their website to find a service near you.

Pink Therapy is an independent therapy organisation that provides a directory of qualified therapists who take an affirmative stance on LGBTIQ+ support

Resources

Films

Audiobook Cancer and your sex life audiobook | Macmillan Cancer Support

EASY ReAD: Your sex life and cancer | Easy read booklet | Macmillan Cancer Support

The Cancer Care Map and Macmillan’s In Your Area are both examples of online directories that aim to link people to sources of support for self-management and peer support.

Find sexual health services near you

Contact the Macmillan information centre for further support

0208 725 2677

Cancer.information@stgeorges.nhs.uk