Men, Cancer and Sexuality

These are some general changes in sexual desire and response that may be linked to cancer and cancer treatment.

Both men and women often lose interest in sexual activity during cancer treatment, at least for a time. At first, concern for survival is so great that sex may not be a priority. This is OK. Few people are interested in sex when they feel their lives are in danger. When people are in treatment, worry, depression, nausea, pain, or fatigue may cause loss of desire. Cancer treatments that disturb the normal hormone balance can also lessen sexual desire.

If there’s a conflict in the relationship, one partner or both might lose interest in sex. Many people who have cancer worry that a partner will be turned off by changes in their bodies or by the very word “cancer.”

Keep in mind that each part of a man’s sexual cycle is somewhat independent from other parts of the cycle. That’s why, after some types of cancer treatment, a man may still desire sex and be able to ejaculate but not have an erection. Other men may have the feeling of orgasm along with the muscles contracting in rhythm, even though semen no longer comes out.

Dealing with the loss of ‘you’

It’s common to feel grief over the losses linked to cancer diagnosis and treatment. You may also notice sadness, anger, and even hostility toward those close to you. Cancer changes your sense of self, that is, how you think of your body and yourself. This can disturb your well-being and affect how you see yourself sexually. It can also affect your ability to maintain relationships.

Grief is a normal response as you give up your old ideas of yourself and begin to find new ways to cope with the changes in your life. It may take time for you to recognize some of these losses and changes. This means new losses may come up even after you think you are finished grieving. This, too, is normal. It can help if you can share your grief with someone close to you. If there’s no one near you that you want to confide in, you might prefer to see a mental health professional. Just as it’s important to take care of pain in your body, painful feelings also need to be dealt with.

Keeping your sex life going despite cancer treatment

Here are some points to help your sex life during or after cancer treatment.

Learn as much as you can about the possible effects your cancer treatment may have on your sexuality. Talk with your doctor, nurse, or any other member of your health care team. When you know what to expect, you can plan how you might handle those issues.

Keep in mind that, no matter what kind of cancer treatment you have, you’ll still be able to feel pleasure from touching. Few cancer treatments (other than those affecting some areas of the brain or spinal cord) damage the nerves and muscles involved in feeling pleasure from touch and reaching orgasm. For example, some types of treatment can damage a man’s ability to have erections. But most men who cannot have erections or produce semen can still have the feeling of orgasm with the right kind of touching. This makes it worthwhile for people with cancer to try sexual touching. Pleasure and satisfaction are possible, even if some aspects of sexuality have changed.

Try to keep an open mind about ways to feel sexual pleasure. Some couples have a narrow view of what sexual activity means to them. If both partners can’t reach orgasm through or during penetration, some may feel disappointed. But for people treated for cancer, there may be times when intercourse is not possible. Those times can be a chance to learn new ways to give and receive sexual pleasure. You and your partner can help each other reach orgasm through touching and stroking. At times, just cuddling can be pleasurable. You can also continue to enjoy touching yourself. Do not stop sexual pleasure just because your usual routine has been changed.

Try to have clear, 2-way talks about sex with your partner and with your doctor, too. The worst enemy of sexual health is silence. If you are too embarrassed to ask your doctor whether sexual activity is OK, you may never find out. Talk to your doctor and tell your partner what you learn. Otherwise, your partner may be afraid that sex might hurt you. Good communication is the key to adjusting your sexual routine when cancer changes your body. If you feel weak or tired and want your partner to take a more active role in touching you, say so. If some part of your body is tender or sore, you can guide your partner’s touches to create the most pleasure and avoid discomfort.

Boost your confidence. Remind yourself about your good qualities. If you lose your hair, help yourself to look and feel better by shaving your head with an electric razor. Or try out different kinds of hats to find one you feel comfortable wearing. Eating right and exercising can help keep your body strong and your spirits up. Talk to your doctor or cancer care team about the type of exercise you are planning before you start, or ask to be referred to a physical therapist. Find something that helps you relax – movies, hobbies, or getting outdoors. Get professional help if you think you are depressed or struggling, or if anxiety is causing problems.

Feeling good about yourself and feeling good about sex

Sex is all too often viewed as something only for the young and healthy. Sex appeal is judged by some as a skin-deep sort of beauty rather than something based on love, kindness, maturity, or a sense of humor. Based on looks alone, most people may not feel all that attractive to start with. And after being treated for cancer, their self-esteem can often fall even further.

After cancer treatment, it’s very easy to focus only on the part of the body that has been affected. Sometimes friends and lovers do withdraw emotionally from a person with cancer. This may not be because of how the person looks, but be caused by some feelings or thoughts in the person who’s doing the looking. When one partner can’t bear to look at the other’s ostomy bag, for instance, it may be a sign of much deeper feelings. Maybe they’re angry because they have to take over their partner’s usual tasks of paying bills and doing household repairs. Or the ostomy may remind one partner of how sad they would feel if the other person died. It may be easier not to love that person so much. A partner may even be more aware of their own mortality, which can be upsetting, too. Yet all these feelings get blamed on a stoma that mars a small part of one partner’s body. The “well” partner also may feel like a failure and know that they’re letting down the partner who’s had cancer at a time when they are most needed.

Don’t give up on each other. It may take time and effort, but keep in mind that sexual touching between a man and his partner is always possible. It may be easy to forget this, especially if you’re both feeling down or have not had sex for a while.

Chemotherapy also changes the way you look

The most obvious change caused by chemo will likely be hair loss. You may expect to lose the hair on your head, but other body hair, such as eyebrows, eyelashes, and pubic hair are often affected, too. You may also lose weight and muscle mass if you have trouble eating. Your skin may get darker, become dry and flaky, or you may be very pale. You nails may become discolored or ridged. And you may also have an infusion (IV) catheter or port placed in your chest or arm.

Some physical changes caused by chemo can be covered up or made less obvious. If you are just starting chemo, you may want to shop for a hairpiece before your hair begins to fall out. Toupees are warm and not really comfortable, so you may decide to save it to wear outside the home or hospital. You may decide to wear a hat or cap instead of a hairpiece in public. Many men feel a hairpiece is just too much trouble, especially since it’s not easy to find one that looks natural. Some men decide to just shave their heads. But other men may feel ashamed for even caring about being bald. It can be just as upsetting for a man to lose his hair during cancer treatment as it is for a woman.

It’s a good idea for a couple to discuss how each of them feels about wearing a hairpiece or head covering during lovemaking. There’s no right or wrong decision.

Disguising weight loss, skin color and nail changes, and infusion catheters is a bigger problem. For the most part, clothes that fit well look better. Wearing something too tight or too baggy will just draw attention to any weight change. High necks and long sleeves can hide a catheter, but may be too hot in warm weather. Look for thin fabrics that will be cool while covering you.

Sometimes the changes in your body are so upsetting that you can’t relax or think positively. Rather than feel like a failure, take this as a clue that some counseling from a health care professional would be helpful. Good communication: The key to building a successful sexual relationship

The most important part in keeping a healthy sexual relationship with a partner is good communication. Men often react to cancer by withdrawing. They think their partner will feel burdened if they share their fears or sadness. But when you try to protect each other, each suffers in silence. No couple gets through cancer diagnosis and treatment without some anxiety and grief. Why not discuss those fears with one another so that you shoulder the load together rather than alone?

Sexual sharing is one way for a couple to feel close during the stress of an illness. But if your partner has been depressed and distant, you may fear that a sexual advance might come across as a demand. You can bring up the topic of sex in a healthy, assertive way. It’s usually not helpful to accuse (“You never touch me anymore!”) or demand (“We have to have sex soon. I can’t stand the frustration!”). Instead, try to state your feelings positively (“I really miss our sex life. Let’s talk about what’s getting in the way of our being close.”).

Overcoming anxiety about sex

Many couples believe that sex should always happen on the spur of the moment, with little or no advance planning. But sometimes you’re dealing with a cancer-related symptom or treatment side effect that makes it impossible to be as spontaneous as you may have been in the past. The most important thing is to open up the topic for discussion and begin scheduling some relaxed time together. Couples need to restart their lovemaking slowly.

Part of the anxiety about resuming sex is caused by the pressure to satisfy your partner. One way to explore your own capacity to enjoy sex is to start by touching yourself. Masturbation is not a required step in resuming your sex life, but it can help. By touching your own genitals and even bringing yourself to orgasm, you can find out if cancer treatment has changed your sexual response without having to worry about frustrating yourself or your partner. It can also help you find out where you might be tender or sore, so that you can let your partner know what to avoid.

Many of us may have learned as children that masturbation was wrong or shameful. But it’s a normal and positive experience for most people. Most men and women have tried touching their own genitals at some time in their lives. Many people who enjoy good sex lives with their partners still masturbate at times. Men and women in their 70s, 80s, and 90s often still enjoy self-stimulation.

If you feel at ease with the idea, try stroking not just your genitals, but all of the sensitive parts of your body. Notice the different feelings of pleasure that you can have.

Resuming Sexual activity with your partner

When you feel ready to try sexual touching with your partner, start with plenty of time and privacy. Plan for a time when you aren’t too tired and when any pain is well-controlled. You may want to set the scene to be especially relaxed. For example, you could light the room with candles or put on some soft, romantic music. Although you may feel a little shy, let your partner know, as clearly and directly as you can, that you would like to have some time to be physically close.

You could even make a date for this purpose. You might say, “I feel ready for sex again, but I’d like to take things slowly. Would you be in the mood tonight to try a little touching? I can’t promise how well it will go, but we can have fun trying.”

It’s a good idea for couples to put some limits on their touching the first few times they try sexual activity after cancer treatment. A good way to start is with a special session devoted to all-over body touching. This is the way body touching works:

  • Each partner takes a turn touching and being touched. One partner lies face down on thbed, allowing the other partner to touch the entire back, from toes to scalp. After about 15 minutes, the partner lying down turns over so the front of the body can be touched.
  • The first time you try a touching session, avoid the breasts and genitals. Your goals are to feel relaxed and to experience sensual pleasure. It’s not important to get sexually excited. If you agree on these goals prior to starting, the touching should not be frustrating. This type of session takes the nervousness and pressure out of being close again.
  • While being touched, your job is to be self-centered and tuned in to your own feelings. Don’t worry about your partner’s thoughts or feelings. When you are doing the touching, enjoy the shape and texture of your partner’s body. Try many types of touching, varying light stroking and a firmer touch, much like a massage.
  • If you both feel relaxed during the first touching session, you can add some genital touching the next time. Over a few sessions, partners can slowly spend more time on genital caresses, until each one can reach an orgasm through stroking with a hand or through oral sex, if that’s comfortable for both of you.

Talking really helps: Many couples don’t talk much about sex. But after cancer treatment, your sexual routine may need to change. This calls for clear communication. This is not the time to let embarrassment silence you. Be sure to let your partner know, either in words or by guiding with your hand, the kinds of touches you like best. Try to express your desires in a positive way. For example, “You have the right place, but I’d like you to use a light touch,” rather than, “Ouch! That’s too rough!” Save sex until both partners really feel ready for it.

If cancer treatment has caused an erection problem, penetration may no longer be possible. Yet a couple can enjoy all the other parts of sex. Don’t give up touching and caressing, just because one aspect of lovemaking has changed.

Making sex more comfortable

If you still have some pain or feel weak from cancer treatment, you may want to try new positions. Many couples have found one favorite position and rarely try another.

The best-known way to have sex is in the “missionary position,” with the man lying on top of the woman. But if you are feeling weak or out of breath, this kind of position may take too much effort. You may be able to enjoy sex more if both of you lie side by side, either facing each other or with your partner’s back next to your front side. Or your partner can be on top.

Another position that may work well for some couples is for your partner to sit or kneel astride you. This allows your partner to move more freely while you relax or touch them.

Physical problems can affect desire and response

Premature ejaculation

Premature ejaculation means reaching a climax too quickly. Men who are having erection problems often lose the ability to delay orgasm, so they ejaculate quickly.

Premature ejaculation is a very common problem, even for healthy men. It can be overcome with some practice in slowing down excitement. A few of the newer anti-depressant drugs have the side effect of delaying orgasm. This side effect can be used to help men with premature ejaculation. Some men can also use creams that decrease the sensation in the penis. Talk to your doctor about what kind of help might be right for you.

Pain

Men sometimes feel pain in the genitals during sex. If the prostate gland or urethra is irritated from cancer treatment, ejaculation may be painful. Scar tissue that forms in the abdomen (belly) and pelvis after surgery (such as for colon cancer) can cause pain during orgasm, too. Pain in the penis as it becomes erect is less common. Tell your doctor right away if you have any pain in your genital area.

What treatments are available to help with erections?

The success rates of these treatments vary greatly, and you may have to try a few to find the one that works best for you. In many cases, some sexual counseling can help a couple discuss their options and plan how to make the new treatment a comfortable part of their sex life.

Pills

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are drugs that come in a pill form and are used to treat erectile dysfunction (ED). All of these drugs help a man get and keep an erection by causing more blood to flow to the penis. If you are having difficulty with erections, these pills are often the first type of treatment that’s tried.

For men who have had certain operations that involve the nerves that help cause erections, using these pills at full strength may not be helpful in getting an erection in the year or so following the operation. These pills work with the nerves responsible for erections. And even with nerve-sparing surgery (saving the nerves responsible for erections that run close to the rectum and along the prostate), the nerves are still damaged and need time to heal. This healing process usually takes up to 2 years. While the nerves are healing, the pills may not work. In fact, men may find the pills don’t work at all the first few months after surgery. Often by about 6 months after surgery, the pills may work a little bit and cause a little swelling in the penis but not nearly enough for an erection. A year after surgery, the pills may be more effective, but still may not produce an erection hard enough for penetration. At 18 to 24 months after surgery, the pills may be very helpful in getting a firm erection. If these pills are not producing a firm erection in the first months after surgery, it’s important to try another treatment to help restore the blood flow to the penis.

Many drugs are known to interact with pills that help Erectile Dysfunction. For example, nitrates (like nitroglycerin and other drugs used to treat heart disease) may interact to cause very low blood pressure – this can be fatal. Be sure your doctor knows about all medicines you take, even those you take rarely. You should only take these pills if they are prescribed by your doctor and come from a legitimate pharmacy. There’s a large counterfeit market for pills for ED, so make sure you are buying them from a pharmacy you know and trust.

The most common side effects of these drugs are headache, flushing (skin becomes red and feels warm), upset stomach, sensitivity to light, and runny or stuffy nose. In rare cases, these drugs may block blood flow to the optic nerve in the back of the eye. This could lead to blindness. Men who have had this problem were more likely to have been smokers or had problems with high blood pressure, diabetes, or high levels of cholesterol or fat in their blood.

Penile injections

Many urologists (doctors who specialize in conditions and diseases of the genitals and urinary tract) teach men to inject their penises with medicines that cause erections. A very thin needle is used to put the drug into the side of the shaft of the penis a few minutes before starting sexual activity. The combination of sexual excitement and medicine helps to produce a firmer and longer-lasting erection.

Penile injections are the most reliable treatment for erectile dysfunction (ED), and work in about 80 to 90% of men who try them. Many men are hesitant to try the injections because they’re afraid they will be painful. But when men are asked to rate the pain of the injection on a 0 to 10 scale, where 0 means no pain and 10 means the worst pain you can imagine, the majority of men rate the pain as a 2 or less.

Penile injections work, but they can have side effects. Because of this, the first injection is usually done in the doctor’s office. Rarely, a man may get an erection that will not go down. If this happens, he needs to go to an emergency room right away for treatment. Some men may develop scarring in the spongy tissue of the penis after repeated injections.

Vacuum constriction devices

Another treatment, the vacuum constriction device (VCD) works well for some men. With a VCD, the man places a plastic cylinder over his penis and pumps out air to produce a vacuum around the outside of the penis. The suction draws blood into the penis, filling up the spongy tissue. When the penis is firm, the man takes the pump off and slips a stretchy band onto the base of his penis to help it stay erect. The band can be left on the penis for up to half an hour.

Some men use the pump before starting sexual touching, but others find it works better after some foreplay has produced a partial erection. The erection from a vacuum device is usually firm, but may swivel at the base of the penis, which can limit comfortable positions for sex. It may take some practice to learn how to use a VCD. Most vacuum devices are prescribed by doctors, but some are available over the counter.

Penile prostheses or implants

Surgery to implant prosthesis in the penis was the first really successful treatment for medical erection problems. Over the past 40 years, many of these operations have been done, and they work quite well to treat permanent erection problems. For men who have tried all the treatments listed above, and have not found one that works well, an implant may be an option to consider. Most men who have implant surgery are very satisfied with the results.

The penile prosthesis generally offers the choice of a soft or hard penis. It’s a pump system placed entirely inside a man’s body. Two tough inflatable silicone cylinders are put inside the penis. A balloon-shaped reservoir (storage tank) that contains a mixture of salt water and x-ray dye is tucked behind the groin muscles. (The x-ray dye is used so that the system can easily be checked for problems after it’s in place.) A pump is placed inside the loose skin of the scrotal sac. All the parts are connected with tubing.

Usually, the salt water stays in the reservoir, leaving the cylinders in the penis empty. From the outside, the penis looks the same as it does when not erect, except that it’s always a little fuller. When you are ready for sex, you stiffen the penis by squeezing the pump under the skin of the scrotum several times. This pumps the salt water into the cylinders and inflates the penis just like blood does in a natural erection. When you have finished sexual activity and no longer want an erection, you press a release valve on the bottom of the pump to deflate the cylinders. The salt water then returns

You also must be realistic about what a prosthesis can and can’t do for you. Any penile prosthesis is just a mechanical stiffener for the penis. Having a penile implant can’t solve any other problems, such as low sexual desire, lack of sensation on the skin of the penis, or trouble reaching orgasm. It can’t turn a poor sexual relationship into a great one.

Overcoming depression

Staying active is a good way to reduce stress and your risk of depression. Talk to your doctor about the kinds of exercise that are right for you. As long as you don’t overdo it, exercise can help you feel better and have more energy during and after treatment. You can also reduce the pain and nausea that some cancer treatments cause by learning skills to help you relax.

If depression lasts more than a couple of weeks, talk to your doctor. What doctors call clinical depression has a number of symptoms. These include:

  • Lack of interest in sex or other things that usually give you pleasure
  • Being unable to feel pleasure at all
  • Trouble sleeping
  • Changes in eating habits (don’t count those that are due to chemo or cancer treatment)
  • Fatigue or tiredness (don’t count tiredness from your cancer treatment)
  • Trouble focusing your thoughts
  • Feeling worthless and hopeless

Depression can be treated with medicine and sometimes other methods that may improve your sleep, appetite, energy, and ability to feel pleasure. In turn, this can help your self-esteem and desire for sex. Talk with your doctor if you think you might be depressed.

Keep in mind that some of the newer anti-depressants, such as selective serotonin reuptake inhibitors (SSRIs), may cause trouble reaching orgasm. There are measures that can be taken to improve this possible side effect. If this is something that’s a problem for you, talk to your doctor about it. There are other anti-depressants that may not have that effect on you.

Men who have sex with men

There are special health guidelines for men who have sex with men, so you should seek care from doctors and nurses who are sensitive to your social situation and respect your privacy. They should also be aware of the extra care you may need. If you are in a relationship, you will want to find health care providers who understand and encourage your partner to be involved in your health care

Health care providers need to know, for instance, that men who have sex with men are at higher risk of becoming infected with hepatitis and human immunodeficiency virus (HIV, the virus that causes AIDS). They need to know how to test for and manage these kinds of problems. Often, men who have sex with men will need extra tests and vaccines, too.

All men, regardless of sexual orientation, have relationship and self-esteem concerns – with or without a cancer diagnosis. But relationship issues are different for men who are already in a long-term relationship than they are for men who are not. Men who are in committed relationships often share communication issues that are much like those of many other couples as they go through cancer. But they often must deal with discrimination, too – sometimes even from family members and friends. This can cause emotional pain and greatly complicate their lives when one member of the couple has cancer.

If your long-term partner is more likely to know your health wishes than your family, it’s important to write advance directives. That way, everyone knows who’s to make decisions for you if you become unable to do so. Make sure your doctors, your partner, and your family knows what you want and give them copies of your advance directives. Otherwise, family members who don’t know what you want may be the ones legally expected to make decisions for you in the event that you become unable to speak for yourself.

Frequently asked questions

Can sex cause cancer?

For most cancers, there’s no link between a person’s sex life and the risk of cancer. Nor does having sex after cancer treatment increase the chances of cancer coming back or getting out of control. But viruses passed from one person to another through sexual contact have been linked to some cancers, including squamous cell carcinoma of the cervix, vulva, vagina, penis, mouth and throat, rectum or anus, and Kaposi sarcoma. Hepatitis B and hepatitis C viruses, which can be passed from one person to another during sex, can increase the risk for liver cancer. Epstein-Barr virus, which causes mononucleosis (also called mono or the “kissing disease”), seems to increase the risk of certain other types of cancer, too.

These cancers are not caused by having sex itself, but by viruses that can be picked up during sexual activity with someone who already has the virus. News stories about viruses and cancer can be confusing. The roles of these viruses are not fully understood, but some can cause changes in the DNA of the cell. Keep in mind that most people who get these viruses never develop cancer.

Human papilloma virus

Nearly all women with cervical cancer have been infected with human papilloma virus (HPV), which is recognized as the main cause of cervical cancer. HPV can also cause cancers of the mouth and throat, anus, penis, vulva, and vagina. HPV is the most common sexually transmitted infection in the United States. HPV is passed from one person to another during skin-to-skin contact. It can be spread during sex – including vaginal sex, anal sex (entering or being entered through the anus), and even during oral (mouth) sex. Most adults who have had sex will at some point get HPV. But HPV does not cause cancer in most people who get it. Some people with HPV may be more at risk of getting cancer because of their age, poor health, family history, or past experience with other cancer-causing agents. For example, women who smoke cigarettes have an increased risk of cervical cancer. Men who are not circumcised are more likely to develop cancer of the penis.

Many patients and their partners worry that cancer is contagious

Despite this myth, a cancer cell from one person’s body simply can’t be transmitted to another during sex, then take root and grow in their body. Cancer is not contagious.

Can AIDS be picked up from sex?

The virus that causes AIDS is called the human immunodeficiency virus (HIV). It can be passed to someone else when blood, semen, or vaginal fluids from an infected person get into the body of an uninfected person. This can happen during oral (mouth), vaginal, and anal sex (entering or being entered through the anus). Nearly everyone with HIV got it in 1 of 3 ways:

  • Unprotected sex with an infected person
  • Sharing an infected person’s needle or equipment during drug or steroid use
  • From a mother to her baby during pregnancy or breast-feeding

Most people with HIV don’t look sick until they have had the virus for many years. During that time, the only way to find out whether a person has the virus is to take an HIV test. Unless you know for sure that neither you nor your partner has the virus, and that both of you are careful to avoid infection, you should practice safer sex. If you are in a trusting relationship, and both of you have been tested and don’t have the virus, unprotected sex may be safe. But both partners must stay faithful in order to protect themselves from HIV.

Examples of safer sex include:

  • Touching each other’s genitals with the hands.
  • Oral sex with a woman if a “dental dam” is used. A dental dam is a rubber sheet that is used to cover the woman’s vulva during oral sex. Or a sheet of plastic kitchen wrap that keeps the woman’s sexual fluids contained can be used instead. Do not taste vaginal secretions without knowing the woman’s HIV status first.
  • Oral sex with a man if he wears a latex or plastic condom from start to finish. Never taste or swallow a man’s semen if you suspect he might have HIV.
  • Vaginal or anal sex using a latex or plastic condom. Condoms only work if they are used correctly, every time, from start to finish. Lots of water-based lubricant can help reduce the risk of the condom breaking. Never use lotion, oils, or petroleum jelly, which weakens latex condoms.

Spermicides (sperm-killing chemicals often used to prevent pregnancy) are not a good idea if you are trying to protect yourself from HIV. The sperm-killing chemicals in contraceptives were once thought helpful in fighting bacteria and some viruses. But some studies have suggested a higher risk of getting HIV infection in people who used nonoxynol-9 (N-9), a popular ingredient in foam, film, and gel contraceptives. N-9 can harm both vaginal and rectal tissues. Some lubricated condoms also have N-9, so you may want to check the label before you use them. Talk with your doctor about what methods might best meet your needs for preventing sexually transmitted infections or pregnancy.

What if I already have HIV?

If you have HIV, safer sex is important to avoid sexually transmitted infections. You will also want to protect your sex partner from HIV. Even if your partner has HIV too, either of you could become infected with a second strain of the virus. Researchers have discovered, for example, that people who were first infected with a type of HIV that could be treated with anti-viral drugs have gotten drug-resistant HIV through unprotected sex. If properly used, latex condoms can keep HIV from being transmitted through sex.

Can sex during treatment be harmful to a patient or partner?

A few chemo drugs can be present in small amounts in semen. You may want to use condoms while you are getting chemo and for about 2 weeks afterward. Some types of radiation treatment require special precautions for a certain amount of time, too. For instance, a man who is having “seed implants” (brachytherapy) for prostate cancer should check with his doctor about safety precautions, like using condoms, because sometimes the seeds can move.

Men who are getting chemo also should avoid causing pregnancy during and for some time after treatment because chemo may damage the DNA in sperm cells. This could lead to birth defects. Ask your doctor about birth control if your partner might get pregnant. You will also want to know when you can stop using birth control for this reason.

Although sexual activity is usually safe for your partner during your cancer treatment, some couples just stop having sex, without checking out their fears with the health care team. If you have been cleared medically to resume sex, but are still unsure, you may just need more time. Think about your feelings. Are there times when you feel a stirring of sexual desire?

Be sure to let your partner know that you’ll want to have sex as soon as you feel better. Give your partner some ideas on helping you feel more sexual again, such as, “Let’s try being affectionate in a relaxed way,” or “I’d like to know that you still find me attractive.”

You may also need to reassure your partner that your cancer treatment does not make sex dangerous. Cancer can’t be caught from another person. If you have external radiation treatments, having sex with you does not expose your partner to radiation.

When should a person with cancer not have sex?

Ask your doctor if sex may be a problem at any time during or after your treatment. Here are some general guidelines to think about:

  • When recovering from surgery, sex can cause bleeding or strain the incision (cut). Sex may also increase your chance of an infection. The time between surgery and when it’s safe to have sex varies. It depends on the type of operation and how well you are healing. Your surgeon can tell you when it’s safe to try sex again.
  • Some types of cancer, like cancer of the bladder, may cause bleeding in the genital area or urinary tract. If this bleeding is worse after sex, talk with your doctor about it. You may need to stop having sex until the bleeding has stopped and the area has healed.
  • During chemo, a person with an infusion catheter sometimes worries that sexual activity will harm it. As long as you take care not to rub against it, sex should not cause any problems..
  • There are things you can do to try to prevent urinary tract infections. Some of the bacteria that can start infections in the urinary tract or genital area may wash away if you urinate a few minutes after sex. You might even want to drink a glass of water before you make love, so it will be easier to urinate afterward.
  • If you notice any sores, bumps, or warts on your partner’s genitals, or any unusual fluids or discharge, you should ask for an explanation of the symptom and decide whether it’s safe to have sex. But you should not expect to be able to screen your partner for sexually transmitted infections (STIs) before having sex. Remember that most STIs never cause signs or symptoms you can see. The only way to detect most of them is to go to the doctor and ask to be tested for them. And often the person with an STI doesn’t even know they have it. You can reduce your chances of getting an STI if you wear a latex or plastic condom for oral, vaginal, or anal sex.

Do other people with cancer feel shame or guilt?

Even if a cancer treatment hasn’t left obvious scars, many people still feel ashamed of having cancer. Some people feel that the person with cancer may be unclean or somehow to blame for the disease. These ideas are not true. Feelings of guilt or blame can only take away from the efforts you make toward solving sexual problems.

My partner is acting different since we talked about my cancer. How do I handle that?

Many people think that cancer is always fatal. But in a nation where 1 out of every 2 to 3 people will have cancer in their lifetime, and where survival rates are steadily going up for those with cancer, this belief is unfounded and harmful. Still, it can affect the way others relate to you.

Talking to your partner about your diagnosis and treatment as it unfolds may help both of you. Fear of the unknown can interfere with intimacy. Your partner may be afraid of losing you but afraid to say so, and sometimes it helps if you can bring that up. You may have some other concerns you would like to share, too.

Sit down in a quiet, private place. Offer a chance to talk, but don’t force the issue if your partner is unable to open up with you at first. Try to be available if your partner wants to talk later. If that doesn’t happen, you may want to try again. If it continues to be a problem, you may want to think about counseling.

What about sex and advanced cancer or at the end of life?

A very ill person is not often seen as a sexual person, but sexual feelings exist in everyone, even in times of very poor health. Touching, caressing, sharing, and emotional intimacy are always important – even at the end of life.

When cancer is far advanced, a person’s needs for affection, sharing of feelings, and touch may become even stronger. Partners of patients can help by remembering how important physical closeness is, even when sex might be too much for the person with cancer.

Other questions

You probably have many other questions that haven’t been addressed here. Don’t be afraid or embarrassed to discuss them with your doctor or other members of your health care team. Write them down now so you’ll remember to ask them at your next visit.

Pleasure Solutions

“We encourage people recovering from the reality of cancer to explore the changes it has created, and learn to enjoy and benefit from new possibilities for intimacy.”

Pleasure Solutions offers a combination of online information, telephone support and products that will encourage people to explore their sexual lives.

We give clinicians peace of mind by providing a resource they can direct to. Adding the extra attention and time people need to help them plan and rediscover intimacy.

Disclaimer: whilst HCCN cannot recommend one company over another this company may offer some useful information.

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