Sex and cancer Cancer treatment can have a dramatic effect on how you feel about sex, and that can have an impact on your relationships. But help is available – just ask.
What can happen? The treatment you’re having can have physical and emotional impacts that change your sexual desires and experiences.
Hormonal changes In women, the female hormone oestrogen is produced by the ovaries. If your hormone production drops or stops due to your cancer treatment, you could experience early menopause which often leads to vaginal dryness and lowered libido. In men, the male hormone testosterone is produced in the testes. If your testosterone levels drop due to the drugs you’re taking or the removal of one or both testes, it could affect your sex drive.
Vaginal discomfort Radiotherapy in the pelvic area can cause your vagina to feel sore. The radiation may also cause scarring which makes your vagina narrower and less flexible. Surgery, too, can change a vagina’s shape or size.
New sensations Surgery that affects your clitoris can change your experience of arousal. A cystectomy to remove your bladder, or a hysterectomy to remove your uterus, can damage blood vessels or nerves to the clitoris.
Breasts and femininity The removal of a breast or part of a breast can impact on your self-image and also change your sexual experience.
Erection problems Treatment for prostate cancer often involves removing the prostate gland. After a prostatectomy, many men have difficulty maintaining an erection. Radiotherapy in the pelvic area can damage nerves and blood vessels around the penis and this, too, can lead to problems with sustaining erections. Radiotherapy can also irritate the urethra so you get a stabbing pain as you ejaculate, but this side effect usually disappears within a few weeks.
Dry ejaculations If you’ve had a radical prostatectomy you may find that you experience dry ejaculations. That’s because you’re no longer producing semen and the sperm you do produce is absorbed back into your body. You may find that your orgasms feel less intense than they used to.
Learning to adapt Changes to your sexuality can be temporary or permanent. In any case, you may want to explore new ways of achieving sexual pleasure.
Touch Forget about sex for now and focus on gentle, physical intimacy instead. Rediscover cuddles and kisses, holding hands, touching and stroking.
Talk If your sex drive is low, talk to your partner about how you’re feeling and come up with solutions together. It may also help to speak to a counsellor.
Nice knickers If you don’t want to be naked during sex, then consider investing in some lovely lingerie. It can help you feel more feminine, too.
Lubrication Vaginal dryness makes penetrative sex very uncomfortable. There are medications, lubricating creams and gels to help with this.
Stretches Narrowing of the vagina is common after radiotherapy in the pelvic area. A solution is to use a set of plastic cones, called dilators, to stretch your vagina. You insert them a few times a week for five or 10 minutes at a time.
Drugs In some cases, drugs that improve the blood flow in your penis make it possible for you to have an erection. Get advice from your care team first.
Injections and pellets An injection of prostaglandin straight into the penis before sex can give some men an erection. If it works for you, you’ll get advice on how to administer the injections yourself. Prostaglandin can also be administered as a pellet into the entrance of the urethra.
Pumps A pump can be used to draw blood into the penis to give you an erection. To maintain the erection you’ll need to slip a soft plastic constriction ring around the base of your penis. This works for some men, but not others.
Words to know
Clitoris the main sexual pleasure organ for women
Cystectomy surgical removal of the bladder
Libido sex drive
Oestrogen the main female sex hormone
Prostate a gland in men that produces part of the fluid that makes up semen
Prostatectomy removal of all or part of the prostate gland
Semen fluid containing sperm and secretions from the testes, ejaculated during orgasm
Sperm the male sex cell, produced in the testes
Testosterone the main male sex hormone
Urethra the tube that carries urine from the bladder to outside the body
Things to ask
Do I need a specialist surgeon? Some surgeons specialise in nerve-sparing surgery which involves sighting and working around key nerves during an operation. Nerve-sparing surgery can reduce the risk of damage around the penis and clitoris. In most cases, nerve-sparing surgery is only possible if the tumour is small. Speak to your care team if you want to know more about it.
Expert's insight: Dr Amanda Hordern Dr Amanda Hordern, director of cancer information and support services at the Cancer Council of Victoria, has explored the sexuality issues that can affect people living with cancer.
“This is a big topic, but it rarely gets coverage. People are sexual beings until the moment they die. Having cancer doesn’t make you asexual. You may be traumatised by the loss of hair or the weight gain, but the sexual appetite still remains.
“What I hear over and over again is that sexuality is way more than just having penetrative intercourse. At a forum recently, I listened to this woman who had quite advanced cancer. She said that sex for her was holding her partner intimately every morning for three minutes. They would breathe in and out together, and it got them going for the day. This was their deep connection, and it didn’t involve a penis or vagina. As a society, we don’t value this as a sexual experience, but it satisfied her.
“Of course, you can have penetrative intercourse if it’s consensual. The only caveat on that is if you’re having some types of chemotherapy. We believe that for the first 24 to 48 hours afterwards you could pass on certain chemicals through the semen or vaginal fluids.
“You may need to ask yourself some questions. What was your sex life like before the diagnosis? Do you still want or feel like sex? Many people with cancer can’t even legitimise having sex. Maybe you consider it too frivolous. For some men, it’s never having an erection again, but re-exploring what it means to be a man and to be a sexual being. We need to teach men that you don’t have to have an erection in order to get to orgasm.”
More help
Relationships Australia 1300 364 277 www.relationships.com.au You may benefit from talking to a counsellor from their Sexual Concerns Service.
It’s a Real Bugger Isn’t it Dear? www.acsa.org.au/gmh_resources.html Stories of different sexuality (gay, lesbian, transgender) and cancer. There is a PDF of the booklet at the web address shown above.
Photo by Paul Harris
IAN SMITH In 2004, Ian Smith had his prostate removed. Now 70, he is part of the Prostate Cancer Foundation of Australia and started its awareness campaign of signs in barber shops. He helps run a support group in Brisbane.
“I was up and about walking around the day after the operation, and the very next day I went home. I had the catheter (a tube that drains urine from the bladder) out 10 days later.
“My main concern was incontinence. Having to put up with incontinence pads is really inconvenient. Add up the total time you have sex in a week compared to the problems you’re having with water, and it’s no contest. Within a week I didn’t have any water problem because of the pelvic floor exercises I’d been advised to do, not just after the operation, but for a month beforehand. Getting over the incontinence was the greatest relief of all time.
“Before the operation I sought the help of an expert doctor for both incontinence and erections. He told me to come and see him the day I got my catheter out. Some people told me not to worry for six months, but I was eager to get started.
“The doctor explained that it was all about getting the blood to flow into the penis. He said it’s a matter of ‘use it ot lose it’. Within a month, I was back to normal. That was because the cancer was detected early which meant I could have nerve-sparing surgery to minimise incontinence and erection problems.
“For most people, a prostate removal operation will cause a slight shortening of the penis. That happened to me but, funnily enough, it’s pretty much back to normal now. I ran into the doctor in the street the other day and told him about it, and he said it wasn’t such an uncommon thing.”