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Living with and beyond cancer

Sexual functioning and intimate relationships

Having treatment for cancer can affect a person’s ability to feel good about themselves sexually, or their physical ability to give and receive sexual pleasure. This may be due to the physical effects of certain cancer treatments or to psychological issues. For many the changes will be temporary. For others they will be long-lasting or permanent. This doesn't need to mean the end of their sex life as there are many ways of adapting and developing new ways of giving and receiving sexual pleasure. Advice is available from professionals and, with support and clear communication, it can still be possible to enjoy fulfilling intimate relationships.
 
While a few people we spoke to said that they had continued having sex with their partner during their cancer treatment, most said that their illness and its treatment had temporarily made them less interested in sex (loss of libido) because they were feeling too ill or tired or they didn’t feel good about their body.  People can worry that they could pass on their cancer to their sexual partner but this is not possible. Many people said that once they had recovered from the short term effects of surgery or other treatments they were able to resume a normal sex life, a few saying they enjoyed sex more after their treatment. A woman who had ovarian cancer surgery said that her husband became temporarily impotent afterwards because penetrative sex felt different. Those who were not in a sexual relationship at the time said that sex was not an issue for them.
 

She didn’t want sex for a while after radiotherapy for cervical cancer, but her husband was...

She didn’t want sex for a while after radiotherapy for cervical cancer, but her husband was...

Age at interview: 36
Sex: Female
Age at diagnosis: 27
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I would say for a long time, six months or so, I didn’t want to anyway because I felt that, I was scared, I think, of bleeding or the pain or the discomfort, and I was douching every day because of scar tissues, and I was told at various treatments afterwards, or appointments afterwards, that it was raw tissue inside, so I didn’t feel very sexual, to be honest. I didn’t feel like I was a complete woman anymore because I didn’t have ovaries that worked, and I did go through a stage where I didn’t feel very attractive or very appealing as a woman even though no one in the street would have known, I knew, and that was quite tough yeah.
 
What effect did that have on your relationship at that time?
 
It didn’t actually, my husband was very supportive again. Again, I think he was quite scared of hurting me as well. And he never put any pressure, you know, we always cuddled, we were quite an affectionate couple anyway, so it didn’t really affect; it didn’t affect our relationship I'd say, definitely not, no. We always talked about it too, which I think is quite important. And when I did feel it was time, and I was ready, it was such a revelation after all those years of bleeding, that suddenly I was normal, and it was normal and this is how it should have been, but I never knew, and that was quite nice really.
 
Can you explain a little bit more about that?
 
Because in the beginning, before I was diagnosed, I did bleed during sexual activity, and when I went to the doctor originally he told me that was normal. It didn’t always happen but when it did happen I just presumed, because it wasn’t something I would talk about with my girlfriends, that it was normal. So suddenly when it wasn’t happening any more that’s when I realised it wasn’t normal at all.
 
OK, and when you actually resumed a sexual life, did it feel any different?
 
Yes, mentally I think for a start because you’re very aware it could be painful, it could be sore, you could affect something, you could bring on another tumour, so all those feelings are going on in your head, but physically it wasn’t painful at all actually. It wasn’t, it wasn’t uncomfortable. I was told in the beginning that I might lose the top of my vagina from my treatment, but it didn’t feel any different for me. My husband said it didn’t feel any different for him. Again, it was the release of not having the blood, it was just so different for me because I’d had that for a few years and suddenly it wasn’t there, it was really good.
 
For others the impact of cancer on their sexuality and sexual activity was longer-lasting or permanent. Some were still in treatment several years after their cancer diagnosis and still experiencing effects that had been temporary for other people. For instance, people taking hormone therapy for several years could experience loss of libido throughout the treatment (see Hormone changes’). A man with lymphoma said that long-term use of steroids had affected his libido. Similarly, those with chronic or slow growing cancers of the blood had a tendency to feel tired a lot of the time.
 

Beverley’s physical experience of sex had not changed as a result of her chronic leukaemia but...

Beverley’s physical experience of sex had not changed as a result of her chronic leukaemia but...

Age at interview: 54
Sex: Female
Age at diagnosis: 47
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Has it had any effect on your sex life?
 
No, not really. You sometime, yes, I mean I think most cancer sufferers have this feeling of you’re infected and could you pass on, or anything else? I know very well I couldn’t but there is still that little part of you. There’s that tiny, tiny little grain there that at the beginning that you think that. But no, no it’s exactly the same as it always has been. There’s nothing to see, is there? There’s nothing to see anywhere with leukaemia, so there isn’t anything that’s going to be any different. Obviously, the only other way that it does affect your relationship is that you are so tired, that, you know, “Forget it. I’m going to bed.” And it doesn’t matter whether it’s eight o’clock in the evening or whether it’s ten, eleven o’clock in the evening. And I think after the length of time my husband and I have been married, he’s so used to me just if I’m too tired, to go to bed and I just go to bed and he cuddles into the back of me or I cuddle into the back of him and fast asleep we go. And so what if we don’t have sex that night? We really don’t worry about it.
For women, cancer surgery could cause damage to nerves or a shortening of the vagina, altering the sensations experienced during sex for themselves or their partner. For instance, a woman who had a hysterectomy for cervical cancer said her vagina had changed shape and she didn’t experience the same responses during sex. Lasting vaginal dryness resulting from pelvic radiotherapy, hormone therapy or the menopause can make it difficult for women to have penetrative sex although there are lubricants available to help.
 

After having a lumpectomy and radiotherapy for breast cancer, Diane has no sensation in the...

After having a lumpectomy and radiotherapy for breast cancer, Diane has no sensation in the...

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Some people say that after they’ve had cancer it can affect things like your sex life. Did you find that?
 
No, I was concerned that my husband would bear it in mind but it hasn’t affected him at all. He’s quite happy. I had no sense of touch on that side. It’s, you know, it’s quite. I don’t know why I haven’t any, don’t get any, I’m not aroused if anybody would touch that side. I think, again, it’s because I’m self-conscious about that side, but no, not for very obvious reason because it doesn’t look, I don’t look deformed or anything. But no, it hasn’t impacted on my husband at all, and again, I don’t know if that’s normal, you know, that for a husband to feel differently, but he hasn’t. I think in some ways I suspect he’s just glad I’m still around. 
The sexual functioning of men can be permanently damaged by certain cancer treatments. Men who have one cancerous testicle removed usually have no long-term sexual problems. However, hormone therapy (e.g. for prostate or breast cancer in men), pelvic radiotherapy and surgery for prostate, bladder, or colorectal cancer can all affect a man’s ability to achieve or maintain an erection. This is known as impotence or erectile dysfunction. Nowadays this can be overcome with medicines (such as Viagra (sildenafil)), injections, implants or a type of vacuum pump. Men may find it difficult to discuss such a personal issue openly but health professionals are very used to dealing with this problem and can give advice. Among the men we spoke to, several had used medicines to help them lead an active sex life, whereas others had either declined an offer of help or had not wanted to ask for help from their health professionals.
 

Treatment for his non-Hodgkin’s lymphoma left him with erectile dysfunction; he now uses Viagra.

Treatment for his non-Hodgkin’s lymphoma left him with erectile dysfunction; he now uses Viagra.

Age at interview: 49
Sex: Male
Age at diagnosis: 39
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Did the treatment have any effect on your fertility?
 
Oh I’ve not got none.
 
Do you know that for a fact?
 
Yes. I was told that way back, 1996, and I mean I get Viagra now and that’s brilliant, you ought to try that. Well not you obviously because you’re female but, you know, I mean if you feel like taking the Viagra at the rate the doctors say you should take it, you know, you could give an 18-year-old a run for his money. But it’s a bit awkward. I mean I know 18-year-olds don’t mind walking about with big lumps in their trousers but when you get to my age it’s just a pain in the arse. So no I don’t think, it made my masculinity a bit more controllable.
 

After his treatment for breast cancer, Derek found that nothing could arouse sexual desire in him...

After his treatment for breast cancer, Derek found that nothing could arouse sexual desire in him...

Age at interview: 65
Sex: Male
Age at diagnosis: 57
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 Did you feel less of a man because of it?

 
That’s a good question. That is a good question. I don’t know how freely you want me to talk on that one. 
 
As freely as you like
 
Up to then I would say we had a good relationship, me and my wife, you know, like normal. Yeah, since then things did go downhill, very… it don’t even… like my wife said she did it for me. She held back, if you want to call it holding back. I didn’t pressure her. I thought oh, we’re not gonna be bothering doing anything like that now, and it’s materialised that we don’t. I still… enjoy… how can I say… I’m not embarrassed. Why should I be embarrassed?
 
I’m not embarrassed, so…
 
I blame it, I say it’s tablets. See what I say, it’s up there or not, I don’t… I can’t get an erection. Sex doesn’t bother me. I can’t get, and I’ve had this for now a lot of years. Without being funny, you’re watching erotic stuff on telly and there’s nothing, nothing whatsoever. I can’t get aroused, anything. I feel as though I’ve lost that part of my life, without a doubt of that. Whether that’s through this, through tablets or that I would really like to know. I know I did have a talk with my doctor once, I was gone a few years and he said, he mentioned Viagra but the wife said no just don’t even think about it. Past that now. You know? So… but yeah. I lost… six, eight years. Which… you just now, I just, it’s just I’m not interested. I can’t say I’m not… I’m not as… I always give my wife a kiss but that’s it. You know, we always before we go to work, before we go to bed, she goes before me, we’ve done that ever since and we always have done. That’s as far as it goes. That’s it, you know? Maybe she says I don’t say I love her like I used to. That goes with time sometimes. But it’s me that… I know I love her, I do love her. With all my heart. Yeah, I feel I missed… I don’t, I’m not angry about it now. It’s just part of me now, it’s just… doesn’t bother us. Not bothered, I don’t think. I don’t even think about it. Why think about it when it’s not going to happen.
 
A man who had breast cancer treatment was prescribed Viagra afterwards but he hadn’t used the pills and he and his wife no longer bother with penetrative sex but find other ways to be intimate. A man who was left impotent after surgery and radiotherapy for colorectal cancer wasn’t allowed Viagra because he had a history of heart attack; he feels bitter about losing his sexual function.
 
Penile cancer is rare and commonly treated with surgery. The extent of surgery depends on the size and position of the tumour, and reconstructive surgery may be an option. Men may find it difficult to come to terms with having surgery on their penis, but it need not necessarily mean the end of a sex life, although those who have their whole penis removed can no longer have penetrative sex.
 

After previous penile cancer treatment proved unsuccessful Barry had his entire penis removed so...

After previous penile cancer treatment proved unsuccessful Barry had his entire penis removed so...

Age at interview: 66
Sex: Male
Age at diagnosis: 51
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Well obviously my sex life’s nothing now. I did have – it wasn’t an active sex life after I – sex, after I had the cancer I mean, obviously once I’d had my radiotherapy and everything, I mean I did have a little bit of a sex life, but not much. But, obviously I’ve lost my penis, so I mean it’s just like anything else, I don’t have a sex life as a sex life, if you understand what I mean. I can’t have a sex life, can I, because I haven’t got a penis. Does it still bother me that I can’t have sex? Obviously it does do. I’m a man. It does bother me in a sense but it’s like anything else, I’d sooner not have sex and be alive than have been able to have sex and be dead, if you understand what I mean. 

For some people their lack of desire to engage in sexual activities was less to do with physical problems and more to do with how they felt about their body after treatment (see also Body image or sense of identity). People who have had body parts removed or have unsightly scars from surgery may feel a loss of confidence in their body and be reluctant to be seen naked even by long standing partners. Norma said she had never worn a nightdress in her married life but started doing so after her colorectal cancer surgery, to hide her scars from her husband. Having a breast removed (mastectomy) can leave a woman feeling unattractive. Using a colostomy or ileostomy bag to collect their faeces through a hole in the abdominal wall (stoma) after surgery for colorectal cancer, can leave people feeling both unattractive and unclean.
 

After 3 operations for her ovarian cancer and losing her hair through chemotherapy, she feels...

After 3 operations for her ovarian cancer and losing her hair through chemotherapy, she feels...

Age at interview: 61
Sex: Female
Age at diagnosis: 54
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Has it affected your relationship in any physical ways, your sex life and so on, or would you not want to talk about it?
 
Well it has, I mean obviously it has, I don’t particularly want to talk about it but it has in the sense that your own image, my own image of my body was horrendous for weeks and weeks and my husband was always very reassuring and would say to me, “You don’t have to wear your wig”, you know, when we went to bed. And you think, “Well it is a bit silly, isn’t it, wearing a wig in bed”, but, you know, you’re... I was so thin and scrawny and, that you don’t really feel attractive even if you felt you had the energy for a wildly exciting sex life, you don’t, you often have to make yourself remember that this is quite an important part of your life and that if you don’t preserve it isn’t going to come back when you feel alright.
 
I think that’s really the way it’s affected it, that often you maybe find yourself perhaps with less enthusiasm than you might have, but you know there is going to come a time when you are going to feel better, but as you get older you might think, “Gosh I let this go”, and so perhaps more self-consciousness about it. But mostly, largely because it’s very difficult, it’s been very difficult for me to think that I want to be seen outside of voluminous night-dresses or pyjamas, you know, terrible, pancake bottoms and things.

 

 

Having a permanent ileostomy for colorectal cancer leaves him feeling unclean; he believes that...

Having a permanent ileostomy for colorectal cancer leaves him feeling unclean; he believes that...

Age at interview: 65
Sex: Male
Age at diagnosis: 35
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I think psychologically they don’t tell you the effect it can have on you.
 
What is the effect?
 
The fact is that when you’ve got that stoma you feel as though you’re a bit unclean, it’s a bit unfair for your wife of husband, if ever it, whatever way it is, like sexually, to think, oh, you must look an awful thing with that bag hanging on you. I think that is for every person their own individual thing, you know. I mean it could be repulsive for the partner I should think. And my wife says it doesn’t make any difference to her; whether she’s just being kind to me I don’t really know, but I mean I’ve only got her opinion on that.
 
But I should think it must be a horrible thing. Nobody ever mentions that to you when you’re having the operation, or had the operation. I think it could be a big thing on a younger person. I mean, I was a bit, well getting more middle-aged I suppose when I had my operation. But for a younger person I should think it could be rather, oh I won’t get a boyfriend now, I won’t get a, nobody will want to see me anymore.

 

It was common for people to say that because they were getting older they were not so concerned about changes to their sex life than if they had been younger. Some implied that this was their reason for not having discussed their difficulties with a professional.
 

Hormone therapy for prostate cancer has ended John’s sex life but at age 80 he has not sought...

Hormone therapy for prostate cancer has ended John’s sex life but at age 80 he has not sought...

Age at interview: 88
Sex: Male
Age at diagnosis: 80
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I don’t know whether you wanted me to say anything about my wife. There’s one thing I haven’t mentioned, of course, this particular treatment does effectively make you cease your sex life altogether. Now, whether if you’d expect to enjoy such things in your eighties is a moot point but if anybody prizes highly a continuing sex life then I can see this being a great disappointment.
 
And is that something that was mentioned in the information that you got at the beginning when you…?
 
I can’t remember whether it was mentioned or not. Logically, I realised it would do so because you’re told that it is to cease the production of semen, and if so then the effects of that are pretty obvious. I can imagine an eighty-year-old who’s just married a nubile twenty-five-year-old with great, very, disappointed.
 
And is that something that you’ve been able to talk about to your GP about or have they given you any advice or not?
 
No, no advice about it. I’ve grumbled occasionally but then that’s just a grumble.
 
You mean you’ve grumbled about it with your GP or to your…?
 
And probably I’ve grumbled about it to my wife but not otherwise.
 
And is that something that you think you would have liked to have had some support for?
 
Frankly, at my age I couldn’t have expected it.
 
You never know. I mean I think if you were to mention it they would probably be able to provide some advice or help.
 

Oh, yes, I mean the last time I mentioned it there was some sort of murmur about help, but frankly, I think mutually we’ve settled down to a relationship that doesn’t have to include active sex. 

Many stressed the importance of the support and understanding demonstrated by their spouse or partner in coming to terms with changes in sexual functioning. Some said that they now slept apart from their spouse. One man said this was because of the night sweats he had because of his lymphoma.
 

Despite encouragement from the nurses, she no longer wanted to have sex after radiotherapy for a...

Despite encouragement from the nurses, she no longer wanted to have sex after radiotherapy for a...

Age at interview: 63
Sex: Female
Age at diagnosis: 52
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Did it interfere with your sex life?
 
Yes. I think I’d just got probably, just disgusted with the workings of my body unfortunately. That didn’t happen at the beginning, but I think as time wore on, I think after I’d had the radiotherapy we didn’t have sex anymore. I think, you know, the nurses tried to sort of encourage me but my husband again was incredibly understanding about it.
 
So it was you who instigated that?
 
Yes it was. I think he just fully understood.

 

Although many people had been reticent to seek help with sexual difficulties, advice is available from doctors, nurses and sex therapists. A woman with ovarian cancer was offered sex therapy but after discussing it with her husband she declined the offer. After seeking help, Christopher said he had a better sex life than ever.
 

Christopher and his wife consulted a nurse about how to improve their sex life after prostate...

Christopher and his wife consulted a nurse about how to improve their sex life after prostate...

Age at interview: 63
Sex: Male
Age at diagnosis: 57
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The sexuality is strange. I can experience an orgasm but it’s different to what I did prior to the operation. It’s almost more, it’s more intense. It’s like some of the nerves have been sort of wired up slightly differently, or they’ve joined up, although they work but the sensation is almost like an electric shock. I mean it’s so intense. I mean it’s pleasurable but it’s so intense that one almost has to stop. It’s like one can masturbate but when you climax it’s so intense that it’s like, “Whoof.” You know, “I’ve got to stop.” You know. 
 
So going back to what you said how it physically it affects me, yeah, I can’t have sex as we all experience it but it’s just as good in a different way. I mean after the operation I went to see, I don’t know what the technical term is, but a sort of a nurse that would deal with sexual problems. And one of the things that they did say was with the consultant that’s not something that’s high on his list of what you’re like after the operation. It was, and I can understand that, because obviously it’s a big operation and technically it’s quite complicated and, you know, that’s his field of expertise. So I can’t expect him to be clever at everything, so I went to see this woman and, again, as I’m talking to you, it’s not sort of something prior to the operation that I would have spoken openly about but it’s since I had several meetings with her it’s quite good. 
 
And I mean she said that there are, you know, you can get Anne Summers and, what was the other one, I can’t think now. But lots of companies that produce, you know, sexual aids and toys and things like that, whatever you want to call them and I was obviously concerned for my wife’s point of view because obviously I’m not going to be able to satisfy her. And to cut a long story short I ended up, I bought a vibrator and it took a while to get used to it. I know my wife was quite angry after the operation because she felt that she was just as big a victim as I was, but no one was talking to her about it. You know, although we both went to see this woman about the sexual problems afterwards together, and I think that helped, but with this vibrator now I can give my wife a better orgasm than I could before. And I think because, the plus side is because I can’t, you know, I can’t satisfy myself in the same way as I could prior to the operation I have more patience and it gives me greater pleasure to see her enjoying a normal sex life or a better sex life than she had before. 
 
Do you feel that now you still need or are you still seeing the nurse about any sexual problems or do you need any more support in that area?
 
No, because I think we’ve got to a stage now where we know what to do, so I know what to do to give my wife pleasure and she knows what to do to give me pleasure. And my wife often turns round and says, “Pity we didn’t know this knowledge years ago because it would have been better then.” You know, but they were very good. 

 



Last reviewed October 2018.
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