Sexual Health During Cancer Treatment

Sex during cancer treatment is generally considered safe. However, there are some health concerns to consider.

Speak to a care team member before you take part in sexual activity. Ask them any questions you have.

Safe sex during cancer treatment

Sexual activity includes vaginal, oral, and anal sex and masturbation. In some cases, there is a risk of bleeding and infection due to certain cancers and treatments. A sexual partner could also be exposed to chemotherapy drugs if they have sex with a patient while the drugs are still active.

Before having sex during cancer treatment, make sure that you:

• Have a blood platelet count of at least 50,000. Platelets are cells that stick together (clot) to stop bleeding. They protect the body against bleeding or bruising that might occur during sex. Your body is less able to stop or control bleeding if a cut or bruise occurs while platelet count is low. This can be dangerous.
• Have an absolute neutrophil count (ANC) of 1000 or more. Neutrophils are a type of white blood cell that helps the body fight infection. Sex can cause yeast or urinary tract infections.
• Wait 3 days after chemotherapy before having sex. Seventy-two hours is the average amount of time that the medicine takes to leave the body. During that time, chemotherapy medicine is present in body fluids. Having any type of sex within 72 hours of chemo treatment may expose a partner to these drugs.
• Some radiation is placed inside your body. This is called brachytherapy. Doctors place small tubes with radioactive material at the tumor site during surgery. This type of radiation lasts 3 to 5 days while you stay in the hospital. You should not have sex until the doctor removes this material.
• There is no set time to wait after external beam radiation. This is radiation you get from a machine outside your body.

Use protection during sex

It is important to use a condom or other form of barrier protection during sex. This is especially important if you have cancer because your immune system may be weak. Sexually transmitted infections (STIs) are a risk for anyone who has unprotected sex.

People who have sex while receiving treatment should use always use barrier protection. This includes latex condoms with nonoxyl-9 spermicide. Using condoms:

• Lowers the risk for sexually transmitted infections
• Decreases the chance of unplanned pregnancy
• Is effective during treatments such as radiation therapy and chemotherapy

Feelings about sex during cancer treatment

Some people experience no problems having sex during and after cancer treatment. For others, feelings and changes during cancer treatment can make it difficult to enjoy sexual intimacy. These can include:

• Feeling tired and nauseated
• Feeling self-conscious about body changes, such as hair loss, scarring or skin changes, weight loss or gain
• Discomfort due to vaginal dryness caused by treatment
• Pain from treatment or recent surgery
• Lack of desire
• Vaginal discharge or bleeding

Many factors can affect feelings about sex during cancer treatment. These emotions can cause a person to want to have sex less often. Or they can make it difficult to have an orgasm or erection. These feelings are all normal.

Ways to resolve these feelings include:

• Wait to have sex until you feel physically and emotionally ready. There’s no rush to have sex. Cancer comes with many emotional and physical challenges. Wait until you are more comfortable.
• Consider other ways to remain close. There are ways to be affectionate with your partner that don’t include sex. These can include kissing, cuddling, and massage.
• Talk with your care team. They can talk to you about physical, emotional, and behavioral aspects to consider before having sex. If necessary, the team can refer you to specialists who can help. Specialists may include a psychologist, physical therapist, and/or sexual therapist.

Talking about sex

Pediatric cancer patients are often uncomfortable talking to their care team about sexual issues. They may not want their parents to find out. The conversation will likely be confidential between the provider and patient.

Some states give providers the option to inform parents that their child is seeking services related to sexual health care. Be clear with your provider if you want your conversation to remain private.

Cancer treatment may affect your ability to have children. It is important to talk to your medical team about this possibility before treatment starts. They can tell you how treatment could affect your fertility. You might be able to store some eggs or sperm before treatment, to have children later. Your care team can explain the risks and your options.

Pregnancy during cancer treatment

Unprotected sex could result in pregnancy during cancer treatment. If a pregnancy happens, doctors may stop therapy or change the treatment plan. Changes may affect how the cancer responds to treatment.

Being pregnant when you have chemo or radiation has serious risks. Chemo and radiation could damage your sperm or eggs. A baby created from those damaged cells could have birth defects.

It is strongly recommended to wait until after treatment to have a baby. To do this, always use protection during sex. Talk to the care team about treatment and how long to wait before trying to have a child.

Sexual health after cancer treatment

Every sexually active woman should regularly see a gynecologist (a doctor who specializes in female reproductive health). Each person reacts differently to cancer treatment. Gynecologists may suggest that some cancer survivors stop taking medicine or birth control for a short time. This can help to resume regular periods.

Women who have not had a period 6 months after treatment should call their gynecologist or talk to their care team.

Always use barrier protection such as condoms during sexual activity to prevent pregnancy and STIs.

If vaginal dryness continues after treatment, a water-based lubricant may help. Water-based lubricants prevent bacteria growth.