Sexual Health During Cancer Treatment

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

Patients are encouraged to speak to a care team member and ask questions before engaging in sexual activity.

Safety of sex during cancer

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

Patients should take certain precautions before having sex during cancer treatment:

• 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.
• Have an absolute neutrophil count (ANC) of 500 or more. Neutrophils are a type of white blood cell that helps the body fight infection, including yeast or urinary tract infections that can result from sex.
• Wait 3 days after chemotherapy before having sex. Seventy-two hours is the average amount of time that it takes the medicine to leave the body. During that time, chemotherapy medicine is present in bodily fluids. Having sex (vaginal, oral, or anal) within 72 hours of chemo treatment may expose a partner to these drugs.

Using protection during sex

Using a condom or other form of barrier protection is especially important for people with cancer because their immune system may be weakened. Sexually transmitted infections (STIs) are a risk for anyone who has unprotected sex.

People having sex while receiving treatment should use always use barrier protection such as latex condoms with nonoxyl-9 spermicide. Using condoms:

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

Feelings about sex during cancer

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

• Feeling tired and nauseated
• Self-consciousness about appearance such as hair loss, scarring or skin changes, weight loss or gain
• Discomfort due to vaginal dryness caused by treatment reducing a women’s natural vaginal lubricant
• Pain from treatment or recent surgery
• Lack of desire
• Vaginal discharge or bleeding

Many factors can affect feelings during sex. These emotions can cause a person to want to have sex less frequently or to have difficulty having an orgasm or maintaining an 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 a number of ways to be affectionate with your partner that don’t include sex, such as 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 such as 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 most likely be kept 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. Patients are encouraged to be clear about their wishes for the conversation to remain private.

Pregnancy during cancer treatment

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

It is strongly recommended to wait until after treatment to have a baby and always use protection during sex. The care team can advise patients on how long to wait to try to have children.

Resuming sexual activity after treatment

All sexually active women should regularly see a gynecologist (a doctor who specializes in female reproductive health), but each patient reacts differently to treatment. For some survivors, gynecologists may suggest women stop taking medicine or birth control for a short time to resume regular periods.

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

Barrier protection, with condoms, should always be used.

If vaginal dryness is a problem, using a water-based (rather than oil-based) lubricant may help. Water-based lubricants inhibit the growth of bacteria.