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Sexuality and Reproductive Issues (PDQ®)

Factors Affecting Sexual Function in Cancer Patients

Certain cancer treatments can affect sexual function.

Surgery

Surgery for the following cancers can cause body changes that have sexual side effects:

  • Breast cancer : Sexual function after breast cancer surgery depends on the type of surgery. Compared to surgery to remove the whole breast, surgery to save or reconstruct the breast seems to have little effect on sexual function (including how often women have sex, the ease of reaching orgasm, or overall sexual satisfaction). Women who have surgery to save the breast are more likely to continue to enjoy breast caressing. However, having a mastectomy (surgery to remove part or all of the breast) has been linked to a loss of interest in sex.
  • Rectal cancer : Problems with sexual and bladder function are common after surgery for rectal cancer. Surgery for rectal cancer can injure the nerves in the pelvic cavity. Nerves can be damaged when their blood supply is affected or when the nerves are cut. Nerve injury is the main cause of problems with erection, ejaculation, and orgasm.
  • Prostate cancer : Surgery for prostate cancer (radical prostatectomy) is being done with newer nerve-sparing techniques. Recovery of erectile function usually happens within a year after having a radical prostatectomy. However, recovery of erectile function after radiation therapy is slow and happens over two or three years. Brachytherapy (internal radiation therapy using radioactive implants) is being used more often to treat prostate cancer. There is less effect on ejaculation and erectile function with brachytherapy alone than when external radiation and/or hormone therapy are added. Many patients have trouble with orgasm after treatment for prostate cancer with radical prostatectomy or radiation therapy. Talk with your doctor about problems with orgasm, changes in penis length, and urinary incontinence during orgasm.
  • Testicular cancer : Most studies suggest that problems with sexual function after testicular cancer and its treatment (such as surgery to remove the testicle) are usually short-term. Function usually returns to about the same level as in men who do not have testicular cancer.
  • Other pelvic tumors : Men who have surgery to remove the bladder, colon, and/or rectum may get erectile function back sooner if nerve-sparing surgery is used. The sexual side effects of radiation therapy for pelvic tumors are similar to those after prostate cancer treatment. Women who have surgery to remove the uterus, ovaries, bladder, or other organs in the abdomen or pelvis may have pain and loss of sexual function depending on the amount of tissue or organ removed. With counseling and other medical treatments, these patients may get normal sensation back in the vagina and genital areas and be able to have intercourse and reach orgasm without pain.

Chemotherapy

For both men and women, chemotherapy is linked to loss of sexual desire and having intercourse less often. Common side effects of chemotherapy can affect your sexual self-image and make you feel unattractive. Side effects may include the following:

In women, chemotherapy can cause the following problems:

  • Pain with intercourse.
  • Trouble reaching orgasm.
  • Decreased estrogen, which can cause the following problems:
    • Vaginal shrinking, thinning, and loss of elasticity (the ability to stretch and then go back to its original shape).
    • Vaginal dryness.
    • Hot flashes.
    • Urinary tract infections.
    • Mood swings.
    • Feeling very tired.
    • Being easily bothered.

Older women who receive chemotherapy have an increased risk of ovarian cancer.

In men, chemotherapy can cause the following problems:

Radiation therapy

Radiation therapy can cause side effects that may decrease sexual desire. Side effects may include the following:

  • Feeling very tired.
  • Nausea.
  • Vomiting.
  • Diarrhea.

In women, radiation therapy to the pelvis can cause changes to the lining of the vagina. The vagina may become narrow and scar tissue may form, which can cause pain with intercourse, painful pelvic exams, infertility, and other long-term problems.

In men, radiation therapy can cause problems getting and keeping an erection. Sexual changes happen slowly over six months to one year after radiation therapy. Men who had problems with erectile dysfunction before getting cancer may be more likely to have sexual problems after being diagnosed and treated for cancer.

Other risk factors in men that cause sexual changes include the following:

Hormone therapy

Hormone therapy can stop or slow the growth of certain cancers, such as prostate and breast cancer. This is done by using hormones made in a laboratory or other drugs to block the body's natural hormones. However, lower hormone levels can cause sexual problems.

Men who get hormone therapy for prostate cancer may have the following problems:

  • Decreased sexual desire.
  • Erectile dysfunction.
  • Trouble reaching orgasm.

Women older than 45 years who are treated with tamoxifen may have slightly more of the following problems:

  • Hot flashes.
  • Night sweats.
  • Vaginal discharge.
  • Vaginal pain.
  • Decreased sexual desire.
  • Trouble reaching orgasm.

Other drug therapy

Drug therapy, such as opioids for pain and drugs to treat depression, can cause sexual side effects. Cancer patients may get drug therapy that affects the nerves, blood vessels, and hormones that control normal sexual function. Drug therapy may also affect their alertness and moods.

Your thoughts and feelings can affect your sexual function.

Misbeliefs

Misbeliefs about cancer might make you confused or unsure about sex when you are recovering from cancer. Common misbeliefs about cancer include the following:

  • Past sexual activities caused the cancer.
  • Having sex will make the cancer come back.
  • Having sex will pass the cancer on to your partner.

Misbeliefs like these can keep you from enjoying sex again. Talk with your doctor to find out the facts so that you can feel more comfortable.

Depression

Depression is more common in cancer patients than in people who do not have cancer. Common symptoms of depression include loss of sexual desire and a decrease in sexual pleasure. Treatment for depression may lessen your sexual problems. (See the PDQ summary on Depression for more information.)

Self-image

Cancer and cancer treatment may cause physical changes, such as hair loss or weight gain from chemotherapy or body changes from surgery. You may not like how you look and you may not want to have sex. Let your health care team know your concerns. You can get help adjusting to body changes caused by cancer and its treatment.

Patients with colostomies or ileostomies need to find a sexual position that does not place weight on the ostomy. Information is available from national organizations related to sexual function.and ostomates.

Stress

The stress of cancer diagnosis and treatment can make relationship problems that you already have even worse. Your sexual relationship can also be affected. Patients who do not have a committed relationship may stop dating because they fear being rejected when a new partner finds out they have cancer. Your feelings about your sexuality before being diagnosed with cancer will affect adjustment after cancer treatment. If you had positive feelings about sex, you may be more likely to continue sex after cancer treatment. Cancer can be hard on any relationship. It is important to get help if stress is causing a problem for you.

  • Updated: December 9, 2013