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5 ways cancer can impact sexual wellbeing

Sophie Wedekind
by Sophie Wedekind | Analysis

17 May 2023

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Difficulties in sexual wellbeing can be experienced by anyone, including those with and beyond cancer. Not everyone with cancer will have or notice changes that affect their sex life. But there are cancers and cancer treatments which can cause changes to a person’s body and make having sex difficult.

How cancer affects sexual wellbeing can look different from person to person, and for some people they can already be experiencing sexual difficulties before diagnosis.

While individual experiences may be different, there are some common ways cancer and cancer treatments can impact sexual wellbeing for those with and beyond cancer.

From physical changes to emotional responses, here are 5 ways cancer can impact sexual wellbeing, and how they can be managed.

1. Fatigue

A common side effect of cancer or cancer treatment is cancer fatigueIt’s different from tiredness, which is usually short term and can be improved by resting.

Cancer fatigue can look different for each individual, with some experiencing it for several weeks and others for years. Having low energy and exhaustion can make everyday tasks incredibly tough, like cooking, going for a walk or taking a bath. And when feeling constantly exhausted, sex can be the last thing on someone’s mind. It restricts sexual activity and also tends to reduce desire and arousal too.

Fatigue can be overlooked at times. Others may assume it’s just being tired or lazyBut it’s more than that. It can be physically troubling and emotionally frustrating. Partners and loved ones may not understand the toll it takes, and that can create emotional distance and make expressing intimacy difficult.

2. Body confidence and self-esteem

Impacts to body confidence and self-esteem isn’t unique to those with and beyond cancer. We have all experienced negative feelings about our bodies at some point. But when diagnosed you can become more aware of your body and the changes that come with illness and treatment.

Cancer can cause physical changes to the body and a change in appearance. These may be temporary or permanent. But no matter how small the change is, it can have significant impact on confidence, which plays a big part in our sexuality.

“When we feel self-conscious, or dislike aspects of our body, we find it more difficult to ‘be in the moment’ and focus on what we are feeling and experiencing with our partner,” says Dr Isabel White, a cancer nurse and psychosexual therapist.

This internal conversation/spectating acts as a distraction and this can lead to difficulties feeling sexual desire and being able to reach climax or orgasm

3. Altered function of sexual organs

When thinking about the impacts to sex and intimacy, your first thought is probably of cancers that affect the sexual organs. This includes pelvic cancers like prostate, ovarianwomb and cervical cancer. Treatments can impact their pelvic organ function and can make sexual activity tough.

Surgery and radiotherapy for vaginal cancer can cause changes like vaginal shortening and these treatments, as well as chemotherapy, can reduce the vagina’s ability to naturally lubricate. So it can make having sex incredibly painful. And for those with prostate cancer some types of surgery cause nerve and vascular damage and alter the ability to get and keep an erection.

However, while its clear to see how cancers affecting sexual organs can have an impact on sex, it’s important to stress that all types of cancer and their treatment can lead to changes in sexual wellbeing.

4. Anxiety and depression

A cancer diagnosis can be an overwhelming experience. While cancer can change you physically, it can also cause mental health problems such as anxiety and depression. Experiencing emotions such as fear, anger and sadness can impact how someone may feel about sex and themselves.

There can be a sense of worry or guilt for those with and beyond cancer, when interacting with a partner. This can lower sex drive and hinders the ability to orgasm. Even though it pushes away the want for intimacy, in some cases simply touching can help those feel cared for and reduce any anxiety and depression that may be there.

5. Hormone changes

Hormones like oestrogen and progesterone (the main sex hormones for women) and testosterone (the main sex hormone for men) all affect sexual desire and arousal. Sex hormone levels can be altered by some cancers or cancer treatments. Usually, they become lowered after cancer treatment either by blocking the actions of the hormones or reducing the level of hormones produced.

Prostate cancer radiotherapy lowers testosterone levels and can lead to long-term effects like erectile dysfunction. Treatments for prostate cancer and breast cancer are most likely to affect hormone levels in the body. But treatment for other types of cancers can affect them too.

Some chemotherapy drugs can affect how the ovaries work. This can lower the amount of oestrogen or stop the production of oestrogen entirely. In some cases, treatments like chemotherapy or radiotherapy can damage the ovaries, leading to treatment induced menopause. Side effects include experiencing vaginal dryness, low sex drive and pain during sex.

Taking steps to help

While some of the changes described above can seem scary and overwhelming, there are resources out there that can help.

For some people it’s important to connect with their sexuality straight after treatment and for others it may be a while before they wish to explore the effects of treatment on their sexual expression and possible solutions. There are alternatives to penetrative sex which can be mutually enjoyable and help people to improve sexual wellbeing, like kissing, touching and talking.

But no matter at what stage a person with or beyond cancer is at with their sexual wellbeing, it is always a conversation you can have with your health professional.

“Research into sexual difficulties after cancer suggests that being proactive in talking about the sexual challenges we may be facing, and actively seeking strategies to help us is more likely to result in improved sexual and relationship wellbeing,” Dr White continues.

“Talking about the struggles we may be facing with partners and health professionals can help us understand where we are emotionally and physically in our sexual adjustment. It reduces assumptions or misunderstandings and encourages working in partnership to seek specialist information, counselling and products, so we can explore and regain sexual pleasure after cancer.”

But raising this issue can be uncomfortable for some. To help overcome the awkward feeling there is a recommended communication tactic called the S.E.A model. The acronym stands for being specific about the problem, explain why it is important, and ask what can be done to help. It helps to make the conversation feel more focussed finding the solution than trying to go around the problem.

Talking may not be the key for everyone but it can often help. Any diagnosis, regardless of the cancer type, can have an impact on a person’s sexual wellbeing and take away the enjoyment that they want to experience. It’s important to have support to help individuals feel more comfortable in their bodies and more confident exploring pleasure beyond cancer.

If you would like to read more information about sexual wellbeing and cancer you can visit our About Cancer pages.

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Listen to our podcast for more

Our episode of That Cancer Conversation, ‘Sex, intimacy and cancer’, covers how cancer can impact sexual wellbeing and how we can have better conversations about it.

We talk to Dr Isabel White, a cancer nurse and psychosexual therapist who has worked in the field for over 20 years. Tara, who shares her personal experience on how cervical cancer impacted her sex life. And Brian Lobel, co-founder of Sex with Cancer, an online initiative for those with and beyond cancer.

Listen to it here!