Sexual health and intimacy

Although not always discussed, sexual health and intimacy are an important part of your well-being, even after a cancer diagnosis. Please note: If you have experienced any type of sexual trauma, we recommend that you seek support and help from a trusted healthcare professional before reading further. 

You may be concerned about how blood cancer and treatment will affect your current or future relationships and your sexual health. Your sexuality encompasses physical, psychological, social, emotional, and spiritual factors. It includes self-image, body image, fertility, emotional intimacy, sensual feelings, and sexual functioning.

Sexual health and sexuality are important regardless of your relationship status. Your sexual health is important even if you are not sexually active. Your sexuality is an integral part of who you are, how you express yourself, and how you feel about yourself.

Cancer or cancer treatment may affect your sexual health in several ways:

• You may have a different sense of self-confidence and relationship with your body than you did before being diagnosed with cancer
• You may feel depressed or anxious or have little or no interest in sex
• You may feel self-conscious or worry that others see you differently because of physical changes, such as weight gain, weight loss, hair loss, swelling, scars, or the presence of a central line or port
• You may have few chances to be alone or intimate with your partner because of hospitalization or treatment schedules
• Survivors of childhood cancer may be self-conscious about underdevelopment or delayed development
• Treatment side effects such as pain, fatigue, nausea, and/or vomiting may interfere with your interest in or enjoyment of sex or intimate activities
• Some cancer treatments may cause sexual side effects, such as lack of desire, erectile disorder, or vaginal dryness/pain
• Your treatment team may advise you to abstain from sexual activities for a period of time if your white blood cell count or platelet count is low, due to risk of infection or bleeding

Dating

Dating can be intimidating no matter your situation. Remember, every date before your diagnosis probably did not go perfectly. You may have bad dates after your diagnosis as well. You may also meet incredible new people.

If you feel well enough during treatment, you never have to stop dating. Due to side effects of treatment, you may not feel up for it. You may want to take time for yourself to heal. It is your choice. Do not feel pressured to date if you are not interested or not feeling up to it. However, do not let cancer stop you from dating if you feel like you are ready to meet new people.

Telling a date about your diagnosis

When and how you tell someone about your cancer diagnosis is your choice. Some people prefer to tell right away to clear the air and to see if the person will be supportive or not. Some people prefer to wait until they trust the person. Take some time to think about which is most comfortable for you.

If your date reacts negatively, it is not your fault. People have different histories with cancer. In some cases, you may be able teach this person what it means to be a person with a cancer diagnosis. In others, you may have to move on.

Talking to your doctor

Sexuality and intimacy are often overlooked topics of discussion within healthcare settings. You may need to bring up the topic with a trusted healthcare professional and ask questions. Know that your sexual well-being is important, and help is available.

Members of your treatment team can also refer you to other healthcare professionals who may be helpful depending on your situation, including a:

• Gynecologist
• Urologist
• Endocrinologist
• Fertility doctor
• Pelvic floor therapist
• Oncology social worker
• Certified sex therapist

Questions to ask members of your healthcare team

• Will my treatment affect my ability to have sex? If it will, how long will this effect last?
• Is it safe for me to have sex?
• What do I need to know about birth control?
• What do I need to know about protection from sexually transmitted infections (STIs)?
• Will my illness or treatment affect my fertility (ability to have a biological child)?
• Will my treatment cause medically induced menopause?
• What are some options to prevent or prepare for sexual health concerns during treatment?
• Who else can I speak with about this topic? Are there counselors, sex therapists, support groups, or other support services in my area?

To help you talk with your healthcare providers, you may want to:

• Bring your partner to your next appointment. Give your partner a chance to ask any questions they may have. This can be done either individually or together.
• Ask if you can record the questions and answers on your phone so you can replay the information later
• Keep a journal or notebook of questions to ask your physician or counselor at your next visit and leave space for answers so that you can refer to them afterward

Disclosing sexual history and/or sexual orientation

When discussing sexual health, your healthcare team may ask about your sexual history. This information can help members of your healthcare team give you the best care. Some sexual activities may call for different types of care to keep you safe and comfortable.

You should never be ashamed or denied medical care because of your sexual history, gender, or orientation. You deserve to receive care from healthcare professionals who will respect and address all your medical needs. If you are not comfortable with a healthcare professional, find another one who will support you. Try asking a healthcare professional you do trust for a referral.

If you are a member of the LGBTQIA+ community, you can find healthcare providers who understand your needs by visiting the LGBTQ+ Healthcare Directory or OutCare to search their directories.

Finding sexual health professionals

To find a sex therapist, visit The American Association of Sexuality Educators, Counselors, and Therapists. You can view each professional’s areas of specialization, such as LGBTQIA+, illness, marriage counseling, or trauma.

Sex and safety during cancer treatment

Preventing pregnancy

Getting pregnant during cancer treatment can be unsafe for both the pregnant person and the fetus. It is important to always use a form of birth control.

Treatment may cause changes to the menstrual cycle, including early menopause. Even if the menstrual cycle stops during treatment, you may still be able to become pregnant, so it is best to continue to use birth control.

Birth control methods include:

• Abstinence
• Condoms
• Condoms also provide protection against sexually transmitted infections (STIs)
• Oral birth control
• Intrauterine device (IUD)
• Implant
• Shot
• Vaginal ring
• Patch
• Spermicide (with or without a diaphragm)
• Non-hormonal vaginal bioadhesive gel

Talk to your doctor about which option is best for you. Get instructions for using your method of birth control. Follow the instructions exactly.

Preventing sexually transmitted infections (STIs)

Sexually transmitted infections (STIs), also called “sexually transmitted diseases (STDs),” are infections that can be spread through sexual contact, including oral, anal, or vaginal sex and genital touching.

Condoms or other barrier protection (such as dental dams) during vaginal, anal, or oral sex help to protect you and your partner from STIs.

Some STIs can be cured with treatment. Early diagnosis and treatment of many STIs is important to decrease the risk of more serious medical issues developing and to prevent spreading the disease to others. If your white blood cell counts are low, you may be more at risk for infection, including STIs.

Other considerations during cancer treatment

Chemotherapy and other drugs can be present in bodily fluids such as saliva, semen, and vaginal fluids for up to 48–72 hours, depending on the drug. The risk of exposure to chemotherapy or other drugs during sexual activity are not clear. Ask your treatment team if you should take any precautions or avoid sexual activities for some time after treatment to protect your partner from exposure.

If you are receiving external beam radiation therapy, you will not expose your partner to radiation.

Intimacy during cancer treatment

Intimacy is closeness between people in personal relationships. Sex and intimacy are not mutually exclusive; one can exist without the other. Sex is not the only way to build or maintain intimate relationships. Additionally, physical intimacy is not always sexual. For example, hugging a friend is a form of intimacy. Trust, safety, communication, and acceptance are the most important aspects of intimate relationships.