Managing Expectations About Chemotherapy and Sex

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Chemotherapy and sex is a subject that many people may wonder about when they’re undergoing treatment, but oncologists rarely discuss sexuality and physical intimacy during chemotherapy with their patients.

Since it's not talked about, many people have a knowledge gap about the safety of sexual activity during cancer treatment and the ways in which their sexuality might be affected by it.

Read on to find out more about how chemotherapy can affect your sex life and how to stay physically intimate with your partner while undergoing cancer treatment.  

A white couple, a female presenting person with a scarf on their head, holding a coffee mug and being tenderly held by a white male presenting person.

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Is Sex During Chemo Safe? 

Having sex while you are undergoing chemotherapy (or chemo) is generally considered safe as long as certain precautions are taken. Patients receiving chemo can typically have sex, but they need to do their best to avoid situations that could affect their treatment or overall health.

Infections

You may develop a low white blood cell count while you are undergoing chemo. This makes you more open to infections. Having sex if you have a lowered white blood cell count places you at risk for infections.

Chemotherapy can also decrease the number of cells that bind together in your blood (platelets) to help form blood clots and prevent excessive bleeding.

If you have sex and you have low blood platelets, you might experience bleeding that could be severe. You might also be more likely to bruise during intercourse if you have a low blood platelet count.

When to Talk to Your Healthcare Provider

Ask your healthcare provider about getting blood tests to check your white blood cell and platelet counts to help determine if it's safe for you to engage in sexual activity while you are undergoing chemotherapy.

Exposure

Chemotherapy drugs can make their way into saliva, semen, and vaginal secretions for up to three days following treatment. It is not clear whether chemotherapy medications can be passed sexually, but you might be more likely to expose a partner to the chemicals in chemotherapy medications if you are intimate during the first few days after treatment.

People who are not undergoing chemotherapy but who are exposed to chemotherapy medications may experience adverse health effects such as:

  • Skin rashes
  • Sore throat
  • Chronic cough
  • Dizziness
  • Headaches
  • Eye irritation
  • Hair loss
  • Allergic reactions
  • Increased risk of developing cancer
  • Infertility
  • Miscarriage

Considerations

Depending on where the cancer is located, you might be told to avoid sex while the area is healing. For example, you might need to avoid sexual intercourse if the cancer is in your genital area, urinary tract, or rectum.

Chemotherapy may lead to painful intercourse (dyspareunia). You may not experience pain, but if you do, be sure to bring up this concern with your doctor. There are ways to address the pain and make intercourse more comfortable.

One study in women being treated for breast cancer found that when they used a liquid lidocaine compress on their genital area prior to sexual intercourse, it helped treat the pain they had been having during sexual intimacy.

Protection, Fertility, and Pregnancy

If you plan to have sex while you are receiving chemo and you could become pregnant, you need to use birth control. Getting pregnant during chemotherapy can be risky because the medication increases the chances of birth defects in the developing fetus during the first trimester.

Undergoing chemotherapy during the second and third trimesters has been associated with low birth weight and an increased risk of stillbirth.

Getting Pregnant After Chemo

In some cases, chemo can cause infertility. However, many people do go on to have children after treatment.

If you want to conceive and have recently had chemo, you should talk to your doctor about when it will be safe for you to stop using birth control and begin trying to get pregnant.

How Chemo Affects Libido 

Chemotherapy can disrupt your sex drive and cause low libido. While this side effect of treatment is rarely talked about, it can severely affect your intimate relationships.

Sexual side effects are not seen with every type of treatment. They're more often experienced by people who are being treated for specific cancers, such as prostate cancer, testicular cancer, and gynecological cancer, including cancers affecting the cervix, ovaries, and uterus.

Chemotherapy medications, in particular, have been associated with a lowered libido and can affect a person's libido in several ways, including:

  • Medication side effects: Chemotherapy has been shown to cause low libido. Other side effects such as nausea, vomiting, and fatigue can also contribute to a lower sex drive.
  • Body Image: Chemotherapy side effects can affect a person’s body image because of weight loss or gain, and hair loss. A person may develop low self-esteem because of these changes, and the way that a person sees themselves has a lot to do with their desire to be intimate. 

Staying in Touch With Your Sexuality During Chemo 

Although chemotherapy can hinder your ability or desire to stay intimate with your partner, there are things you can do to help improve the experience.

Open the Lines of Communication

If you no longer desire sexual intimacy but do not discuss the change with your partner, they may feel rejected and unloved. You will want to be open and honest with each other about how your treatment has affected the physical aspect of your relationship.

Having open communication can also help you brainstorm solutions to maintain a level of intimacy that is satisfactory to both you and your partner.

Partner Play

When you and your partner are ready to try being sexually intimate again, it’s important that you ease into it. Make use of any ideas you had in your earlier discussions.

Remember that there is more to physical intimacy than intercourse. Exploring new ways to be with someone physically can be a fun and exciting opportunity to reignite your desire for sexual touch. If you're having pain, try different positions that make intercourse more comfortable.

Going Solo 

Sometimes it might be difficult or undesirable to be intimate with someone else. When you are feeling this way, you might want to explore your sexuality independently.

According to the American Cancer Society, self-stimulation can help ease you back into sexual feelings as you are recovering from chemotherapy.

It can also help you identify any areas on your body that might be sore or tender. That way, when you do go to have sexual intercourse, you will be aware of what hurts and you can communicate about these sensitive areas beforehand.  

Resources

One resource that you might explore with a partner is couples counseling, which can give both you and a partner insight into how the other person is feeling about the current state of your physical relationship.

Sometimes it's helpful to have someone else mediate conversations if the topic is sensitive. In this case, a sex therapist could help you identify and fix obstacles that have been preventing you from expressing yourself sexually.

Seeking out a therapist who can help you overcome any body image challenges that you have after cancer treatment can help you rebuild your self-esteem. This, in turn, could increase your drive to be physically intimate.

According to the American Psychological Association, there are many avenues that you can explore to help address lowered libido and sexual dysfunction caused by chemotherapy.

For example, you might try mindfulness-based approaches, psychotherapy, and couples therapy with a partner.

Summary

Sexual dysfunction is a side effect of chemotherapy that can cause a person to feel worse about themselves, which may result in problems in romantic relationships.

Aside from the physical changes that may come with treatment, such as lowered libido, having sex while you are undergoing chemo can also pose extra health risks, making it even more difficult to participate in.

If you are having chemotherapy, you should express your desires, needs, and concerns about sex to your healthcare providers to ensure that they can help you regain your sexual life after treatment. Your provider might also be able to help you connect with a sex or couples therapist.

A Word From Verywell 

Dealing with a lack of sexual intimacy in a relationship can be tough, but it can be even more difficult if it's the result of an already stressful situation like cancer treatment.

You might find it challenging to help your partner understand what you’re going through. Not being able to be physically intimate with them may put a strain on your relationship.

Know that you can have sex while undergoing chemotherapy as long as your healthcare provider says that it's safe and you understand the precautions that you need to take to keep things safe.

Communicating openly with your partner, exploring new ways to be physically intimate, and asking your doctor any questions you have about physical intimacy during chemotherapy can all help you maintain the physical aspect of your relationship with your partner and yourself both during treatment and when you are recovering from it.

Frequently Asked Questions

  • Should you wait to have sex after chemotherapy?

    Some people are advised to avoid sex while they are having treatment, but this is not the case for everyone. Ask your healthcare provider about whether it is safe for you to have sex during your treatment.

  • Can you still become aroused during chemo?

    Although it’s possible to lose your libido during chemotherapy, not everyone will experience this side effect. If you do, there are still ways to become aroused while your desire for sexual intercourse is low.

    For example, playing out fantasies in your head, practicing different forms of intimacy with or without a partner, and fostering good self-esteem can all be helpful.

  • What should you avoid after chemotherapy?

    When you've reached the end of treatment, you might be ready to jump back into sexual intimacy—but there are a few things to be aware of.

    For example, if you get pregnant shortly after you are done with treatment, there is a risk that the fetus will have birth defects. If you are able to become pregnant, you will probably be on birth control during treatment to help prevent this.

    After you're done with chemo, talk to your healthcare provider if you are planning to resume sexual activity and wish to go off birth control, especially if you would like to try to conceive.

  • How long after chemo can you have a baby?

    Getting pregnant shortly after chemotherapy comes with risks for the developing fetus. Some health experts believe that you should wait at least six months after finishing your treatment to begin trying for a baby. Other health experts have said that two to five years is the optimal time to wait before getting pregnant after you've had chemotherapy.

    Discuss your posttreatment conception plans with your healthcare provider, as they will be able to give you the best recommendation based on your situation.

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