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Early menopause

Some types of cancer treatment can affect your sex life and sexuality because they cause an early menopause (also called the change of life). These treatments include

  • Surgery to remove the ovaries
  • Radiotherapy to the pelvis
  • Hormone therapy
  • Chemotherapy

Early menopause due to cancer treatment can feel shattering physically and emotionally, partly because it is a shock. A sudden menopause can cause more severe symptoms than a natural menopause. It may be reassuring to know that the symptoms will pass. But they can take a couple of years to do so. Hormone replacement therapy (HRT) is helpful in relieving symptoms for most women who are able to take it. HRT means taking a tablet form of female sex hormones to replace the hormones that your body used to produce naturally.

But HRT isn’t advisable after some types of cancer, such as breast cancer. It is helpful to talk to your doctor about whether you can take HRT. If you can't they can tell you about other ways of reducing menopausal symptoms. Your doctor may be willing to give you HRT if you are having really troublesome symptoms and nothing else has helped.

The biggest effect of the menopause is that you can no longer become pregnant and have a baby. This is because you no longer produce an egg from your ovaries each month. This loss of fertility can be upsetting even if you’ve had a family or did not intend to have children. There is information about losing your fertility further down this page. Menopause can also cause

Most of these can affect your sex life in some way.

Hormone replacement therapy (HRT) will reverse most of these effects for some women. It can help with the emotional effects of menopause. If loss of sexual desire remains a problem it might help to combine HRT with testosterone patches (Intrinsa). These patches are only available for women who have an early menopause due to cancer treatment. Some studies have shown that testosterone patches can improve sexual desire, frequency of intercourse and overall satisfaction, when compared to a placebo. But it is still not certain how helpful they are. As we don't yet have information about the long term safety of testosterone replacement therapy in women some doctors don't like to prescribe them. 

The testosterone patches must always be used alongside HRT. You put them on the skin of the lower abdomen and they need to be changed every 3 to 4 days. The patches may take at least a month to work and your doctor may stop them if they have not shown an improvement in sexual desire after about 3 months.

It is important to remember that many factors can influence the loss of sexual desire after treatment for cancer. For emotional and relationship issues you may find counselling helpful, either on your own or as a couple. Or it may just take some time and the support of your partner, friends and family to rebuild your confidence and positive feelings about yourself.

Here are some other ways to help with the physical effects of menopause if you can't take HRT.

Vaginal dryness

This may be quite uncomfortable. It can make the vagina become very sore, especially during intercourse. And it can also make you more prone to vaginal infections because the natural lubricating and cleaning process of the vagina is not working. Even if you can't take HRT, you may be able to use vaginal oestrogen. This is oestrogen in a cream or tablet (called a pessary) that you put into the vagina about twice a week. Your body will absorb a little bit of oestrogen, but not really enough to have an effect on the rest of your body. It is worth asking your cancer doctor whether this is a good idea for you.

You can buy other non hormonal creams from the chemist that may help. For example Replens is a cream that you put into the vagina regularly 2 or 3 times a week. Other creams or water based lubricants are put into your vagina just before you have intercourse. They include Vielle, Sylk, Yes, KY jelly, Aquaglide and different types of Durex lube.

Hot flushes and sweats

If you can’t take HRT, flushes and sweats can be difficult to control. They can be made worse by some hormone treatments such as tamoxifen and aromatase inhibitors. And they can keep happening for months or years. Many different ways of trying to combat flushes have been tried including

Low dose progesterone has been shown in research to reduce hot flushes and sweats in men and women who are taking hormone therapy for cancer. If you are interested in trying low dose progesterone, talk to your cancer doctor. Although progesterone is a sex hormone, many doctors think it is safe to take even with hormone dependent cancers when it is at a very low dose.

Acupuncture has been tested in trials for hot flushes. Some studies seem to show that particular types of acupuncture may help. You can read about acupuncture for hot flushes on the acupuncture page. 

Homeopathy has been used in a couple of trials for hot flushes and they suggested that it may be helpful but we need more research to be sure. You can read about research into homeopathy on the homeopathy page.

Plant oestrogens such as evening primrose oil, may be helpful for some women. There is no scientific evidence about whether evening primrose oil really helps or not. But some women say that it does. Other herbs and vegetables that contain plant oestrogens include ginseng, liquorice root, red raspberry leaves, sarsaparilla, spearmint, damiana, motherwort, chasteberry (also known as Vitex), black cohosh, red clover and wild yams. These may reduce hot flushes for some women but it is not known how safe they are for women who have had breast cancer. You should always tell your doctor if you are planning to take plant oestrogens.

There is information about dealing with hot flushes and sweats in our section about coping with hormonal symptoms.

 

Hormone therapy for cancer

Hormone therapies are treatments for cancer that use hormones, or drugs that block hormones. Some of the side effects of these treatments can affect your sex life. Many hormone treatments for breast cancer can cause changes to your vagina such as discharge or dryness. Progesterone is a hormone treatment for womb cancer. Its side effects include a lowered sexual interest.

Some hormone treatments can cause an early menopause. This may be reversible, as it is with the hormone treatment goserelin (Zoladex). Goserelin is sometimes used to block female sex hormones in younger women with breast cancer. Other hormone treatments, such as tamoxifen, may make you more likely to go into menopause. The closer you are to the age at which you would have menopause naturally, the more likely it is that tamoxifen will cause menopause.

Some post menopausal women with breast cancer take aromatase inhibitors instead of tamoxifen. These medicines also lower levels of oestrogen, which can reduce sexual desire. Aromatase inhibitors may have side effects such as fatigue and depression, both of which can affect sexual desire.

In a study which compared the aromatase inhibitor letrozole to tamoxifen, women taking letrozole reported slightly fewer hot flushes and less vaginal bleeding. They reported a similar amount of vaginal irritation and nausea but more painful joints and aching muscles. Most of these side effects can reduce sexual desire and arousal.

 

Sexuality and breast surgery

Whether you have had part or all of a breast removed, it will be an emotional time for you. You may feel relieved and happy that your cancer has been found and removed. Maybe you will feel some grief and anger about what you have had to go through. And the surgery might affect your sexual feelings.

The first milestone will be when you see your scar. It will take time to deal with your changed appearance. And this will affect your partner too. When both you and your partner are ready, you will need to show your scar. You may prefer your doctor or nurse to be there when your partner sees the scar for the first time. They can explain how any swelling or bruising will go down and how the scar will fade with time.

But you may feel a greater loss if your breasts are very important to how you respond sexually. The breast cancer treatments surgery and radiotherapy will cause a certain amount of loss of feeling in that breast. If you have had a mastectomy, you will have lost the feeling along with the breast. This can't be brought back and it will take time for you to mourn the loss. If you have had both breasts removed (a double mastectomy) you may have an even greater sense of loss.

If your breasts were really important to you or your partner in getting turned on to sex, then you can find other ways to achieve this together. Try stroking or massaging other sensitive parts of your body. You may want to wear a bra or camisole in bed to help your confidence.

There is more information about sex and fertility after breast cancer in the living with breast cancer section.

Breast reconstruction

You may be able to have more surgery to make a new breast shape. This won't bring back lost sensation, but it may help you to recover from your mastectomy. Everyone is different, but if you think this would help you, you can talk to your surgeon. There is information about breast reconstruction in the breast cancer surgery section.

 

Surgery to remove the womb, cervix or ovaries

You may need to have a hysterectomy (have your womb removed) if you are diagnosed with

If you have cancer of the cervix and have not yet had your menopause, your surgeon may not take out your ovaries as well as the womb. If you are past your menopause, your surgeon will probably want you to have your ovaries removed as well.

Surgery to the pelvic area can cause physical problems with sex. After some types of pelvic surgery, you may have vaginal dryness and a slight shrinking of the vagina or shortening of the vagina. Some women notice a change in the sensation of orgasm after having their womb removed.

Emotionally, you may feel very sad after a hysterectomy. Losing your womb can be a big reminder that you can no longer have children. You may feel like this even if you went through the menopause a while before your surgery. The strength of your feelings may surprise you. Like all emotional upheavals, it can take some time to deal with this. You may need some help and support.

If you would like to talk to someone outside your own friends and family, look in our talking about cancer section for counselling organisations. To find out more about counselling look in the counselling section.

 

Surgery to the genital area

This type of surgery is usually only done if you have cancer of the vulva or cancer of the vagina, which are both quite rare. You may also have genital surgery for some skin conditions, which cause severe itching and pain and which may lead to cancer if they are not treated. There is information here about

Vulval surgery

The vulva is the area between your legs, including the outer and inner lips of your vagina and the clitoris. Sometimes you may need to have all these parts of your vulva removed during surgery. The surgery causes numbness and if your clitoris is removed you may not be able to have an orgasm. With time and patience, you should still be able to have sexual intercourse. And you may still be able to have an orgasm through stimulation of other sensitive areas of your body, such as your breasts.

If you have a radical vulvectomy, the lymph glands in your groins will be removed as well as your vulva. Removing the lymph glands may cause swelling in the area and in your ankles and legs. This type of surgery can be very distressing. You may feel very sad and upset at first. It may take some time for both you and your partner to get used to the changes in your body.

There is more information about sexuality after vulval cancer in the vulval cancer section. It can help a lot to talk to someone who has been through this type of treatment. You can ring the RV Club, which is run by someone who has had vulval surgery and will understand what you are going through.

Vaginal surgery

The vagina is the passage that leads from the cervix to the vulva. If you've had the lower part of your vagina removed then you may have a drop in sexual desire or pleasure or have problems reaching orgasm.

You may also have some numbness in your genital area after this type of surgery. If you have vaginal reconstruction using a thigh flap, you may feel a strange sensation in your inner thighs when you have sexual intercourse. Women have described this sensation as feeling as if your inner thighs are being stroked. It happens because the nerves that supply the thigh tissue are now part of the walls of the rebuilt vagina. Your brain picks up this message and thinks that the leg is being touched. This can be very off putting at first but with time you will get used to it and it can even become sexually stimulating.

Women have also said that they don’t feel that they can contract the muscles around the entrance to the vagina as easily as before their surgery. This will mean that you won’t be able to squeeze your vagina as hard around your partners’ penis. You and your partner may need to experiment a bit and try different sexual positions. With time and patience, you will be able to find some positions that you both enjoy.

There is information about vaginal reconstruction and your sex life after vaginal surgery in the vaginal cancer section.

If sex is painful

Scar tissue from surgery can make having sex uncomfortable, or even painful. If this has happened to you, ask your doctor or nurse about using vaginal dilators and avoid intercourse in the meantime.

If you are worried

If you feel nervous about starting your sex life again, try not to worry. You probably just need more time to come to terms with all that has happened to you. If you are worried, anxious or depressed, you are not likely to feel like having sex. Give yourself more time. And talk things over with your partner. Together you should be able to work out what is best for you both. There are sex therapists you can see if you want to and there are organisations who help with relationship and sexual issues.

 

Radiotherapy to the pelvis

Any radiotherapy to the pelvic area can cause an early menopause by stopping your ovaries from working. This can cause symptoms such as vaginal dryness and loss of interest in sex.

Radiotherapy for cancer of the cervix can cause other side effects that may affect your sex life. You may have radiotherapy for this type of cancer both externally and internally. You have internal radiotherapy with a radioactive source inside the vagina. This gives a high dose of radiotherapy both to the cervix and the vagina. Both external and internal radiation can cause

After pelvic radiotherapy, the skin inside the vagina can become thin, delicate and easily torn. The skin is so delicate that it can be damaged easily, which can lead to pain, discomfort or bleeding, and may make intercourse painful. Rarely, ulcers (sores) can form inside the vagina when the skin tears. These can take a few weeks (or even months) to heal. For many people it is best to avoid intercourse altogether during this time. But you can still enjoy a sexual relationship. There are many other ways of satisfying each other. It is important to talk to each other about what you want.

You may not feel like having sex while you are having a course of pelvic radiotherapy. The treatment can make you feel very tired and give you bladder inflammation (cystitis) and diarrhoea. You may also find that you feel too sore to have sex comfortably.

If you are going to have pelvic radiotherapy it is important that you know how to prevent narrowing of your vagina. Narrowing of the vagina is caused by fibrosis. This is a side effect of radiotherapy that makes the tissues less stretchy. When this happens to the vagina, it can become so narrow that you can't have sex. To prevent this you can use vaginal dilators from 2 to 8 weeks after the treatment ends. Vaginal dilators are cone shaped plastic objects which you put into your vagina to help stretch it. The dilators come in sets of different sizes. You begin with one of a comfortable size and use larger ones until your vagina is stretched enough for you to have sex comfortably.

You use vaginal dilators with a water soluble lubricating gel from twice a week up to daily, for 3 to 10 minutes each time. Some people like to involve their partner with this. Your radiotherapy department should give you a set of dilators when you start your treatment. If they don’t offer, ask your doctor, radiotherapy nurse or radiographer.

International guidelines for using vaginal dilators advise that

  • You should start with the smallest size and go up to the largest (size 4) in the weeks following radiotherapy treatment
  • Dilators should be used a minimum of 3 times a week for 3 to 10 minutes for an indefinite time period
  • Doing pelvic floor exercises during the insertion makes the dilation work better
  • A water soluble lubricant should be placed on the dilator and around the entrance to the vagina before inserting the dilator
  • A small amount of bleeding is usual at first but contact a health professional if you have a lot of bleeding or pain

Sexual intercourse also helps to keep the vagina open and is a good alternative to using dilators. Or you may prefer to use your fingers or a vibrator to help stretch your vagina. If water soluble lubricants don't give enough lubrication for comfortable intercourse you may want to try a silicone based lubricant. These give more lubrication and are usually fine to use after any vaginal irritation caused by radiotherapy, has settled down.

 

Chemoradiotherapy for pelvic cancer

Sometimes chemotherapy is combined with radiotherapy for cancers in the pelvic area, such as cervical, rectal or anal cancer. Having the two treatments together can make the vaginal area very fragile and sensitive.

 

Taking precautions

Always use reliable contraception if you are having chemotherapy treatment. It is not advisable to become pregnant, as the treatment drugs could harm the baby. Women who have or have had breast cancer are usually advised not to take the pill because the cancer may be affected by the hormones it contains.

Using condoms protects your partner from the possible risk that chemicals from the chemotherapy drugs could be in your vaginal fluids. It has been suggested that chemotherapy can get into vaginal fluids, but as the doctors don’t know for sure, they advise using a condom during a course of chemotherapy treatment and for a week or so afterwards.

 

Coping with a low sex drive

Cancer and its treatments can make you lose interest in having sex. Your desire for sex may be lower because of

Many of these problems will disappear once your treatment finishes and your interest in sex may go back to normal. But it may take a bit of time so don’t worry too much if you don’t feel like having sex for a while.

If you are in a relationship it will be important to talk about this with your partner. Sometimes if you lose your interest in sex it stops you making the effort to enjoy other physical contact with your partner. This can be very difficult for you both. Even though you don’t feel like having sex it doesn’t mean that you can’t still enjoy kissing, cuddling and staying close to your partner. Kissing and touching can be very comforting and relaxing, as long as you are both clear about how far you are expecting to go.

It may be helpful (or necessary) to put intercourse on hold for a while and concentrate on showing each other affection in other ways. But some people find that even though they don’t feel like having sex at first, once they become physical with a partner or pleasure themselves, they do become aroused. So it can help to be open to this.

It may help to talk things through with a counsellor or therapist. There is information about talking about sex and sexuality in this section.

 

Coping with losing your fertility

Loss of fertility can be a side effect of some cancer treatments. This means that you will no longer be able to get pregnant. It may be temporary but sometimes it is permanent. Infertility can be very hard to come to terms with. The sense of loss can be strong for people of all ages.

Discuss this risk with your doctor before you start your treatment. If you have a partner they will probably want to join in during the discussion. Then you both learn all the facts and have the chance to talk over your feelings and choices for the future.

Research is looking into freezing ovarian tissue and later reimplanting it so that women can still be fertile after chemotherapy. This is still experimental at the moment, and so is not generally available.

If you are interested in this, you can talk to your specialist about it. You may be able to take part in some of the research. It is also now possible for women to have unfertilised eggs frozen. The fertilisation rate for frozen eggs is low, but it is improving as researchers develop better techniques. In the fertility and chemotherapy section there is information about how women can keep their fertility if they are having chemotherapy.

There is also information about radiotherapy and sex and fertility for women in the radiotherapy section.

People are different in their reaction to infertility

  • Some accept it more easily and feel that beating cancer is more important
  • Others accept the news calmly when they start treatment, but find it hits them later, when the treatment is over

You may feel you have lost a part of yourself and are less manly or less feminine if you can't have children. You may be very sad or angry that the treatment has caused changes to your body and your self confidence may be affected.

There is a section on your feelings in the cancer and emotions section that you may find helpful.

 

If you have advanced cancer

Having advanced cancer means that your cancer can’t be cured. But it doesn't necessarily mean that you are terminally ill. But whatever your situation, you may still have needs and desires. Even if you don’t feel like having sexual intercourse, you may still have sexual feelings even if you are very ill.

If your cancer is in the advanced stages you may have an even stronger need for intimacy in your life than before you had cancer. Physical closeness, sharing your feelings and touching may become very important. Knowing your cancer can’t be cured can bring up some very strong emotions for you. This can be very difficult to cope with, especially if you are single and don’t have the support of a caring partner. But it may help to talk to someone else about how you are feeling.

 

Help and support

If you are at all worried about anything to do with your sex life and sexuality you may want to talk through how you feel with a counsellor or therapist. If you would like to talk to someone outside your own friends and family, look in our talking about cancer section for counselling organisations or the general organisations page for organisations who help with relationship and sexual issues. To find out more about counselling look in the counselling section.

 

More information about sexuality

There is information in other sections about how particular types of cancer can affect your sex life. For example, there is information about  sex and bowel cancer in the living with bowel cancer section.

There is also information about

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Updated: 24 October 2013