Sex and fertility and non Hodgkin lymphoma
This page tells you about how non Hodgkin lymphoma and its treatment may affect your sex life and ability to have children. You can find the following information
Sex and non Hodgkin lymphoma
During your treatment, if you have a very low platelet count, intercourse may not be recommended because of the risk of bleeding. Discuss this with your doctor or nurse if you are not sure.
If you are a man having chemotherapy, you should always wear a condom. This is because semen can cause a stinging sensation in the woman's vagina if her partner is having chemotherapy. This means some of the drug may be coming through and doctors don't know enough about whether this could be harmful.
If you are a woman having chemotherapy, you should make sure you use contraception. The drugs you are having could damage a developing baby. Even if your periods have stopped it may be possible to get pregnant, so you should take precautions.
Treatment and your risk of becoming infertile
Some chemotherapy treatment for non Hodgkin lymphoma can cause infertility. If possible, doctors will use drugs that do not cause infertility. But the first priority is treating your non Hodgkin lymphoma.
If you become infertile you will not be able to have children after your treatment. Having a bone marrow or stem cell transplant will almost certainly mean you will be infertile.
You can view and print the quick guides for all the pages in the living with NHL section.
Having non Hodgkin lymphoma or being treated does not always affect your sex life. But you will probably go through times when you do not feel like sex because you are too tired or have side effects from the treatment.
You need to take precautions against pregnancy if you are having treatment. Couples should always use reliable contraception.
If you are a man having chemotherapy, you always need to wear a condom during sex. Some women have said that when their partner was having chemotherapy the semen caused a stinging sensation in their vagina. This means some of the drug may be coming through and doctors don't know enough about whether this could be harmful.
If you are a woman having chemotherapy and become pregnant, the drugs you are having could damage the developing baby. Even if your periods have stopped, it may be possible to get pregnant so you should still take precautions.
And if you have a very low platelet count, intercourse may not be recommended. Discuss this with your doctor or nurse if you are not sure.
If your periods stop permanently after chemotherapy, you have had an early menopause. This can cause other symptoms apart from not having periods. You may have
- Hot flushes and sweats
- Dryness of the vagina
- Less interest in sex
- Dry skin
- Loss of energy
- Mood swings, loss of concentration or just feeling low
Your doctor will probably offer you hormone replacement therapy or HRT. HRT is treatment with the female sex hormones you would produce naturally if you had not had an early menopause. The hormones are called oestrogen and progesterone. HRT can stop all the symptoms of early menopause. It can also help to prevent long term problems like bone thinning (osteoporosis).
HRT can be taken as tablets or given in skin patches that are like plasters. The dose of hormones in hormone replacement therapy is lower than the dose you would normally produce if you had not had an early menopause. So you are very unlikely to have any side effects.
Some chemotherapy treatment for non Hodgkin lymphoma can cause infertility. But this does not happen with all chemotherapy treatment used for NHL. If they can, doctors will use drugs that do not cause infertility instead of those that do. But the first priority is treating your non Hodgkin lymphoma effectively.
If you become infertile you will not be able to have children after your treatment. Having a stem cell or bone marrow transplant will almost certainly mean you will be infertile.
With some chemotherapy treatment, it is not possible for your doctor to be certain whether you will be infertile or not. This will depend on
- The drugs you are given
- The total dose of each drug
- Your age if you are a woman
Some drugs are likely to cause infertility but do not always do so. Some people may be made infertile at a lower dose of a particular drug than other people. Some drugs cause temporary infertility. So your fertility may come back from six months to a year after your treatment has finished.
Your doctor or specialist nurse will tell you whether your chemotherapy is likely to make you infertile and can answer your questions before you start your treatment. If you have a partner, you may want to see the doctor together. You can then both ask questions and discuss any fears or worries.
Even if your treatment will stop you producing sperm, it may be possible for you to have sperm frozen and stored before you start your treatment. This is called sperm banking. Sperm banking means you will be able to have children in the future because the frozen sperm can be used to make your partner pregnant.
Teenage boys can also have sperm frozen. Their sperm can be stored for use in later years.
Sometimes men who have lymphoma have fewer sperm in their semen. It is not then possible to store the sperm. But there are newer techniques to help men with low sperm counts. It is important that you discuss sperm banking with your doctor before your treatment starts.
There is more information in the fertility and chemotherapy section.
If you are a woman, the closer you are to your menopause (or change of life), the more likely it is that chemotherapy will make you infertile. But if your periods stop, or become irregular during your chemotherapy, this does not necessarily mean you will be infertile. Your periods may go back to normal six months to a year after treatment has finished.
The only ways for women to preserve fertility are to have embryos or eggs frozen. This is more complicated than it is for men, because you have to take hormones to stimulate your ovaries to make many more eggs than usual. This takes a couple of weeks at least, depending on where you are in your menstrual cycle. If you have a partner, you can have the eggs fertilised and stored as embryos. But it is now possible to have just your eggs frozen.
If you think you would like to do this, talk to your lymphoma specialist as early as possible. It needs to be done before you have treatment. And as it takes a few weeks, it may delay your chemotherapy. You will have to talk this over with your own doctor. With some types of faster growing lymphoma, this may not be possible. Your doctor may feel you need to start treatment straight away.
It can be extremely distressing to find that your cancer treatment means you will not be able to have children. It can seem very unfair to have to cope with this as well as your cancer. Even if you haven't really thought about having children before, losing your fertility can be very difficult to come to terms with. It can affect the way you feel about yourself.
It will take time to come to terms with this. Give yourself time to adjust and feel sad. Talking to someone close will almost certainly help. But you may not be able to do this for a while.
You may want to talk to someone other than your partner, family or friends. Some people find it helpful to talk to a therapist or counsellor. Ask your doctor or nurse if you can be put in touch with some professional help if you think it would be helpful for you.
If you would like to talk to someone outside your own friends and family, look in our coping with cancer section for counselling organisations. You can also find out more about what counselling is in the talking about cancer section.
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