Sex and Cancer: Contraception and safer sex
When you begin treatment your Doctors may need to start specialist hormone medicine which might stop your periods (if you have them) to reduce the risk of bleeding when your platelets are low. Whilst they may stop your periods they are not a reliable contraceptive.
Your cancer team should ask you about any medication you are taking including contraception. Have a discussion with your clinical team about the safest and most effective contraception for you, especially if you have been told that you have a hormone-receptive cancer which may include breast, womb, or ovarian cancer.
BARRIER METHODS
Condoms
STIs are passed on through sexual contact and the risk of catching an STI can be reduced dramatically by using a condom.
Condoms come in many varieties, but two key types are external condoms (for penises) and internal condoms (for vaginas).
They work as a contraceptive by stopping sperm from reaching an egg by creating a physical barrier between them. It is important to make sure that the condom is put on before the penis touches the vagina. If any semen makes it into the vagina while using a condom due to a leak, a break, or the condom slipping, you should speak to someone about emergency contraception and consider having an STI test if necessary.
Free condoms are always available, you just need to ask a member of staff if you would like some at any time during your treatment. If you are between 13 and 24 years old you are eligible to have a C Card. With a C Card you can access free condoms and lube from registered GP’s, pharmacies, and some shops, schools and colleges. Alternatively, you can arrange to have them delivered to your address. For Further information on joining the C Card scheme, search for ‘C Card’ and the area you live in. You can also find your local providers of free condoms via the NHS search feature.
How do I use an external condom correctly?
- Check the condom packet has the European CE mark – a recognised safety standard.
- Check that the current date is not later than the expiry date.
- Take the condom out of the packet, taking care not to tear it with jewellery, finger nails or teeth.
- Place the tip of the condom over the tip of the erect penis.
- If there is a teat on the condom, use your thumb and forefinger to squeeze the air out of it.
- Gently roll the condom down to the base of the penis.
- If the condom won’t roll down, you’re probably holding it the wrong way round – if this happens, throw it away as it may have sperm on it. Use a new condom.
- After sex, withdraw the penis while it is still erect – hold the condom at the base of the penis while you do this.
- Remove the condom from the penis, being careful not to spill any semen.
- Throw the condom away in a bin (not down a toilet).
- If you have sex again – use a new condom.
How do I use an internal condom correctly?
- Check the condom packet has the European CE mark – a recognised safety standard.
- Check that the current date is not later than the expiry date.
- Take the condom out of the packet, taking care not to tear it with jewellery, finger nails or teeth.
- The closed end is used for placing in the vagina and the thick inner ring holds the condom in place. The thin, outer ring remains outside of the body, covering the vaginal opening.
- Find a comfortable position. While holding the outside of the condom at the closed end, squeeze the sides of the inner ring together with your thumb and forefinger and insert into the vagina.
- Using your finger, push the inner ring as far up as it will go until it rests against the cervix. The condom will expand naturally and you may not feel it doing so.
- Be sure the condom is not twisted.
- The thin, outer ring should remain outside vagina.
- Stop intercourse if you feel anything slip between the condom and the walls of vagina or if the outer ring is pushed into vagina.
- To remove, gently twist the outer ring and pull the condom out of the vagina, being careful not to spill any semen
- Throw the condom away in a bin (not down a toilet).
- If you have sex again – use a new condom.
30 minute rule: If you are having a long sex session, change the condom after 30 minutes. Friction can weaken the condom, making it more likely to break or fail.
Condoms come ready lubricated but you may want to use extra lube. This is particularly advised for anal sex to reduce the chance of the condom splitting.
Oil based lubes can thin condoms and make them more likely to split so we recommend that you only use water or silicone based lubes with condoms.
Dams
A dam (which used to be called a dental dam) is a latex or polyurethane (soft plastic) square, about 15cm by 15cm, which is used to cover the anus or vulva and vagina during oral sex. It acts as a barrier to help prevent sexually transmitted infections passing from one person to another. Dams cannot be used for penetrative sex. They are available from sexual health services or can be ordered online or in pharmacies and come in many different flavours. There are now also dams that can be worn as disposable underwear (mylorals.com)
How do I use a dam?
- Cover the genital area (vulva, vagina, or anus) with the dam before there is any contact with the mouth.
- You will need to hold it in place.
- It doesn’t matter which side you use, but do not turn over the dam once it has come into contact with the genital area or mouth.
- Don’t use a dam on the vulva and vagina after it has been on the anus as bacteria which are harmless around the anus can be transferred to the vagina and cause an infection.
- Only use water based lubricants as oil based lubricants can damage the dam.
- Only use it once.
Latex gloves
Gloves protect genitals from the germs found on fingers and underneath the fingernails during fingering and/or fisting. They also keep the finger or hand free from body fluids and provide some protection from fingernails to reduce the risk of internal tears occuring. Gloves can be used with lots of lube and if there is a latex allergy, nitrile gloves can be used instead.
Gloves should only be used on one body part at a time. When removing the glove, it should be disposed of by holding the gloves cuff on one side at the wrist and turning the glove inside out as it comes off the hand. Consider if you need to wash your hands before applying new gloves.
LONG ACTIVE REVERSIBLE CONTRACEPTIVES
Long acting reversible contraceptives (LARCs) like the implant, coils (hormonal and non-hormonal) and the Depo-Provera contraceptive injection are:
- very effective at preventing pregnancy;
- convenient;
- very safe;
- a good alternative to taking pills.
Note: Hormonal contraceptives may not be advised if your cancer is a hormone receptive cancer – see box at the end of this section.
Contraceptive implant
The implant is a flexible rod the size of a matchstick that goes just under the skin in your upper arm. It releases a progestogen hormone slowly over 3 years. It can be used for the full 3 years, or removed sooner if you don’t want or need it any more. The skin of your arm is numbed before inserting or removing the rod so that the procedure is not painful.
The implant nearly always changes your periods, but this effect can vary between people. Some people get no bleeding with it, some people have occasional bleeds, some continue with regular bleeds, and others experience frequent bleeding. If the rate of bleeding is a problem, medication can be considered to reduce the problem, or alternatively the implant can be removed.
Coils
Coils come in two main varieties:
- hormonal (IUS);
- or non hormonal (copper IUD).
A coil gets its name from being either copper (IUD) or a progestogen hormone (IUS) wrapped around a T-shaped plastic device. The coil is inserted into the uterus by a doctor or nurse and different forms of pain relief can be offered for the fitting.
Flexible threads tied to the end of the coil, hang down through the cervix a few centimetres into the vagina and allow for removal at a later date.
A copper IUD can make periods heavier or longer in some people. Most people using an IUS have lighter periods, or no periods at all.
Coils can stay in place for 3-10 years and are a very effective form of contraception.
Depo-Provera injection
Depo-Provera is a contraceptive injection that contains a progestogen hormone. The injection is usually put in your buttock (bottom cheek) every 12 weeks. The Depo-Provera injection usually reduces bleeding and often stops periods completely after some months of consistent use. It is a very effective contraceptive as long as you remember to have the injection on time.
Contraceptive pills
Chemotherapy side effects, such as sickness and diarrhoea, may make the contraceptive pill less effective if you vomit up the pill, or poo it out, before you have fully absorbed it.
Combined pills contain 2 hormones – an oestrogen and a progestogen. It is the oestrogen that increases blood clot risk. Combined pills can be taken with a regular break once every 4 weeks, to have a regular bleed, or can be taken back to back to stop periods.
Progestogen only pills contain 1 hormone – a progestogen. You have to take the progestogen only pill every day for them to work. No breaks!
Some people have regular periods with the progestogen only pill, whilst many others have less bleeding and some stop having periods whilst taking this pill.
If you are already using a contraceptive pill and you wish to continue taking this, it is important to discuss this with your cancer care team. Some cancer treatments can increase the risk of blood clots forming, especially around central lines (port-a-caths, PICCs, and Hickman Lines) and this risk may be increased by the use of the combined oral contraceptive pill. Progestogen only or “mini” pills do not increase the blood clot risk.
Contraceptive patch (Evra)
This is a form of combined hormonal contraception, similar to the combined pill, containing an oestrogen and a progestogen. Therefore, it increases the risk of blood clots. You stick the patch on non-hairy skin (eg your upper arm) for 1 week at a time. Like the combined pill, you can choose to have a period every month (by taking the patch off for a week) or run patches together for no bleeding.
Contraceptive ring (Nuvaring)
This is another combined hormonal contraceptive with an oestrogen and a progestogen. It is a flexible ring that fits in the top of the vagina and the hormones are absorbed from there. It is similar to the combined pill and patch, but due to the way it delivers the hormones, some people experience less side effects. However, the increase in blood clot risk is still there.
Both the patch and the ring avoid the problem of absorbing pills if you have vomiting or diarrhoea as side effects of your treatment.
Emergency contraception
Emergency contraception is when you get the contraception after the sex has happened.
It is very important to avoid an unintended pregnancy whilst you are in the middle of cancer treatment.
If unprotected sex does happen, or your means of contraception fails (e.g. a condom splits on you), then you should get advice about emergency contraception quickly.
Two different emergency contraception tablets, commonly known as “morning after pills”, are available. These are available to buy from pharmacies and sometimes are provided for free to young people in some areas. Because of the potential drug interactions with chemotherapy, it is best to contact your CNS, your GP, or the local sexual health clinic for advice if you need to take emergency contraception.
A copper coil can also be fitted for emergency contraception. This option might be suitable if you can’t take the pills. This method also contains no hormones. Your local sexual health service should be able to offer this option to you.
You need to get emergency contraception within 5 days of unprotected sex – but the sooner you take it the more effective it will be, so don’t delay.
The NHS provides confidential sexual health services that will not share information with other members of your healthcare team without your permission. You can find your local service online via the NHS search feature.