Sex and Cancer: General impacts
Cancer and its associated treatments can affect many parts of our sexual wellbeing. These can range from physical changes, such as impacts from treatments, or emotional, when you might be stressed or processing difficult or complex feelings.
Masturbation
Hands and fingernails should be as clean as possible to minimise the risk of causing an infection. Latex gloves and lube can help with this if necessary, and can support safer masturbation with less friction if you have sore skin.
In some cases, masturbation and ejaculation can be painful during or after treatment. If you have any concerns or questions related to pain, raise them with your clinical team.
Bruising & bleeding
There may be times in your treatment when your platelet count is low (less than 50) or your neutrophil count is low (less than 0.5). Having low platelets means that you are at increased risk of prolonged bleeding that may be difficult to stop. Having low neutrophils means that you are at increased risk of infection.
A love bite is essentially a bruise caused by sucking and/or biting on a partner’s body in a sexual way. If you have low platelets you are a lot more susceptible to bruising and bleeding therefore it would not be advisable to receive a love bite. Giving a love bite to someone else should be fine.
You will need to be extra careful to avoid bleeding whilst your platelet count is low. This means avoiding rough sex (including hitting/spanking/fisting) that could lead to bruising or tearing, and avoiding activities that might break the skin (e.g. impact play or use of needles).
Any break in the skin has the potential to let bacteria into the body and can lead to something called ‘neutropenic sepsis’ (a serious, life threatening infection) if your neutrophil count is low.
Sex Toys
If you are using a sex toy alone, this is a particularly safe sexual activity as long as you follow a good standard of hygiene that is necessary for sex toys.
If the sex toy is shared with your partner(s) it should ideally be cleaned or a condom used and changed before going from one person to another.
STIs, including HPV and herpes, can survive on sex toys, so good hygiene for shared toys is important.
Sex toys should be clean and vaginal penetration should never occur after anal penetration unless a condom on the sex toy is changed or the sex toy is cleaned.
When cleaning a sex toy, first check if it is waterproof (can be submerged in water) or splashproof (should not be submerged in water). If it’s waterproof, you will be able to clean it in warm soapy water. If it’s splashproof, wipe it down with a warm soapy washcloth instead.
Avoid scented soaps when cleaning your toys. Instead, opt for plain antibacterial soaps. Specific toy cleaning soaps and wipes are also purchasable from sex shops.
Most sex toys fall into two main categories: porous materials and nonporous materials. If the material is porous, it means that it has microscopic holes (like pores) that can harbour bacteria, fungi, and even soap. Ideally, a sex toy is made out of a non-porous material, meaning these toys do not absorb any bacteria. Silicone, stainless steel, glass, and certain types of plastic are safe and toys made out of these materials can be sanitised between uses.
Some materials may be porous but non-toxic, like elastomers, which a lot of masturbation sleeves are made out of. These toys are typically used on the outside of the body and are only intended for a limited number of uses (often single use).
Good toy hygiene includes safe storage. Keep sex toys in a clean box, pouch or bag before storing them in a drawer with other things.
Excessively large sex toys that can stretch the tissues and cause potential damage to the tissues should be avoided during treatment for cancer.
If you are using sex toys for anal play, be sure to use products with a flared base, to ensure they can’t be inserted further than intended.
It is advisable to only use sex toys that are designed for the purpose of sexual activity. This ensures that the quality is high and that they are designed for safe use (e.g. flared bases on anal toys). If you want to be extra careful, you can check for the ISO 3533 standard on the product or packaging that shows it meets industry safety standards.
It is also important if you are using toys with removable parts that they have a locking feature so that they can’t come away whilst in use.
Anal play with sex toys is not advised if your neutrophils are less than 0.5 and/or your platelets are less than 50 due to the risks of bleeding and the potential of causing an infection. If you are not sure if it is safe to engage in anal play, ask your medical team to check your bloodwork.
Cancer induced menopause
Menopause is when your periods stop and your ovaries stop producing eggs. This results in the levels of the oestrogen and progesterone hormones in your body dropping.
Some treatments for cancer can cause premature menopause which may be temporary or permanent.
The types of treatment that can cause an early menopause include, chemotherapy, radiotherapy to the pelvis, and surgery to remove both ovaries.
Hormonal treatments used to treat breast cancer can also cause a temporary menopause or menopause-like symptoms. Some hormonal treatments, such as Tamoxifen for breast cancer, might make early menopause more likely.
This change in hormones related to menopause can cause a loss of interest in sex. But losing interest in sex can happen for lots of reasons including stress and feeling tired.
Low oestrogen levels can also cause the vagina to become thinner, dry, itchy, and inflamed. It can also make it more difficult for the vagina to expand during sex which can cause some pain or discomfort. There are vaginal creams that can be applied 2-3 times a week to help moisturise the vagina making sex less painful.
Urine tract infections are also more common in people going through menopause as a result of cancer treatment. This can be a particular problem for people taking Tamoxifen.
Going through early menopause can be a shock and might feel physically and emotionally overwhelming at first. Some people feel confused or frustrated by what is happening to them.
Talk to your specialist cancer team if you are having any problems related to early menopause and its side effects as they may be able to recommend treatment or lifestyle changes that could help.
You can also get further support and information on how to manage menopausal symptoms from the Useful Links section of this resource.
Depending on the type of cancer and treatment you are having it may be possible to have hormone replacement therapy (HRT). This treatment replaces the hormones that your ovaries are no longer producing to help relieve menopausal symptoms.
Unfortunately, HRT is not possible for every patient. If you have a hormone related cancer then doctors may advise against using HRT as it may increase the risk of the cancer growing or coming back. Cancers that may be hormone sensitive include breast cancer, ovarian cancer, womb cancer, and prostate cancer.
In these cases, there are alternative prescription medicines you can take instead of HRT and this is something you can speak to your doctor or CNS about.
Testosterone helps to regulate sex drive as well as mood, memory and concentration. Some people may benefit from taking testosterone as part of their HRT which can be given as a cream, gel, or implant. You can speak to someone in your cancer care team to see if this might be suitable for you.
Erections
It may be difficult to get or keep an erection (erectile dysfunction) for various reasons including physical, psychosocial and emotional. It is also often linked to things like stress, tiredness, and alcohol consumption. Having a cancer diagnosis can be stressful and treatments can cause tiredness (fatigue).
Erectile dysfunction can also be caused if the cancer or treatment has damaged the nerves or blood vessels leading into the penis. This is a very common side effect of surgery and radiotherapy to the pelvis.
Low levels of the sex hormone testosterone can also cause difficulties with erections. This can sometimes happen if there has been radiotherapy or surgery to the testicles (balls) or a gland in the brain called the pituitary gland. Hormone therapies for prostate cancer also affect testosterone. These treatments either block testosterone or temporarily stop the body from producing it.
There are various treatments available for erectile dysfunction. These can include:
- Manual – Penis pumps can be used to encourage blood flow into the penis and can be supported by also using a ‘cock ring’. Medical grade penis pumps are different from those found in sex shops;
- Medications – These can be taken orally, injected into the penis, used as an urethral pellet (a pill placed inside where you pee from) or an ointment placed at the opening to your urethra (where you pee from);
- Surgery – An implant placed into the penis that is pumped to create an erection.
Anal sex requires a firmer erection compared to vaginal sex. For some people, this has affected their choice of erectile dysfunction treatment. You can discuss the options available with your cancer care team and how they can support the sex you want to continue having.
Oral sex
You should avoid oral sex if you or your partner has cuts on their mouth, cold sores, genital herpes, or thrush on the genitals or in the mouth.
If you are neutropenic (neutrophil count 0.5 or less), your body is less able to fight infection. For this reason, you should avoid being the giver of analingus (rimming) until your immune system recovers. It is ok if you are the receiving partner.
If you are using topical medicines (e.g. gels or creams) on the genital area, make sure these are washed off before having oral sex.
Vaginal sex
Chemotherapy, hormone therapy, and radiotherapy (to the pelvic area) can cause vaginal dryness and thinning of the vaginal tissues. This may be due to a lowering of the levels of oestrogen in the body and can make having sex more painful.
If your cancer treatment has led to low oestrogen levels it may be appropriate for you to have local or systemic hormone replacement therapy (HRT). You can discuss this with your treatment team or your GP so that the most appropriate HRT can be prescribed for you to help with the vaginal dryness and help to reverse thinning of vaginal tissues.
There is ongoing research into the safety of HRT in cancers that are sensitive to oestrogen so you may want to check with your cancer care team for up to date information if you have been told in the past that you cannot have HRT.
There are also lots of non-hormonal intimate lubricants and vaginal moisturisers (e.g. Yes VM, Hyalofemme) available which you can get from your CNS or GP to help with vaginal dryness. Or alternatively, you may wish to purchase a high quality water based lubricant from a local or online sex shop, or a supermarket.
To help prevent vaginal infections we recommend that you:
- use water based lubricants rather than oil based lubricants (like petroleum jelly or lotions)
- use a barrier method such as condoms or latex gloves when inserting anything into the vagina
- wear cotton underwear
- avoid tight trousers
If you do get an infection, it should be treated straight away. It is important that you do not have treatment without letting your cancer team know. Even simple treatment for vaginal thrush can increase the harm from some chemotherapy drugs. Your doctor may also prescribe a cream or pessary (a small soluble block that is inserted into the vagina) to help with any infection.
It is also possible to introduce infection that may be present around the anus (back passage) into the vagina if care is not taken. Condoms should be changed after anal penetration, before engaging in vaginal penetration. If sex toys are used anally, a condom should also be used and changed before vaginal penetration.
Anal sex
If you are neutropenic, we recommend that you avoid anal sex due to the risk of infection. Anal douching is also not advised as this can wash away the protective layers from the lining of the rectum and anus which protect the inner walls from drying and tearing.
There may be times in your treatment when your platelet count is low (less than 50). You will need to be extra careful to avoid bleeding whilst your platelet count is this low. Anal sex has a greater risk of tearing and bleeding, so if your platelets are low, it may be safer to avoid anal sex. If you do wish to continue having anal sex, be sure to use enough lubricant to reduce friction. It is also advisable to avoid rough sex that could lead to tearing.
It is possible to introduce infection that may be present around the anus (back passage) into the vagina if care is not taken. Condoms should be changed after anal penetration, before engaging in vaginal penetration. If sex toys are used anally, a condom should also be used and changed before vaginal penetration.
Group sex
Having sex with multiple people at the same time has the potential to raise the chance of acquiring an STI. Therefore, it is of utmost importance to protect yourself in group sex situations with adequate barrier method protection, such as internal or external condoms or dams.
When your immune system is functioning at reduced capacity (due to your cancer treatment) you are at increased risk of any type of infection which ultimately can lead to septicaemia. This includes STIs, so it is important to always use barrier methods to protect yourself from such infections.
Using poppers
Some cancer treatments can cause changes in your blood pressure and your heart’s rhythm. Poppers (amyl nitrate) dilate your blood vessels, sending blood to your brain and boosting your heart rate. Sniffing (inhaling) poppers can be bad for anyone with potential heart problems and those taking heart rate altering medication. This is because poppers can cause irregular or fast heart rhythms. Repeated use can also damage your eyesight.
Chemsex
Certain drugs, herbal supplements and even foods can affect the way cancer treatments work in the body. In some cases, these interactions can be deadly. If you are using recreational drugs, it is important to let your clinical team know so that they can inform you of any increased risk associated with your cancer treatment.
Using drugs during sex (chemsex) can affect risk taking behaviours and pushing boundaries, increase the risk of acquiring STIs, and lead to long term physical and psychological harm. The drugs commonly used in chemsex, such as Methamphetamine (Crystal Meth/ Tina), Mephedrone (Meth/M-Cat/Meow-Meow), GHB and GBL (G), can also have harmful drug interactions. Please talk to your health care providers and sexual health clinic if you need further information and support.
Some drugs will be more harmful than others. You can ask to speak to a pharmacist for more information if necessary as they will be able to look up which drugs could cause adverse reactions and explain what might happen.