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Sex is an important part of being in a relationship, but hormone therapy and certain types of chemotherapy can cause sexual problems to develop. Managing these issues might involve several different therapies, treatments, or devices, or a combination of them. Counseling can also be helpful.

The information below describes common sexual problems an adult female getting chemo or hormone therapy may experience. If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

It’s very important to talk about what to expect, and continue to talk about what's changing or has changed in your sexual life as you go through procedures, treatments, and follow-up care. Don't assume your doctor or nurse will ask about any concerns you have about sexuality. Remember, if they don't know about a problem you're having, they can't help you manage it.

How chemotherapy can affect sex

It’s very important to talk to your cancer care team about if it's safe to have sex while getting chemo. There might be limitations to what you can do, or precautions you need to take to keep you and your partner safe.

You can find out about the effects of chemo on specific types of cancers in Cancer A to Z. Chemo is often given through an intravenous (IV) tube into a vein in the bloodstream, and some chemo pills are given by mouth (orally). Both IV and oral chemo send the drug traveling throughout the body. Some types of chemo can directly affect how a woman's sex organs function, or change hormone levels. Your doctor will be able to tell you if your treatment plan includes any of these chemo drugs.

In some cases, the drugs are sent right to the tumor through a catheter or port. Some drugs might have sexual effects, and here are some examples:

• For cancer of the bladder, chemo is sometimes put right into the bladder through a catheter. Treatment like this usually only has a minor effect on a woman’s sex life. But she may notice some pain during sex because the bladder and urethra may be irritated from the drugs.
• Women with tumors in the pelvis may get chemo by pelvic infusion through a catheter. Depending on the type and dose of chemo, there could be long-term effects on a woman’s sex life.
• Another way of giving chemo is by intraperitoneal infusion. The drugs and extra fluid are put into the space around the tumor, using a port in the abdomen (belly). The extra fluid causes the abdomen to swell. The drugs and liquid are then drained out after a short period of time.

Pregnancy and fertility during and after chemo

If you think you might want to have children in the future, it’s important to talk to your cancer care team about this before starting chemo. You need to know if treatment will affect your fertility. See Female Fertility and Cancer for more information.

Many of the drugs used to treat cancer can harm an unborn baby. Because of this, women are usually advised to use birth control to keep from getting pregnant during treatment. Even if you think you can't get pregnant, you should talk to your doctor about this. It's important to know what kind of birth control is best and safest for you to use. If you want to get pregnant, talk with your doctor about how long you should wait after treatment is over.

After chemo, it may still be possible for some women to get pregnant. Keep in mind that, even if you’re still having monthly periods, it’s hard to say if you will be able to get pregnant. Women who don’t want to become pregnant should use birth control, even after having chemo, and should talk to their doctor about how long birth control will be needed.

Early menopause with chemo

Women who have not yet started menopause and are getting chemo might have symptoms of early menopause during and after treatment. These symptoms include hot flashes, vaginal dryness, vaginal tightness, and irregular or no menstrual periods. If the lining of the vagina thins because of treatment, there may be a light spotting of blood after sex.

Other chemo-related problems that may affect your sex life

Some chemo drugs that irritate the mouth might also affect all mucous membranes in the body. This includes the lining of the vagina, which may become dry and inflamed.

Infections that affect sex can happen because chemo can weaken the immune system. If you have a vaginal infection, tell your team and have it treated right away. For example:

• Yeast infections could happen during chemo, especially in women taking steroids or antibiotics to treat or prevent bacterial infections. If you have a yeast infection, you may notice itching inside your vagina or on the vulva. You may also have a thick, whitish discharge, and you may feel some burning during sex. Yeast infections might be prevented by not wearing pantyhose, nylon panties, or tight pants. Wear loose clothing and cotton panties to avoid trapping moisture in the vaginal area. Wipe front to back after emptying your bladder and do not douche. Your doctor may also prescribe a vaginal cream or suppository to reduce yeast or other organisms that grow in the vagina.
• If you've had flare-ups of genital herpes or genital warts in the past, chemo may make them happen again.
• It’s important to avoid sexually transmitted diseases. If you are having sex with someone, practice safe sex from start to finish (use condoms or other barriers to avoid body fluids). Do this every time you have oral, anal, or vaginal sex.
• It’s important to avoid touching the vagina and the urethra with anything that has been used to stroke near the anus. Lingering germs from the bowel can cause infection if they get into these areas.

Chemo and sexual desire

Chemo has different side effects that can have an impact on sexual desire, such as fatigue, mouth soreness, neuropathy, nausea, decreased appetite, and pain. Anxiety or depression can also affect your sex life and leave little energy for sex. Sexual desire often returns when a woman feels better, or in between cycles of treatments.

Women getting chemo also tend to be sensitive about their appearance. Hair loss, weight loss or gain, and skin changes might happen, depending on the type of chemo you're getting.

How hormone therapy can affect sex

Hormone therapy may be used to treat certain types of cancers of the breast and the lining of the uterus (endometrial cancer). This treatment blocks hormones these cancers need to grow. Since sexual desire and sexual function are affected by hormones, blocking them can affect your sex life.

There are different types of hormone therapy, so be sure you understand which one is part of your treatment plan. Know the possible side effects so you know what to expect, and how to help manage them. It's also important to talk to your partner about what might be expected. Some of these side effects can be very bothersome, and adjusting to them can be hard to do. They include hot flashes, menstrual cycle changes, and vaginal dryness.

You can find out about the effects of hormone therapy on specific types of cancers in Cancer A to Z.

To learn more about physical problems related to cancer surgery and sexuality and how to talk to your cancer care team about them, see in Managing Female Sexual Problems Related to Cancer.