Cancer treatment: fertility and sexual side effects in women

Many cancer treatments can cause sexual side effects. But you are more likely to have these side effects if you are being treated for one of these types of cancer:

• Cervical cancer
• Ovarian cancer
• Colorectal cancer
• Uterine cancer
• Vaginal cancer
• Breast cancer
• Bladder cancer

For women, the most common sexual side effects include:

• Loss of desire
• Pain during sex

Other side effects can include:

• Not being able to have an orgasm
• Numbness or pain in the genitals
• Problems with fertility

Many people also have emotional side effects after cancer treatment, such as feeling depressed or bad about your body. These side effects can also affect your sex life. You may not feel like having sex or may not want your partner to touch your body.

Different types of cancer treatment can affect your sexuality and fertility in different ways.

Surgery for cancer:

• Pelvic surgery can cause pain and problems having sex or getting pregnant.
• Some women who have surgery to remove all or part of a breast find they have less interest in sex.
• The type of side effect you have depends on which part of the body where you have the surgery and how much tissue is removed.

Chemotherapy can cause:

• Loss of sexual desire
• Pain with sex and problems having an orgasm
• Vaginal dryness and shrinking and thinning of the vaginal walls due to lower estrogen.
• Problems with fertility

Radiation therapy can cause:

• Loss of sexual desire
• Changes in the lining of your vagina. This can cause pain and problems with fertility.

Hormone therapy for breast cancer can cause:

• Loss of sexual desire
• Vaginal pain or dryness
• Trouble having an orgasm

One of the most important things you can do is to talk with your health care provider about sexual side effects before your treatment. Ask what types of possible side effects to expect and how long they will last. This way, you will know what to expect. You should also talk about these changes with your partner.

If your treatment can cause fertility problems, you may want to see a fertility doctor before your treatment to discuss your options if you want to have children. These options may include freezing your eggs or ovarian tissue.

Although many women continue to have sex during cancer treatment, you may find you are not interested in sex. Both of these responses are normal.

If you do want to have sex, make sure to ask your provider if it is OK. Also ask about using birth control. In most cases, it is not safe to get pregnant during cancer treatment.

Sex may feel different for you after your treatment, but there are ways to help cope.

• Focus on the positive. Feeling bad about your body can affect your sex life. Look for little ways to give yourself a lift, such as a new hairstyle, new makeup or a new outfit.
• Give yourself time. It can take months to heal after cancer treatment. Do not push yourself to have sex just because you think you should. Once you are ready, remember that it may take longer for you to feel aroused. You also may need to use a lubricant.
• Keep an open mind. There is not just one way to have sex. Try to stay open to all ways of being intimate. Experiment with new ways of touching. You may find that what feels good after treatment is not the same as what felt good before treatment.
• See your provider. If you are having pain with sex, tell your provider. You may be recommended creams, lubricants, or other treatments.
• Talk with your partner. This is very important. Try to be open about your feelings. Be honest about what would make you feel good. And try to listen to your partner's concerns or desires with an open mind.
• Share your feelings. It is normal to feel anger or grief after cancer treatment. Do not hold it in. Talk with close friends and family. It can also help to talk with a counselor if you cannot shake feelings of loss and grief.

Radiotherapy - fertility; Radiation - fertility; Chemotherapy - fertility; Sexual dysfunction - cancer treatment

American Cancer Society website. How cancer and cancer treatment can affect fertility in females. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html. Updated February 6, 2020. Accessed October 28, 2022.

American Cancer Society website. Questions women have about cancer, sex, and getting professional help. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/faqs.html. Updated January 12, 2017. Accessed October 28, 2022.

Mitsis D, Beaupin LK, O'Connor T. Reproductive complications. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 43.

National Cancer Institute website. Fertility issues in girls and women with cancer. www.cancer.gov/about-cancer/treatment/side-effects/fertility-women. Updated February 24, 2020. Accessed October 28, 2022.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.