Can I Have Sex During Cancer Treatment?

Both of NCI's pages on sexual health during cancer treatment open the same way. Most women can be sexually active during treatment. Most men can be sexually active during treatment. Both add the same caveat: confirm it with your doctor.

That is a more permissive starting point than many people expect. Feeling close to a partner does not have to be put on hold for the length of treatment.

NCI also notes that you may need to raise the subject yourself. Its suggested opening questions are practical ones: what sexual changes are common with this treatment, and what methods of birth control or protection are advised.

NCI names one situation where the answer changes. There may be times during treatment when you are at increased risk of infection or bleeding, and you may be advised to abstain.

Those windows are not guesswork. They follow your blood counts, which are checked before most cycles. Two counts matter: the white cells that fight infection, and the platelets that let blood clot.

Ask when your counts are expected to be lowest. That turns an open-ended worry into a few marked days.

This is the part most people have not heard, and it is the reason condoms come up even between long-term partners who do not need contraception.

NCI says condoms may be advised to prevent your partner's exposure to chemotherapy drugs that may remain in semen. Its page for women says the same about some types of chemotherapy that may remain in vaginal secretions.

NCI does not print a number of days. It says "for a period of time." Your team can give you the window for your particular drugs, and that is worth asking for directly rather than guessing from a general figure.

Avoiding drug exposure and avoiding pregnancy are two different goals, and NCI treats them separately.

For women, NCI says that if you are of childbearing age, contraceptives may be advised to prevent pregnancy while you are receiving treatment and for a period of time following treatment. For men, it says contraception may be advised based on a partner's age.

Note the phrase "and for a period of time following treatment." The advice does not necessarily end when the last cycle does. Ask how long.

NCI is specific about the physical changes, which helps, because a vague warning is hard to plan around.

For women:

• Chemotherapy can lower estrogen and cause primary ovarian insufficiency, with hot flashes, irregular or absent periods, and vaginal dryness that can make sex painful.
• Chemotherapy can also affect vaginal tissue, which may cause sores.
• Radiation to the pelvis can cause dryness, a narrower or shorter vagina, thinning of the vaginal wall, and itching or burning.
• Opioids and some antidepressants can lower interest in sex.

For men:

• Chemotherapy may lower testosterone and libido during treatment. NCI says it does not usually affect the ability to have an erection.
• Radiation to the pelvis and brachytherapy can affect erections, and prostate damage can cause a dry orgasm.
• Hormone therapy lowers testosterone and can reduce sex drive.
• Surgery for pelvic cancers can affect the nerves involved in erections.

NCI lists what a team can offer, which is more than most people assume:

• Vaginal gels or creams for dryness, itching, or burning.
• Lubricants and moisturizers.
• Vaginal estrogen cream, which NCI notes may be appropriate for some types of cancer.
• A dilator, where radiation or graft-versus-host disease has caused scarring.
• Pelvic floor exercises, which NCI says can lower pain and increase blood flow to the area.
• For men, medicines that increase blood flow to the penis, and implanted devices.

It also lists the side effects worth mentioning because they spill into this: pain, fatigue, hair loss, sadness, loss of interest in things, trouble sleeping.

NCI's own suggested questions are a good script, and using its wording takes some of the awkwardness out:

• What sexual problems are common with this treatment?
• When might these changes start, and how long might they last?
• What precautions do I need to take — should my partner use a condom?
• What method of birth control do you advise?
• Are there times when I should avoid sexual activity?
• Is there a specialist or a support group you would suggest?

Your team has this conversation regularly. NCI suggests writing the questions down beforehand, which helps if you would rather not improvise.

This is general information. Your care team's specific instructions for your treatment always take priority.

• NCI — Sexual Health Issues in Women with Cancer
• NCI — Sexual Health Issues in Men with Cancer
• NCI — Infection and Neutropenia during Cancer Treatment