Sex and breast cancer treatment

Treatments for breast cancer can have physical effects which may affect intimacy and sex.

Pain and numbness

Breast cancer treatments can cause pain, numbness and sensitivity for a number of reasons.

The most common treatments that can cause pain, numbness and sensitivity are:

  • surgery
  • radiotherapy
  • hormone therapies, particularly aromatase inhibitors such as anastrozole (Arimidex) or letrozole (Femara).

This can make it difficult to touch, hug or be physically close to someone which can be frustrating or upsetting, even if it’s only for a short time.

Some treatments can cause vaginal dryness, which can make full sex painful or uncomfortable. Find out more information about treatments for vaginal dryness.

If you’re in pain, you may want to concentrate on feeling well again and may not have the energy or desire for intimacy or sex.

Tips for being intimate if you experience pain

  • Pain from surgery or radiotherapy should lessen as the area heals. Pain relief can help with any discomfort, although having to think about this before being intimate or having sex may change how you feel about the experience.
  • If pain isn’t helped by paracetamol or ibuprofen, you may want to see your GP or hospital team to have the pain assessed.
  • Try experimenting with different sexual positions until you find one that’s more comfortable for you. This could be a position that puts less pressure on your chest, such as lying side by side or in a ‘spoons’ position (with your partner lying behind you).
  • Reading erotic fiction together and mutual masturbation may require less energy and not involve painful or sensitive areas of your body.
  • You may have feelings of tension or fear and worry about experiencing pain during sex. Your partner may be anxious or fearful as well. Talking honestly with your partner about exactly what kinds of activity may cause pain or sensitivity can help you both to relax.

Read more tips about coping with pain after treatment.

Fatigue

Fatigue is extreme tiredness that doesn’t go away with rest or sleep and is a common side effect of cancer treatment, such as chemotherapy and radiotherapy.

If you’re feeling fatigued, you may not want to have sex at all or you may want to take a less active role. This may take time to get used to if you’ve always been very physical during sex.

It’s important to be aware of your current limits and not to push yourself too much. Fatigue will gradually lessen over time and you may then have more energy for sex.

Tips for if you’re feeling fatigued

  • Increasing the amount of exercise you do can help with fatigue. Our DVD Eat well, keep active after breast cancer has lots of ideas on getting active after treatment.
  • Talk to your hospital team about how you feel as sometimes the cause of fatigue can be treated. For example, if you have anaemia, you may be given iron supplements.
  • Spend time with your partner with no sexual expectation. Hand or feet play and stroking are all ways to feel close to your partner when you have little energy.

Find out more about fatigue and what may help.

Menopausal symptoms

Menopausal symptoms can happen as a result of treatment, and symptoms such as hot flushes, night sweats and vaginal dryness can have an effect on intimacy and sex.

Menopausal symptoms can affect sexual desire or mean you feel less sensation during arousal.

You may simply feel too tired to have any interest in sex, perhaps as a result of symptoms like night sweats.

Younger women being treated for breast cancer can have menopausal symptoms that are initially more intense than those of a natural menopause. Having menopausal symptoms at a younger age can make someone feel older than they are, which can have a negative effect on how they feel sexually.

Find out more about menopausal symptoms and what can help relieve them.

Vaginal dryness and irritation

Some treatments affect the level of the hormone oestrogen in your body. Reducing the levels of oestrogen or blocking its action can cause vaginal changes, such as dryness or irritation.

Vaginal dryness is a common symptom in women who have had treatment for breast cancer and can be very distressing. Vaginal dryness or irritation can also make sex or intimacy painful. You can still enjoy other forms of sex, even if your vagina is not lubricated and you’re not keen to use extra lubricants that we mention below.

Vaginal dryness may not be a side effect mentioned by your treatment team but if you’re experiencing problems discuss this with your breast care nurse or GP.

There are a number of treatments that can help with vaginal dryness including vaginal moisturisers and lubricants. These can be prescribed by a doctor, bought in a chemist or ordered online.

Non-hormonal treatments for vaginal dryness

Vaginal moisturisers

Vaginal moisturisers can help give relief from dryness and discomfort regardless of sexual activity. They can be used every few days but need to be used regularly over time for best effect.

Vaginal moisturisers include:

  • Replens MD
  • Hyalofemme.

Vaginal lubricants

Vaginal lubricants tend to be shorter acting than moisturisers and are either water or oil-based. Lubricants are intended to help prevent friction and pain during sex and intimacy, but can also be used more generally to relieve dryness and discomfort.

These include:

  • Yes
  • Astroglide
  • Pasante TLC
  • Sylk
  • Pre Seed.

Pelvic floor exercises

Doing pelvic floor exercises can also help to increase blood flow to this area and help you learn to relax these muscles during sex and intimacy to minimise pain. Knowing how to relax these muscles can also help reduce pain during pelvic examinations, for example when you have a smear test.

Other treatments

Some women find that spermicidal gel also helps make intercourse more comfortable.

Intercourse itself helps to stimulate the blood flow to the vagina and will help maintain its suppleness and elasticity.

Hormone-based treatments for vaginal dryness

The most commonly used treatment for vaginal dryness is HRT. HRT is not usually recommended for women after a diagnosis of breast cancer. But some specialists will consider prescribing hormone treatments that are applied directly to the vagina for a short time. These include oestrogen pessaries, tablets, cream or a ring.

When vaginal oestrogens are used, minimal amounts of oestrogen are thought to be absorbed into the body.

Vaginal oestrogen may be more safely prescribed for women taking tamoxifen. This is because the tamoxifen is thought to counteract any oestrogen entering the bloodstream.

If you are taking an aromatase inhibitor, vaginal oestrogen is not usually recommended, but you may be able to change to tamoxifen.

You can talk to your specialist team about using these types of hormone treatments. Vaginal dryness and irritation can also be caused by infection, so it’s best to visit your GP if you’re experiencing problems so they can rule this out.

Changes to how you experience orgasm

The effects of breast cancer and its treatments can affect how you experience orgasm.

If you have menopausal symptoms due to treatment, you may feel less sensation during sexual arousal, which means it can take longer to orgasm or the intensity of your orgasm may be reduced.

There’s some evidence that chemotherapy can cause problems with arousal and orgasm, particularly soon after treatment.

Tension and anxiety can also reduce a woman’s ability to become aroused and reach orgasm, so you and your partner may want to explore techniques that help you both relax.

Some anti-depressant drugs can reduce sexual desire and may make reaching orgasm more difficult.

Contraception

If you’re sexually active with men, you should discuss contraception with your specialist team. They may refer you to a family planning clinic or your GP (local doctor), who can advise you on the most appropriate contraception for you.

Find out more about contraception on our fertility and breast cancer page.

Help if you need it

Talking about changes to your body, sex and intimacy can be difficult. But addressing your concerns is an important part of your breast cancer treatment and care. Our ‘prompt list’ is designed to help you discuss these issues with your healthcare professional or when calling our Helpline. Talking about changes to your body, sex and intimacy can be difficult. But addressing your concerns is an important part of your breast cancer treatment and care. Our ‘prompt list’ is designed to help you discuss these issues with your healthcare professional or when calling our Helpline on 0808 800 6000. 

PDF icon Your body, sex and intimacy after breast cancer: a prompt list for discussions (PDF) 

Last reviewed: June 2016
Next planned review begins 2018