Treatments such as surgery and radiotherapy can have physical effects on intimacy and sex.
Some of the most common effects of breast cancer treatment on sex are:
- pain and numbness
- menopausal symptoms
- vaginal dryness and irritation
- problems with arousal and orgasm
Breast cancer treatments can cause pain, numbness and sensitivity for a number of reasons.
The most common treatments that cause this are:
- hormone therapies, particularly aromatase inhibitors (letrozole, anastrozole and exemestane)
After breast surgery you may continue to feel sore and your arm may feel stiff for several weeks or longer. For some people the pain after surgery continues and is related to nerve damage that happens at the time of surgery. This type of pain is often accompanied by burning, a feeling of pressure and numbness.
If you’ve had radiotherapy, the area being treated may be tender during and for a while after treatment, and may feel too painful to be touched.
Taking hormone therapies, particularly aromatase inhibitors may mean you experience pain or stiffness in your joints.
Chemotherapy drugs (such as docetaxel) can also cause numbness and tingling in the hands and feet (peripheral neuropathy) as well as painful muscles and joints.
You may find it difficult or too painful to touch, hug or be physically close to your partner. This can be upsetting, even if it’s only for a short time.
Some treatments can cause vaginal dryness, which can make sex painful or uncomfortable.
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 and numbness
1. Try pain relief
Pain relief can help with any discomfort. You might have to think about this in advance of being intimate or having sex, to give the pain relief time to work.
Pain from surgery or radiotherapy should lessen as the area heals. However, if pain isn’t helped by paracetamol or ibuprofen, you may want to see your GP or treatment team to have the pain assessed.
Lubricants and moisturisers can help with vaginal dryness and irritation.
2. Get to know how your body feels
Exploring your body yourself can help you discover what kind of touch is still pleasant or where it is painful.
3. Try other ways of being intimate
Reading erotic fiction together and mutual masturbation (touching each other intimately) can use less energy and avoid painful or sensitive areas of your body.
4. Try different positions
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).
5. Talk openly with each other
You may have feelings of tension 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.
Fatigue is extreme tiredness that doesn’t go away with rest or sleep and is a common side effect of cancer treatment. It can get worse as treatment goes on and can continue once treatment has finished.
The treatments most likely to cause fatigue are chemotherapy and radiotherapy, although surgery and hormone therapies can also affect your energy levels.
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 if you’re feeling fatigued
1. Try and get some exercise
Increasing the amount of exercise you do can help with fatigue. Find out more about staying active after treatment.
2. Talk to your treatment team
If you feel fatigued, let your treatment team know. Sometimes the cause of fatigue can be treated – for example, if you have anaemia, you may be given iron supplements.
3. Take the pressure off
Spend time with your partner with no sexual expectation. It might help to discuss this in advance so there are no mixed expectations. 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 can happen as a result of breast cancer treatments whether you have already gone through the menopause or not. These might include:
- hot flushes
- night sweats
- vaginal dryness
Menopausal symptoms such as these can have an effect on intimacy and sex.
Menopausal symptoms may mean you feel less sensation during arousal, which means you may not orgasm or it can take longer or the intensity of your orgasm may be reduced. 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.
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, often distressing symptom in women who have had treatment for breast cancer. Vaginal dryness or irritation can also make sex or intimacy painful. You can still enjoy other forms of intimacy, 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. You may be able to get these on prescription from your doctor, or you can buy them from a chemist or online.
You may not find a product that suits you straight away but it’s worth persevering. If you are still experiencing vaginal dryness and irritation and can’t find a product that suits you, you may want to talk to your GP or healthcare professionals to see if there are other options.
Non-hormonal treatments for vaginal dryness
Moisturisers are usually applied with a pessary (a small, soluble block that dissolves in the vagina) or tampon-style applicator.
Vaginal lubricants tend to be shorter acting than moisturisers and are either water or oil-based. If you are using condoms you will need to avoid oil-based lubricants as they can cause the condom to break.
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.
Lubricants are available as a pessary or a tube of liquid or gel.
Some products are available on prescription and some companies will send you a free sample to try.
You can use lubricants and moisturisers alongside each other.
Some women find that spermicidal gel also helps make intercourse more comfortable.
Top tips for finding a vaginal moisturiser/lubricant
- Search the manufacturer’s website for their range of products. Each manufacturer will have different options so it’s worth looking at how the product works, what it contains and any user reviews.
- Some products will be organic, vegan or paraben free – this may be important to you.
- Some manufacturers will provide free samples to try. This can allow you to test different products until you find one that works for you.
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.
You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet. However, it is not recommended that you regularly stop your flow or urine midstream, because it can be harmful to the bladder.
To strengthen your pelvic floor, sit comfortably and squeeze these muscles 10 to 15 times in a row. Don’t hold your breath or tighten your stomach, buttock or thigh muscles at the same time. When you get used to doing this regularly, you can try holding each squeeze for a few seconds. Every week, add more squeezes. Always have a rest between sets.
Intercourse and masturbation
If it’s comfortable for you, intercourse itself can help to stimulate blood flow to the vagina and will help maintain its suppleness and elasticity. Using a vibrator or masturbating can also help in the same way.
Hormone-based treatments for vaginal dryness
The most commonly used treatment for vaginal dryness is HRT (hormone replacement therapy). 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, because tamoxifen is thought to counteract any oestrogen entering the bloodstream.
If you are taking an aromatase inhibitor (such as letrozole, anastrozole or exemestane), vaginal oestrogen is not usually recommended, but you may be able to change to tamoxifen.
You can talk to your treatment team about using these types of hormone treatments.
It’s important to note that vaginal dryness and irritation can also be caused by infection, so it’s best to visit your GP so they can rule this out.
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.
Some anti-depressant drugs can reduce sexual desire and may make reaching orgasm more difficult.
Tension and anxiety can also reduce your ability to become aroused and reach orgasm, so you and your partner may want to explore techniques that help you both relax.
Is it safe to have sex during treatment for breast cancer?
It’s thought that chemotherapy drugs can’t pass into semen or vaginal fluids, but there is not enough evidence to completely rule this out. For the first few days after chemotherapy, you may want to avoid unprotected intercourse, oral sex, or any contact that involves the sharing of semen or vaginal fluids to ensure that your partner is not exposed to the chemotherapy drugs. Most hospital specialists will advise using barrier methods of contraception, such as condoms, for a few days after chemotherapy treatment is given.
If you’re having chemotherapy, it’s best to avoid unprotected sex.
Is it safe to get pregnant during treatment for breast cancer?
Generally women are advised not to get pregnant while having treatment for breast cancer. This is because treatment for breast cancer can damage an unborn baby at the early stages of development.
If you’re worried or want more information about sex and chemotherapy, talk to your specialist or breast care nurse.
Will I be able to get pregnant after breast cancer treatment?
After breast cancer treatment, if you’re 40 or over, you should assume that you can still get pregnant unless you haven’t had a period for at least a year. If you’re under 40 you should assume that you can still get pregnant unless you haven’t had a period for two years. However, this is a general guide and varies for each person.
If you’re sexually active with men, you should discuss contraception with your treatment team. They may refer you to a family planning clinic or your GP, who can advise you on the most appropriate contraception for you.
Find out more about contraception on our fertility, pregnancy and breast cancer pages.
Further help and support
Talking about changes to your body, sex and intimacy can be difficult, but it’s important to tell your treatment team, breast care nurse or GP if you’re experiencing any of these issues. You can also call Breast Cancer Care’s Helpline on 0808 800 6000 to talk through your worries and concerns.
You might find our prompt list (PDF) helpful when you discuss these issues.