Sexuality and Reproductive Issues (PDQ®)
Topics in This Section
- Sexual Problems as a Side Effect of Cancer
- Factors Affecting Sexual Function in Cancer Patients
- Assessing Sexual Function in Cancer Patients
- Treatment of Sexual Problems in Cancer Patients
- Fertility Issues
- Current Clinical Trials
- Changes to This Summary (12/09/2013)
- About This PDQ Summary
- About PDQ
- Purpose of This Summary
- Reviewers and Updates
- Clinical Trial Information
- Permission to Use This Summary
- Contact Us
- Questions or Comments About This Summary
- Get More Information From NCI
Many types of cancer and cancer treatments can affect sexual function. These changes may be temporary or permanent. Sexual problems are common in patients with the following types of cancer:
- Breast cancer.
- Gynecologic cancers.
- Prostate cancer.
Less is known about how other types of cancer affect sexuality.
The most common sexual problems for cancer patients include the following:
- Loss of desire for sexual activity in both men and women.
- In men, problems getting and keeping an erection.
- In women, pain during intercourse.
Less common problems in men include the following:
- Being unable to ejaculate.
- Ejaculation going backward into the bladder.
- Being unable to reach orgasm.
Less common problems in women include the following:
- Pain or numbness in the genitals.
- Trouble reaching orgasm.
Unlike many other physical side effects of cancer treatment, sexual problems may not get better within the first year or two after cancer treatment. The problems may get worse over time and can get in the way of returning to normal life. That is why it is important to get help with learning to adapt to changes in sexual function.
Sexuality involves both the body and the mind. "Normal" sexual functioning covers a wide range. You and your partner define what is normal for you. Your "normal" may be affected by the following:
- Attitudes about sex.
- Religious values.
- Cultural values.
Sexual function can be an important part of your quality of life. Talk with your doctor if you have problems or concerns about your sexual function. If your doctor cannot talk with you about sexual problems, ask for information from other places or for the name of a doctor who is comfortable talking with you about them.
Surgery for the following cancers can cause body changes that have sexual side effects:
- Breast cancer: Sexual function after breast cancer surgery depends on the type of surgery. Compared to surgery to remove the whole breast, surgery to save or reconstruct the breast seems to have little effect on sexual function (including how often women have sex, the ease of reaching orgasm, or overall sexual satisfaction). Women who have surgery to save the breast are more likely to continue to enjoy breast caressing. However, having a mastectomy (surgery to remove part or all of the breast) has been linked to a loss of interest in sex.
- Rectal cancer: Problems with sexual and bladder function are common after surgery for rectal cancer. Surgery for rectal cancer can injure the nerves in the pelvic cavity. Nerves can be damaged when their blood supply is affected or when the nerves are cut. Nerve injury is the main cause of problems with erection, ejaculation, and orgasm.
- Prostate cancer: Surgery for prostate cancer (radical prostatectomy) is being done with newer nerve-sparing techniques. Recovery of erectile function usually happens within a year after having a radical prostatectomy. However, recovery of erectile function after radiation therapy is slow and happens over two or three years. Brachytherapy (internal radiation therapy using radioactive implants) is being used more often to treat prostate cancer. There is less effect on ejaculation and erectile function with brachytherapy alone than when external radiation and/or hormone therapy are added. Many patients have trouble with orgasm after treatment for prostate cancer with radical prostatectomy or radiation therapy. Talk with your doctor about problems with orgasm, changes in penis length, and urinary incontinence during orgasm.
- Testicular cancer: Most studies suggest that problems with sexual function after testicular cancer and its treatment (such as surgery to remove the testicle) are usually short-term. Function usually returns to about the same level as in men who do not have testicular cancer.
- Other pelvic tumors: Men who have surgery to remove the bladder, colon, and/or rectum may get erectile function back sooner if nerve-sparing surgery is used. The sexual side effects of radiation therapy for pelvic tumors are similar to those after prostate cancer treatment. Women who have surgery to remove the uterus, ovaries, bladder, or other organs in the abdomen or pelvis may have pain and loss of sexual function depending on the amount of tissue or organ removed. With counseling and other medical treatments, these patients may get normal sensation back in the vagina and genital areas and be able to have intercourse and reach orgasm without pain.
For both men and women, chemotherapy is linked to loss of sexual desire and having intercourse less often. Common side effects of chemotherapy can affect your sexual self-image and make you feel unattractive. Side effects may include the following:
- Mucositis (sores in the mouth from an inflamed lining of the digestive system).
- Losing or gaining weight.
- Losing hair.
- Changes in taste and smell.
In women, chemotherapy can cause the following problems:
- Pain with intercourse.
- Trouble reaching orgasm.
- Decreased estrogen, which can cause the following problems:
- Vaginal shrinking, thinning, and loss of elasticity (the ability to stretch and then go back to its original shape).
- Vaginal dryness.
- Hot flashes.
- Urinary tract infections.
- Mood swings.
- Feeling very tired.
- Being easily bothered.
Older women who receive chemotherapy have an increased risk of ovarian cancer.
In men, chemotherapy can cause the following problems:
- Loss of sexual desire.
- Problems making testosterone.
Radiation therapy can cause side effects that may decrease sexual desire. Side effects may include the following:
- Feeling very tired.
In women, radiation therapy to the pelvis can cause changes to the lining of the vagina. The vagina may become narrow and scar tissue may form, which can cause pain with intercourse, painful pelvic exams, infertility, and other long-term problems.
In men, radiation therapy can cause problems getting and keeping an erection. Sexual changes happen slowly over six months to one year after radiation therapy. Men who had problems with erectile dysfunction before getting cancer may be more likely to have sexual problems after being diagnosed and treated for cancer.
Other risk factors in men that cause sexual changes include the following:
- Heart disease.
- High blood pressure.
Hormone therapy can stop or slow the growth of certain cancers, such as prostate and breast cancer. This is done by using hormones made in a laboratory or other drugs to block the body's natural hormones. However, lower hormone levels can cause sexual problems.
Men who get hormone therapy for prostate cancer may have the following problems:
- Decreased sexual desire.
- Erectile dysfunction.
- Trouble reaching orgasm.
Women older than 45 years who are treated with tamoxifen may have slightly more of the following problems:
- Hot flashes.
- Night sweats.
- Vaginal discharge.
- Vaginal pain.
- Decreased sexual desire.
- Trouble reaching orgasm.
Drug therapy, such as opioids for pain and drugs to treat depression, can cause sexual side effects. Cancer patients may get drug therapy that affects the nerves, blood vessels, and hormones that control normal sexual function. Drug therapy may also affect their alertness and moods.
Misbeliefs about cancer might make you confused or unsure about sex when you are recovering from cancer. Common misbeliefs about cancer include the following:
- Past sexual activities caused the cancer.
- Having sex will make the cancer come back.
- Having sex will pass the cancer on to your partner.
Misbeliefs like these can keep you from enjoying sex again. Talk with your doctor to find out the facts so that you can feel more comfortable.
Depression is more common in cancer patients than in people who do not have cancer. Common symptoms of depression include loss of sexual desire and a decrease in sexual pleasure. Treatment for depression may lessen your sexual problems. (See the PDQ summary on Depression for more information.)
Cancer and cancer treatment may cause physical changes, such as hair loss or weight gain from chemotherapy or body changes from surgery. You may not like how you look and you may not want to have sex. Let your health care team know your concerns. You can get help adjusting to body changes caused by cancer and its treatment.
Patients with colostomies or ileostomies need to find a sexual position that does not place weight on the ostomy. Information is available from national organizations related to sexual function.and ostomates.
The stress of cancer diagnosis and treatment can make relationship problems that you already have even worse. Your sexual relationship can also be affected. Patients who do not have a committed relationship may stop dating because they fear being rejected when a new partner finds out they have cancer. Your feelings about your sexuality before being diagnosed with cancer will affect adjustment after cancer treatment. If you had positive feelings about sex, you may be more likely to continue sex after cancer treatment. Cancer can be hard on any relationship. It is important to get help if stress is causing a problem for you.
As part of the assessment, your doctor will talk with you alone or with both you and your partner. You may be asked the following questions:
- Do you have any problems or concerns related to sexuality?
- How often do you feel a desire to have sex?
- Do you enjoy sex?
- Do you have enough energy for sex?
- Do you become sexually aroused (for men, are you able to get and keep an erection, or for women, does your vagina expand and become lubricated)?
- Are you able to reach orgasm during sex? What types of stimulation can cause an orgasm (for example, self-touch, use of a vibrator, shower massage, partner caressing, oral stimulation, or intercourse)?
- Do you have pain during sex? Where do you feel the pain? What does the pain feel like? What kinds of sexual activity cause pain? Does this cause pain every time? How long does the pain last?
- When did your sexual problems begin? Was it around the same time that you were diagnosed with cancer or had cancer treatment? Did you have sexual problems before you were diagnosed with cancer?
- Are you taking any medicines? Did you start taking any new medicines or did the doctor change the dose of any medicines around the time that your sexual problems started?
You may be asked the following questions if you have a partner:
- How long were you with your partner before you were diagnosed with cancer?
- How stable was your relationship?
- How did your partner react when you were diagnosed with cancer?
- Are you concerned about how your partner may be affected by your treatment?
You and your partner may have sexual problems and concerns and fears about your relationship. It is important that you and your partner talk about these things with a doctor you feel comfortable with.
You may be asked the following questions about your lifestyle:
- Do you smoke? If yes, how much and how often do you smoke? If no, have you smoked in the past?
- Do you drink alcohol? If yes, how much and how often?
- Do you take prescription or over-the-counter medicines? If yes, what kinds and how much?
The following tests and procedures may be done:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood tests: Tests done on a sample of blood to measure the amount of certain substances in the blood or to count different types of blood cells. Blood tests may be done to look for signs of disease or agents that cause disease, to check for antibodies or tumor markers, or to see how well treatments are working.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
Measurement of nighttime erections: A test to check whether a man is having erections during sleep. If there are good erections during sleep, there is probably no physical cause for his erection problems. Nighttime erections are measured during sleep using the following:
- Snap gauge: A device made of plastic rings fitted around the penis, which break when there is an erection.
- Electronic monitoring: A device that records the number of erections that occur and how long and rigid they are.
- Blood hormone studies: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by organs and tissues in the body. An unusual (higher- or lower-than-normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
You may be afraid or anxious about having sex after cancer treatment. Fear and anxiety can cause you to avoid intimacy, touch, and sexual activity. Your partner may also be afraid and anxious that starting sexual activity will make you feel pressured or cause you pain. Even when a couple has been together a long time, talking about these things is important. Honest communication of feelings, concerns, and preferences can help.
Health professionals who specialize in treating sexual problems can give you the names of organizations that offer support. They can also tell you about educational materials such as Internet sources, books, pamphlets, and DVDs. These resources can help you learn ways to adapt to changes in sexual function.
Sexual counseling may help you. Counseling may be for you alone, with you and your partner, or in a group.
You may be helped by medical treatments such as hormone replacement, drugs, medical devices, or surgery.
Radiation therapy and chemotherapy may cause infertility (being unable to have children). This may be temporary or permanent. The risk of infertility as a side effect of cancer treatment depends on the following:
- Age at time of treatment.
- Type and dose of radiation therapy and/or chemotherapy.
- Where in the body the radiation is given.
- Whether you had one type of therapy or more than one.
- How long ago you had treatment.
Ask your doctor if your cancer or its treatment may cause infertility or sexual side effects. Your doctor can tell you what changes may happen. A child may be too young to understand issues about infertility or sexuality. Parents can decide what they want their child to know about these issues.
Talk to your doctor before treatment if you are concerned about the effects of cancer treatment on your ability to have children. Your doctor can recommend a counselor or fertility specialist who can tell you your options and help you and your partner make a decision. Options may include freezing sperm, eggs, or ovarian tissue before cancer treatment.
The following chemotherapy agents have been shown to affect fertility:
Fertility is likely to get better the longer you have been off chemotherapy. If you are taking chemotherapy, your age is an important factor. In women older than 40 years, adjuvant hormone therapy increases the risk that chemotherapy will cause infertility.
A man's age and the amount of radiation given directly to the testicles affects his risk of infertility. Lower doses of radiation and using lead shields to protect the testicles can help men keep their fertility. Sperm counts usually take 10 to 24 months to return to the level they were before radiation therapy. Usually, the higher the radiation dose, the longer it takes to recover. If the body is not making hormones normally, hormone therapy may help restore fertility. Radiation given to boys who have not reached puberty can cause problems with fertility.
Radiation therapy to the ovaries may cause infertility in women of any age. High doses of radiation in women younger than 26 years may cause early menopause. Lower doses of radiation can cause infertility in women older than 40 years. Regaining fertility is more likely if radiation to the ovaries is given before puberty. Doctors are sometimes able to protect the ovaries during radiation therapy.
Check NCI’s list of cancer clinical trials for U.S. supportive and palliative care trials about sexuality and reproductive issues, sexual dysfunction, fertility assessment and management and cryopreservation that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was completely reformatted and some content was added.
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
This PDQ cancer information summary has current information about sexuality and reproductive issues that cancer patients may experience during or after treatment. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials are listed in PDQ and can be found online at NCI's Web site. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
The best way to cite this PDQ summary is:
National Cancer Institute: PDQ® Sexuality and Reproductive Issues. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-fertility-women/sexuality-pdq. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site’s E-mail Us.
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s E-mail Us. We can respond only to email messages written in English.
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- 9609 Medical Center Dr.
- Room 2E532 MSC 9760
- Bethesda, MD 20892-9760
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).