Cancer and cancer treatment often cause changes in your sex life. You may have both physical and emotional changes. You may not feel as good about your body. There may be changes in the way your body feels, looks, and works. You may have pain or find that you don't really care about sex.

Sexual problems tend to be worse during and right after treatment. They can also show up months or even years after treatment ends. Some problems get better over time. In some cases, it may take a few years to feel normal again. Or you may find that you'll need to adjust to a new normal.

Gender words are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your doctor as you talk about your care.

Sexual problems can be caused by many kinds of cancer treatment. Radiation, surgery, chemotherapy, and hormone therapy can all cause sexual problems. They can cause damage to nerves and blood vessels, side effects from the removal of glands and organs, changes to the way your body looks, scar tissue, and alter the balance of sex hormones in your body.

Many people with cancer have sexual problems. Your risk depends on:

• The type of cancer and where it was in your body.
• Your sexual function before cancer.
• The kinds of treatment you had.
• The amount or dose of treatment.
• How long treatment lasted.
• Your age at the time of treatment.
• Your stress level and how you are coping with changes.

Cancer treatments can cause many kinds of sexual changes. Some of these may get better or go away with time. For instance, nerves, blood vessels, and other tissues can heal as you recover. But some changes can be permanent, such as premature menopause and the changes it can bring.

Possible changes you might have can include:

• Low sex drive. This means loss of interest in having sex. It's also called low libido.
• Vaginal dryness. This can make the vagina less flexible.
• Vaginal stenosis. This is the narrowing or tightening of the vagina. It can make it difficult and painful to have sex.
• Vaginismus. This is a spasm of the muscles of the vagina that can make sex hurt.
• Pain during sex. This is a very common side effect of cancer treatment. It can be caused by vaginal dryness, scar tissue, damage to vaginal or vulvar tissues, or low hormone levels. Or it can be caused by a combination of these.
• Vulvovaginal atrophy. This is a thinning and dryness of the tissues of the vulva, the lining of the vagina, or both. It can lead to pain during sex.
• Vaginal shortening. This can make sex more difficult and painful.
• Change in sensitivity. You may have reduced feeling in the vulva, vagina, or clitoris. Breast surgery and radiation can lead to reduced feeling in the nipple and breast.
• Changes in orgasm. It may take you longer to have an orgasm. You may have orgasms that are less intense. Less often, you may no longer have orgasms.
• Other physical problems. You may have extreme tiredness (fatigue), pain, nausea, bowel or bladder problems, or shortness of breath after cancer treatment. These may lead you to avoid sex, or make it harder to enjoy sex.
• Body image problems. You may have also lost or gained weight, lost breast tissue, and have changes in your vulva or vagina. You may have an ostomy bag on your belly. You may have scars or skin changes. Any of these changes can make you feel self-conscious and less interested in sex.
• Mood changes. Depression and anxiety after cancer treatment can cause a loss of interest in sex. And medicines that can help treat depression and anxiety may affect your sex life while you're taking them. You may be afraid to have sex, worry that you won't satisfy your partner, or feel embarrassed talking about what does and doesn't feel good.
• Infertility. Sometimes cancer treatment leaves you unable to have children. Your treatment team should have talked with you about this possibility before treatment started. If there's a chance you could still become pregnant but don't want to be, talk to your doctor about birth control.

Some sexual problems may get better over time. But talk with your health care team to get help. You may find it hard or awkward to talk about sex, but there are many kinds of treatment that may help. To get treatment for sex problems, you may work with different kinds of health care providers, such as:

• Your primary doctor. Your primary doctor may be able to treat some kinds of sexual problems. Or they can refer you to someone else.
• Gynecologist. This doctor treats problems of the female genitals and reproductive organs.
• Counselor. A counselor may be a licensed social worker, psychologist, or psychiatrist. They can provide different kinds of talk or behavioral therapy, and they may be able to prescribe medicine.
• Sex therapist. A sex therapist can help you work with your partner to find new ways to enjoy sex or find methods or positions that make sex less difficult.

Some types of treatment include:

• Hormone therapy. Sometimes hormones can be used to help boost sex drive and restore vaginal health. You may be given hormones in a cream, vaginal ring, ointment, or patch.
• Vaginal dilator therapy. This is a series of slim plastic or rubber wands that you can use for a short time each day (like a tampon) to help gently stretch and widen your vagina. It can help make sex easier and less painful.
• Pelvic floor physical therapy. These are exercises to help train and strengthen pelvic floor muscles. This therapy may help reduce pain during sex.
• Topical lidocaine. This is pain medicine in a cream or ointment. It can help lessen pain during sex.
• Vaginal moisturizers and lubricants. Moisturizers are used every few days to help ease vaginal dryness. Lubricants are used during sex. They can increase comfort and improve sexual pleasure.

Many cancer treatments cause the ovaries to stop working. This can lead to menopause. Menopause is when your ovaries stop releasing eggs and make a lot less estrogen. It's when you stop having menstrual periods. You may start having symptoms like hot flashes, sleep problems, and mood changes. Menopause can also cause low sex drive, painful sex, and vaginal dryness and irritation.

Blood tests might be done to check your hormone levels and confirm menopause. If needed, your doctor can help you manage the symptoms of menopause. Talk with your health care team about ways to feel better.

Talk with your doctor about the best and safest kinds of birth control to use after cancer. Depending on the type of treatment you had, you may not need to use birth control. But you still might need to protect yourself from sexually transmitted infections. Your doctor can talk with you about the best ways to do this.

Coping with sexual changes after cancer treatment can be upsetting. You may feel angry, sad, or scared. You may worry about disappointing your partner. But it's important to keep in mind that there are many ways to have sexual pleasure. Talk with your partner about your concerns. Together you can work on new ways to give and receive pleasure. You can also work with a counselor or sex therapist. And remember that some sexual changes are short term. Your health care team can tell you more about how long sexual side effects may last and can help you get treatment for them.