Skip to Content
Home > Patients & Visitors > Health Library > Sexuality and Reproductive Issues (PDQ®): Supportive care - Patient Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
This patient summary on the sexual side effects from cancer and cancer treatment is adapted from the summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials, is available from the National Cancer Institute. Better treatment of many cancers has resulted in more patients experiencing longer periods of disease-free survival. In addition, the side effects associated with cancer and cancer treatments have also become more prevalent.
This patient summary addresses the impact cancer and cancer treatment can have on all aspects of an individual's sexuality, including sexual desire and physical and psychological sexual dysfunction.
This summary is about sexuality and reproductive issues in adults and children with cancer. Section titles show when the information is about children.
Sexuality is a complex characteristic that involves the physical, psychological, interpersonal, and behavioral aspects of a person. Recognizing that "normal" sexual functioning covers a wide range is important. Ultimately, sexuality is defined by each patient and his/her partner according to sex, age, personal attitudes, and religious and cultural values.
Many types of cancer and cancer therapies can cause sexual dysfunction. Research shows that approximately one-half of women who have been treated for breast and gynecologic cancers experience long-term sexual dysfunction. Men who have been treated for prostate cancer report problems with erectile dysfunction that varies depending on the type of treatment. Less is known about how other types of cancer, especially other solid tumors, affect sexuality.
An individual's sexual response can be affected in many ways. The causes of sexual dysfunction are often both physical and psychological. The most common sexual problems for people who have cancer are loss of desire for sexual activity in both men and women, problems achieving and maintaining an erection in men, and pain with intercourse in women. Men may also experience inability to ejaculate, ejaculation going backward into the bladder, or the inability to reach orgasm. Women may experience a change in genital sensations due to pain, loss of sensation and numbness, or decreased ability to reach orgasm.
Unlike many other physical side effects of cancer treatment, sexual problems may not resolve within the first year or two of disease-free survival. These problems may even increase over time and can interfere with the return to a normal life. Patients recovering from cancer should discuss their concerns about sexual problems with a health care professional.
Both physical and psychological factors contribute to the development of sexual dysfunction. Physical factors include loss of function due to the effects of cancer therapies, fatigue, and pain. Surgery, chemotherapy, and radiation therapy may have a direct physical impact on sexual function. Other factors that may contribute to sexual dysfunction include pain medications, depression, feelings of guilt from misbeliefs about the origin of the cancer, changes in body image after surgery, and stresses due to personal relationships. Getting older is often associated with a decrease in sexual desire and performance, however, sex may be important to the older person's quality of life and the loss of sexual function can be distressing.
Surgery can directly affect sexual function. Factors that help predict a patient's sexual function after surgery include age, sexual and bladder function before surgery, tumor location and size, and how much tissue was removed during surgery. Surgeries that affect sexual function include breast cancer, colorectal cancer, prostate cancer, and other pelvic tumors.
Sexual function after breast cancer surgery has been the subject of much research. Surgery to save or reconstruct the breast appears to have little effect on sexual function compared with surgery to remove the whole breast. Women who have surgery to save the breast are more likely to continue to enjoy breast caressing, but there is no difference in areas such as how often women have sex, the ease of reaching orgasm, or overall sexual satisfaction. Having a mastectomy, however, has been linked to a loss of interest in sex. Chemotherapy has been linked to problems with sexual function.
Sexual and bladder dysfunctions are common complications of surgery for rectal cancer. The main cause of problems with erection, ejaculation, and orgasm is injury to nerves in the pelvic cavity. Nerves can be damaged when their blood supply is disrupted or when the nerves are cut.
Newer nerve-sparing techniques for radical prostatectomy are being debated as a more successful approach for preserving erectile function than radiation therapy for prostate cancer. Long-term follow-up is needed to compare the effects of surgery with the effects of radiation therapy. Recovery of erectile function usually occurs within a year after having a radical prostatectomy. The effects of radiation therapy on erectile function are very slow and gradual occurring for two or three years after treatment. The cause of loss of erectile function differs between surgery and radiation therapy. Radical prostatectomy damages nerves that make blood vessels open wider to allow more blood into the penis. Eventually the tissue does not get enough oxygen, cells die, and scar tissue forms that interferes with erectile function. Radiation therapy appears to damage the arteries that bring blood to the penis.
Brachytherapy (internal radiation therapy using radioactive implants) is being used more often to treat prostate cancer. With brachytherapy alone, ejaculation and erectile function are better preserved than when external radiation and/or hormone therapy are added. Radiation damage to nerves and blood vessels may occur with brachytherapy, and higher doses of radiation may cause more damage.
After treatment for prostate cancer with radical prostatectomy or radiation therapy, many patients report trouble with orgasm. Problems can include:
Problems related to orgasm after prostate cancer treatment can be managed, but at this time, there is no treatment that will return orgasm to the way it was before surgery. Pain during orgasm may occur in the penis, abdomen, or rectum. Pain can be treated with alpha-blockers, drugs that relax muscle tissue in blood vessels and in the prostate gland. Incontinence or leakage of urine from the bladder during orgasm can be managed by limiting fluid intake and emptying the bladder before sexual activity or by using condoms, if the leakage is minor.
The penis may be 1 to 2 centimeters shorter after a radical prostatectomy. This shortening of the penis may be related to nerve injury or structural changes that can occur right after surgery or months after surgery.
Testicular cancer and its treatment can affect sexual well-being. Most study results suggest that problems with sexual function are usually short-term. Function improves later to about the same level as seen in men who do not have testicular cancer.
Other Pelvic Tumors
Men who have surgery to remove the bladder, colon, and/or rectum may improve recovery of erectile function if nerve-sparing surgical techniques are 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 experience pain and loss of sexual function depending on the amount of tissue/organ removed. With counseling and other medical treatments, these patients may regain normal sensation in the vagina and genital areas and be able to have pain-free intercourse and reach orgasm.
Chemotherapy is associated with a loss of desire and decreased frequency of intercourse for both men and women. The common side effects of chemotherapy such as nausea, vomiting, diarrhea, constipation, mucositis, weight loss or gain, and loss of hair can affect an individual's sexual self-image and make him or her feel unattractive.
For women, chemotherapy may cause vaginal dryness, pain with intercourse, and decreased ability to reach orgasm. In older women, chemotherapy may increase the risk of ovarian cancer. Chemotherapy may also cause a sudden loss of estrogen production from the ovaries. The loss of estrogen can cause shrinking, thinning, and loss of elasticity of the vagina, vaginal dryness, hot flashes, urinary tract infections, mood swings, fatigue, and irritability. Young women who have breast cancer and have had surgeries such as removal of one or both ovaries, may experience symptoms related to loss of estrogen. These women experience high rates of sexual problems since there is a concern that estrogen replacement therapy, which may decrease these symptoms, could cause the breast cancer to return. For women with other types of cancer, however, estrogen replacement therapy can usually resolve many sexual problems. Also, women who have graft-versus-host disease (a reaction of donated bone marrow or peripheral stem cells against a person's tissue) following bone marrow transplantation may develop scar tissue and narrowing of the vagina that can interfere with intercourse.
For men, sexual problems such as loss of desire and erectile dysfunction are more common after a bone marrow transplant because of graft-versus-host disease or nerve damage. Occasionally chemotherapy may interfere with testosterone production in the testicles. Testosterone replacement may be necessary to regain sexual function.
Radiation Therapy-Related Factors
Like chemotherapy, radiation therapy can cause side effects such as fatigue, nausea and vomiting, diarrhea, and other symptoms that can decrease feelings of sexuality. In women, radiation therapy to the pelvis can cause changes in the lining of the vagina. These changes eventually cause a narrowing of the vagina and formation of scar tissue that results in pain with intercourse, infertility and other long term sexual problems. Women should discuss concerns about these side effects with their doctor and ask about the use of a vaginal dilator.
For men, radiation therapy can cause problems with getting and keeping an erection. The exact cause of sexual problems after radiation therapy is unknown. Possible causes are nerve injury, a blockage of blood supply to the penis, or decreased levels of testosterone. Sexual changes occur very slowly over a period of six months to one year after radiation therapy. Men who had problems with erectile dysfunction before getting cancer have a greater risk of developing sexual problems after cancer diagnosis and treatment. Other risk factors that can contribute to a greater risk of sexual problems in men are cigarette smoking, history of heart disease, high blood pressure, and diabetes.
Hormone Therapy-Related Factors
Hormone therapy for prostate cancer can decrease normal hormone levels and cause a decrease in sexual desire, erectile dysfunction, and problems reaching orgasm. Younger men do not always experience the same degree of sexual dysfunction. Some treatment centers are experimenting with delayed or intermittent hormone therapy to prevent sexual problems. It is not yet known if these modified treatments affect the long-term survival of younger men.
Women older than 45 years who are treated with adjuvant tamoxifen therapy may have slightly more hot flashes, night sweats, and vaginal discharge. Studies show that patients who take tamoxifen do not have less sexual activity, but may have slightly less sexual desire and more problems reaching orgasm.
In a large study of women with breast cancer who were treated with adjuvant hormone therapy, patients who took exemestane, a type of aromatase inhibitor, had fewer hot flashes and less vaginal discharge than those who took tamoxifen. However, patients who took exemestane had more vaginal dryness, bone pain, and sleep disorders than patients who took tamoxifen.
Patients recovering from cancer often have anxiety or guilt that previous sexual activities may have caused their cancer. Some patients believe that sexual activity may cause the cancer to return or pass the cancer to their partner. Discussing their feelings and concerns with a health care professional is important for patients. Misbeliefs can be corrected and patients can be reassured that cancer is not passed on through sexual contact.
Loss of sexual desire and a decrease in sexual pleasure are common symptoms of depression. Depression is more common in patients with cancer than in the general healthy population. It is important that patients discuss their feelings with their doctor. Getting treatment for depression may be helpful in relieving sexual problems. (Refer to the PDQ summary on Depression for more information.)
Cancer treatments may cause physical changes that affect how an individual sees his or her physical appearance. This view can make a man or woman feel sexually unattractive. It is important that patients discuss these feelings and concerns with a health care professional. Patients can learn how to deal effectively with these problems.
The stress of being diagnosed with cancer and undergoing treatment for cancer can make existing problems in relationships even worse. The sexual relationship can also be affected. Patients who do not have a committed relationship may stop dating because they fear being rejected by a potential new partner who learns about their history of cancer. One of the most important factors in adjusting after cancer treatment is the patient's feeling about his or her sexuality before being diagnosed with cancer. If patients had positive feelings about sexuality, they may be more likely to resume sexual activity after treatment for cancer.
Childhood Cancer Survivors
Being treated for cancer as a child may lead to sexual problems in adulthood. Childhood cancer survivors who were diagnosed at age 21 years or younger with different types of cancer were surveyed in their late teens, twenties, or thirties. About one-half of the women and one-third of the men in the study reported trouble with sexual function, including problems becoming aroused or lack of interest in sex. Childhood cancer survivors who had emotional and health problems were more likely to have problems with sexual function.
Although women in the study reported more sexual problems, men reported more feelings of distress. While this study did not directly link a cancer diagnosis or cancer treatment with sexual problems, it found that childhood cancer survivors, especially men, had more problems with sexual function than the same age group with no history of cancer.
Sexual function is an important factor that adds to quality of life. Patients should discuss their problems and concerns about sexual function with their doctor. Some doctors may not have the appropriate training to discuss sexual problems. Patients should ask for other information resources or for a referral to a health care professional who is comfortable with discussing sexuality issues.
General Factors Affecting Sexual Functioning
When a possible sexual problem is identified, the health care professional will do a detailed interview either with the patient alone or with the patient and his or her partner. The patient may be asked any of the following questions about his or her current and past sexual functioning:
Psychosocial Aspects of Sexuality
Patients may also be asked about the significance of sexuality and relationships whether or not they have a partner. Patients who have a partner may be asked about the length and stability of the relationship before being diagnosed with cancer. They may also be asked about their partner's response to the diagnosis of cancer and if they have any concerns about how their partner may be affected by their treatment. It is important that patients and their partners discuss their sexual problems and concerns and fears about their relationship with a health care professional with whom they feel comfortable.
Medical Aspects of Sexuality
Patients may be asked about current and past medical history since many medical illnesses can affect sexual function. Lifestyle risk factors such as smoking and high alcohol intake can also affect sexual function as well as prescribed and over-the-counter medications. Patients may be asked to fill out questionnaires to help identify sexual problems and may undergo a variety of physical examinations, blood tests, ultrasound studies, measurement of nighttime erections, and hormone tests.
The side effects of medicines can add to the sexual side effects of surgery, radiation therapy, and chemotherapy. Cancer patients may receive drug therapy that can affect nerves, blood vessels, and hormones that control normal sexual function. Mental alertness and moods may also be affected. These side effects may occur in cancer patients who take opioids for pain and drugs to treat depression, for example.
Many patients are fearful or anxious about their first sexual experience after cancer treatment. Fear and anxiety can cause patients to avoid intimacy, touch, and sexual activity. The partner may also feel fearful or anxious about initiating any activity that might be thought of as pressuring to be intimate or that might cause physical discomfort. Patients and their partners should discuss concerns with their doctor or other qualified health professional. Honest communication of feelings, concerns, and preferences is important.
In general, a wide variety of treatment modalities are available for patients with sexual dysfunction after cancer. Patients can learn to adapt to changes in sexual function through reading books, pamphlets, and internet resources or listening to and watching videos and CD-ROMs. Health professionals who specialize in sexual dysfunction can provide patients with these resources as well as information on national organizations that may provide support. Some patients may need medical intervention such as hormone replacement, medications, medical devices, or surgery. Penile rehabilitation may be helpful for men who have had surgery for prostate cancer. Patients who have more serious problems may need sexual counseling on an individual basis, with his or her partner, or in a group. Further testing and research is needed to compare the effectiveness of various treatment programs that combine medical and psychological approaches for people who have had cancer.
Current Clinical Trials
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about sexuality and reproductive issues and sexual dysfunction 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.
Radiation therapy and chemotherapy treatments may cause temporary or permanent infertility. These side effects are related to a number of factors including the patient's sex, age at time of treatment, the specific type and dose of radiation therapy and/or chemotherapy, the use of single therapy or many therapies, and length of time since treatment.
When cancer or its treatment may cause infertility or sexual dysfunction, every effort should be made to inform and educate the patient about this possibility. When the patient is a child, this can be difficult. The child may be too young to understand issues involving infertility or sexuality, or parents may choose to shield the child from these issues.
For patients receiving chemotherapy, age is an important factor and recovery improves the longer the patient is off chemotherapy. Chemotherapy drugs that have been shown to affect fertility include: busulfan, melphalan, cyclophosphamide, cisplatin, chlorambucil, mustine, carmustine, lomustine, vinblastine, cytarabine, and procarbazine. In women older than 40 years, adjuvant endocrine therapy increases the risk that chemotherapy will cause permanent loss of menstrual periods.
For men and women receiving radiation therapy to the abdomen or pelvis, the amount of radiation directly to the testes or ovaries is an important factor. In women older than 40 years, infertility may occur at lower doses of radiation. Fertility may be preserved by the use of modern radiation therapy techniques and the use of lead shields to protect the testes. Women may undergo surgery to protect the ovaries by moving them out of the field of radiation.
Patients who are concerned about the effects of cancer treatment on their ability to have children should discuss this with their doctor before treatment. The doctor can recommend a counselor or fertility specialist who can discuss available options and help patients and their partners through the decision-making process. Options may include freezing sperm, eggs, or ovarian tissue before cancer treatment.
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about 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.
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.
Changes were made to this summary to match those made to the health professional version.
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.
Purpose of This Summary
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.
Reviewers and Updates
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.
Clinical Trial Information
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).
Permission to Use This Summary
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://cancer.gov/cancertopics/pdq/supportivecare/sexuality/Patient. 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 Coping with Cancer: Financial, Insurance, and Legal Information 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 Contact Form.
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. 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:
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).
Last Revised: 2012-06-13
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
How this information was developed to help you make better health decisions.
Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Feeling under the weather?
Use our interactive symptom checker to evaluate your symptoms and determine appropriate action or treatment.
Our interactive Decision Points guide you through making key health decisions by combining medical information with your personal information.
You'll find Decision Points to help you answer questions about:
Get started learning more about your health!
Our Interactive Tools can help you make smart decisions for a healthier life. You'll find personal calculators and tools for health and fitness, lifestyle checkups, and pregnancy.
Send Us Your Feedback
North Kansas City Hospital.