How cancer and treatment affect sexual desire
The most common cancer treatments are surgery, radiotherapy, chemotherapy and hormone therapy. These treatments, as well as the cancer itself, can have temporary or permanent effects on a person’s sexuality by changing:
- his/her feelings (they may cause fear, anger, anxiety, sadness, relief and joy)
- the body’s production of the hormones needed for sexual response
- the physical ability to give and receive sexual pleasure
- a person’s body image and level of self-esteem
- roles and relationships.
Chemotherapy uses drugs to kill or slow the growth of cancer cells. The drugs are called cytotoxics and they particularly affect fast-growing cells such as cancer cells. Other cells that grow quickly, such as the cells involved in hair growth, can also be damaged. The side effects of chemotherapy vary depending on the individual and the drugs given. Common side effects include tiredness, nausea, vomiting, diarrhoea, constipation, hair loss and mouth ulcers – all of which may reduce a person’s desire to have sex. Chemotherapy can also directly affect the levels of hormones linked to libido. I notice in my clinical practice that sex drive usually returns after treatment ends.
Common sexual problems for men and women include:
- tiredness and fatigue
- depression and anxiety
- loss of interest in sex
- painful intercourse
- changed body image, e.g. due to scarring, loss of a body part, hair loss from any part of the body, changes in weight
- loss of a body part, such as a reproductive organ
- incontinence
- fertility problems (temporary or permanent)
- strain on, or changes to, your relationship(s).
Both men and women often lose interest in sexual activity during cancer treatment, at least for a time. At first, treating the cancer is often the main concern, so sex may not be a priority. Few people are interested in sex when they feel their lives are in danger. When people are in treatment, things like worry, depression, nausea, pain, or fatigue may cause loss of desire. Cancer treatments that disturb the normal hormone balance can also lessen sexual desire.
The effects of cancer treatment on sexual desire in men
Men sometimes feel pain in the genitals during sex. If the prostate gland or urethra is irritated from cancer treatment, ejaculation may be painful. Scar tissue that forms in the abdomen (belly) and pelvis after surgery (such as for colon cancer) can cause pain during orgasm, too.
Changing a man’s hormone balance can also affect desire. For example, treatment for prostate cancer that has spread beyond the gland often includes hormone therapy to lower testosterone levels. The main ways to do this are:
- Using drugs to keep testosterone from being made
- Removing a man’s testicles (called orchiectomy)
The goal of hormone therapy is to starve the prostate cancer cells of testosterone. This slows the growth of the cancer. These treatments have many of the same kinds of sexual side effects because they affect testosterone levels. The most common sexual problem with hormone treatment is a decrease in desire for sex (libido). Hormone therapy may also cause other changes, such as loss of muscle mass, weight gain, or some growth in breast tissue. A program of exercise may help one to limit muscle loss, to gain weight and to deal with tiredness.
Equally important will be the psychological effects of hormone therapy on men as these men may often feel like “less of a man.” They fear as a result of the lowered testosterone they may start to look and act like a woman. This is a myth. Manhood does not just depend on hormones but on a lifetime of being male. Hormone therapy for prostate cancer may decrease a man’s desire for sex, but it cannot alter his sexual orientation.
Hormone therapy in men has also been linked to depression. Do seek treatment for this problem as it can be effectively treated with medications and therapy.
The effects of cancer treatment on sexual desire in women
Women who are getting chemotherapy often notice decreased sexual desire. Physical side effects, such as an upset stomach, decreased appetite and weakness can leave little energy for sex. Sexual desire most often returns when a woman feels better. If a woman is getting chemotherapy every 2 or 3 weeks, her sexual interest might only come back a few days before she’s due for her next treatment. After the treatment ends, the side effects slowly fade, and sexual desire often returns to previous levels.
Women getting chemo also tend to feel unattractive. Hair loss, weight loss or gain, and sometimes central venous catheters (tubes in the vein that stay in for weeks or months) can make it harder to have a positive sexual image of herself.
Women getting chemo often have symptoms of early menopause. These symptoms include:
- hot flashes,
- vaginal dryness,
- vaginal tightness, and
- irregular or no menstrual periods.
If the lining of the vagina thins, there may be a light spotting of blood after sex.
Yeast infections are common during chemo, especially in women taking steroids or antibiotics to treat or prevent bacterial infections. A woman with a yeast infection may notice itching inside the vagina or on the vulva. She may also have a thick, whitish discharge, and may feel some burning during sex. Chemotherapy can also cause a flare-up of genital herpes or genital warts if a woman has had them in the past.
