Sex and the effects of breast cancer treatment

Breast cancer treatments can cause pain, numbness and sensitivity for a number of reasons.

For example, you may have:

• Soreness and numbness after breast surgery, including stiffness in your arm 
• Pain and tenderness in the area being treated by radiotherapy
• Joint pain or stiffness if you’re taking hormone therapy, particularly aromatase inhibitors
• Numbness and tingling in the hands and feet (peripheral neuropathy) and painful muscles and joints caused by chemotherapy

You may find it difficult or too painful to touch or be touched, hug or be physically close to your partner. This can be upsetting, even if it’s only for a short time.

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 have pain and numbness

The following tips may help if you have pain or numbness caused by treatments such as surgery or radiotherapy.

If you have pain or discomfort during sex because of vaginal dryness, you may find our section on vaginal dryness and irritation more useful.

Get to know how your body feels 

Exploring your body yourself can help you discover what kind of touch is pleasant or where it’s painful.

Talk openly with your partner

You may worry about pain during sex. Your partner may be anxious or fearful as well. Talking honestly about exactly what kinds of activity may cause pain or sensitivity can help you both to relax.

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.

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).

Try pain relief

Pain from surgery or radiotherapy should lessen as the area heals.

Pain relief, such as paracetamol or ibuprofen, can help with any discomfort caused by surgery or radiotherapy. You might have to think about this before being intimate or having sex, to give the pain relief time to work.

If pain isn’t helped by pain relief, you may want to see your GP or treatment team to have the pain assessed.

Read more tips about coping with pain after treatment.

Fatigue is extreme tiredness that doesn’t go away with rest or sleep. It’s a common side effect of cancer treatment. Fatigue can get worse as treatment goes on and can continue once treatment has finished.

Chemotherapy and radiotherapy are most likely to cause fatigue, 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 be difficult 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.

Tips if you're feeling fatigued

Try to get some exercise

Increasing the amount of exercise you do can help with fatigue. Find out more about staying active after treatment.

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, your doctor may give you iron supplements.

Take the pressure off

Spend time with your partner with no sexual expectations. It might help to discuss this in advance. Touching and stroking each other are 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
• Loss of sexual desire

Menopausal symptoms such as these can affect intimacy and sex.

For example, you may feel less sensation during arousal. This may mean:

• You may not orgasm
• It may take longer to orgasm
• The intensity of your orgasm may be reduced

You may feel too tired to have any interest in sex.

Sometimes hot flushes and night sweats can make sharing a bed or being intimate difficult.

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.

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.

Because oestrogen helps maintain the vagina’s moisture and elasticity, a lack of it can cause the vagina to become dry and less supple. This may make sex or intimacy painful.

If it’s not treated vaginal dryness can get worse, so it’s important to get help if you need it.

Vaginal dryness and irritation can also be caused by infection, so it’s best to see your GP to rule this out.

Non-hormonal treatments for vaginal dryness

There are several 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 trying different products. If you continue to have vaginal dryness and irritation and cannot find a product that suits you, you may want to talk to your GP or healthcare professional. There may be other options, such as being referred to a specialist menopausal clinic.

You can still enjoy other forms of intimacy even if your vagina is not lubricated and you’re not keen to use lubricants or moisturisers.

Vaginal moisturisers

Vaginal moisturisers can help give relief from dryness and discomfort, regardless of sexual activity. They can be used every few days but need to be used regularly over time for best effect.

Moisturisers can come as a pessary (a small, soluble block that dissolves in the vagina) or as a cream or gel that can be applied with a tampon-style applicator.

Some vaginal moisturisers contain ingredients that can cause irritation. Always do a skin test on the inner and outer lips of your vagina before using any products.

Vaginal lubricants

Vaginal lubricants are intended to help prevent friction and pain during sex and intimacy. They can also be used more generally to relieve dryness and discomfort.

You can use lubricants and moisturisers alongside each other.

Vaginal lubricants tend to be shorter acting than moisturisers. They can be water-, silicone- or oil-based. You will need to avoid oil-based lubricants if you are using condoms, as they can cause the condom to break. Silicone-based lubricants are not recommended for use with sex toys.

Lubricants are available as a pessary or a tube of liquid or gel.

Some people find spermicidal gel also helps make intercourse more comfortable.

A number of products are available on prescription.

Vaginal lubricants can contain ingredients that can cause irritation. Always do a skin test on the inner and outer lips of your vagina before using any products.

Top tips for finding a vaginal moisturiser or 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, which may be important to you.

Often, manufacturers will provide free samples to try. Or your breast care nurse may be able to give you free samples. This can allow you to test different products until you find one that works for you.

Tips for reducing pain during sex

Pelvic floor exercises

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.

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’s not recommended that you regularly stop your flow of urine midstream as this 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.

If you have issues with your pelvic floor, a pelvic health physiotherapist may be able to help. Your GP can refer you to your local hospital for this. Or you can find a private pelvic physiotherapist on the Pelvic Obstetric and Gynaecological Physiotherapy website.

Vaginal dilators

You could also try using a vaginal dilator. A vaginal dilator gently stretches the vagina to open it more, increasing the suppleness of the vagina.

Dilators are available in sets of different sizes. You can start by using a narrow dilator with a lubricant to make it more comfortable.

If you have been given dilators on the NHS, these may be plastic. However, you may prefer to use silicone dilators.

You may wish to use a slim vibrator or dildo instead. These will gently stretch your vagina. Using a slim vibrator also promotes blood flow to the vagina, which increases natural lubrication and helps keep the tissues lubricated and flexible.

There are a number of reputable retailers who sell vibrators and dilators. You can find some of these listed in the “Further help and support” section of this webpage.

Intercourse and masturbation 

If it’s comfortable for you, sexual intercourse can help to stimulate blood flow to the vagina. This 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 used treatment for vaginal dryness is HRT (hormone replacement therapy).

HRT is not usually recommended after a diagnosis of and treatment for breast cancer. But some specialists will consider prescribing hormone treatments that are applied directly to the vagina for a short time. This could be as:

• Oestrogen pessaries
• Oestrogen tablets
• Oestrogen cream
• An oestrogen 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 if you’re taking tamoxifen, because tamoxifen is thought to counteract any oestrogen entering the bloodstream.

If you’re taking an aromatase inhibitor, vaginal oestrogen is not usually recommended. However, you can talk to your treatment team about the risks and benefits of this.

You can talk to your treatment team about using these types of hormone treatments.

 

Breast cancer and its treatments can affect how you experience orgasm or sexual satisfaction.

If you have menopausal symptoms due to treatment, you may feel less sensation during sexual arousal. This means it may take longer to orgasm or the intensity of your orgasm may be reduced.

There’s some evidence chemotherapy can cause problems with arousal and orgasm, particularly soon after treatment.

Some anti-depressant drugs can also reduce sexual desire and may make reaching orgasm more difficult.

Tension and anxiety can reduce your ability to become aroused and reach orgasm. 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?

You can still have sex during treatment. It’s thought chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out as chemotherapy drugs can pass into the blood and some other bodily fluids. 

Most treatment teams will advise using barrier methods of contraception, such as condoms, during treatment and for a few days after chemotherapy is given.  You can try different brands of condoms to find which works best for you and your partner. Try to avoid scented condoms as these can cause irritation.

Talk to your treatment team about contraception during chemotherapy. 

Is it safe to get pregnant during treatment for breast cancer?

It’s important to avoid getting pregnant while having breast cancer treatment, as the treatment can harm an unborn baby during the early stages of development.

If you’re worried or want more information about sex and chemotherapy, talk to your treatment team or breast care nurse.

If you’re sexually active with a chance of becoming pregnant, 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.

Will I be able to get pregnant 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 2 years.

However, this is a general guide and varies for each person.

Find out more about contraception on our fertility, pregnancy and breast cancer pages.

Talking about 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 our helpline on 0808 800 6000 to talk through your worries and concerns.

You might find the prompt list in our Your body, intimacy and sex booklet helpful when you discuss these issues.

There are places you can get support if you’re concerned about any issues relating to how you feel about your sex life.

The Fruitfly Collective has a resource on sex and intimacy during and after cancer.

OUTpatients has a sex and cancer information hub which contains resources for LGBTIQ+ people.

Flat Friends offers support and information for women who have had a mastectomy without reconstruction.

Sex with Cancer has an answer bank of questions relating to sex and cancer, and partners with a reputable retailer of pleasure products.

Ann Summers has information on sex and intimacy, and is a reputable retailer for pleasure products.

Jo Divine has information on sex and breast cancer, and is a reputable retailer for pleasure products.