How chemotherapy can affect women's sexual health — and what can help

If you’ve been diagnosed with cancer, it stands to reason that one of the last things on your mind is your sexual health. But many women tell gynecologic oncologist Dr. Katharine Esselen that chemotherapy, as well as other cancer treatments, have nevertheless changed their sex lives in myriad — and often unexpected — ways.

Chemotherapy side effects can include far more than the typical fatigue, nausea, and vomiting. Chemotherapy drugs can cause wide-ranging effects on the body, including diminished hormone levels that spur physical changes in the vagina and vulva and color how you feel about intimacy.

Ultimately, women’s sexuality doesn’t vanish when cancer shows up, says Dr. Esselen, who practices at Harvard-affiliated Beth Israel Deaconess Medical Center.

“Sexual health and intimacy are an important part of people’s wellness,” she says. “If that’s not working, it can worsen someone’s overall quality of life during their cancer experience and afterward.”

Physical and emotional effects

Decreased hormone levels resulting from chemotherapy drugs can set off a chain reaction affecting body and mind, leading to physical issues such as

• vaginal dryness and irritation
• diminished arousal or sensation
• pain during sex.

“Chemotherapy damages ovarian tissue, which disrupts an important feedback loop from the ovaries to the brain that tells ovaries how much estrogen and progesterone to produce,” Dr. Esselen explains. “The ovaries can even stop producing hormones, and that drives many functional changes in vaginal health, thinning the lining of the vagina and producing less lubrication. This directly affects a woman’s ability to have pain-free intercourse or enjoyable vaginal sex.”

Shifts in emotions and body image are also a major part of the picture. The effects of chemotherapy can include hair loss and weight changes, shaking a patient’s sense of self. Anxiety and depression are also common after a cancer diagnosis, Dr. Esselen says. Any of these changes, or a combination, can affect a woman’s sex drive.

“Chemo makes people feel lousy,” she says. “If someone’s not feeling well, it’s no surprise their libido may go down.”

Younger women might also face early menopause, and those who hope to become pregnant after treatment might need to explore assisted fertility techniques such as egg freezing or in vitro fertilization.

Targeted tactics

What practical solutions can help? Dr. Esselen suggests these strategies.

For vaginal dryness and discomfort:

• Use over-the-counter lubricants and vaginal moisturizers. “Much like you moisturize other parts of your body, you can use these products several times a week both during chemotherapy and beyond,” she says. “They can be very beneficial.”
• Consider hormone therapy. If your type of cancer isn’t hormone-sensitive (check with your oncologist), you may be able to use hormone therapy to shore up flagging estrogen and progesterone levels. It’s available for systemic use in patches, pills, and skin gels, or for localized use with rings, suppositories, and creams that are inserted into the vagina.
• Try pelvic floor physical therapy. This approach uses exercises and other techniques to strengthen, relax, or coordinate muscles surrounding the pelvic floor (the sling of muscles supporting the vagina, uterus, bladder, and rectum). “Those muscles can be very tight and spasm,” Dr. Esselen says. “Physical therapy can restore their function, which can be very helpful for pain with intercourse.”

For emotional challenges, opt for counseling or sex therapy. A therapist can help you sort through treatment side effects that affect how you see yourself or your relationship, Dr. Esselen says.

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