Sexual Side Effects

Updated 
August 31, 2015

Breast cancer and its treatments can cause fatigue, discomfort, pain and other side effects that impact your sexual desire and activity. It’s normal to lose interest in sex because of such side effects.

These effects can develop during treatment, or months or years afterward.

Your Sex Life Is Not Over

No matter what kind of treatment you have, breast cancer does not mean an end to your sex life. There is help for dealing with sexual side effects that can restore sexual enjoyment and intimacy.

Start slowly and take a broader view of sex and sexual activity. Even if you are not yet comfortable with penetration, you’ll still be able to feel pleasure from physical touch. Holding hands, stroking an arm or getting a hug can nurture intimacy and help you remain connected to your partner. As you find help for sexual side effects and concerns, you’ll be better able to have sexual activity.

Finding Help

Talk with your doctor or a healthcare team member about potential sexual side effects of treatment and any steps you can take to prevent or ease them. Many providers are sensitive to this issue and want to help you. Even if they don’t have all the answers, your providers can lead you to other professionals who can help.

Don’t be afraid to ask for advice or for a referralinfo-icon. While it’s understandable to feel shy or embarrassed, if you don’t discuss your sexual concerns, you may never get the help you want.

Here are some tips to start the conversation:

  • When you make your appointment, mention you would like a few extra minutes to ask questions.
  • Write down questions and symptoms before your appointment. This may help you overcome any shyness or embarrassment.
  • Be specific. For example, say, “I have pain during penetration. Will the problem get better? What can I do to get relief?”
  • Rehearse what you want to say before your appointment. Saying the words out loud, to a partner, a friend or in front of a mirror, can help.

If your providers are unsure how to help or seem uncomfortable discussing your sexual concerns, ask for a referral to a specialistinfo-icon in sexual health, cancer survivorship medicineinfo-icon or both. These professionals give specialized care to people with cancer who are coping with issues related to sex and intimacy.

Sexual Side Effects of Surgery

Mastectomyinfo-icon and lumpectomyinfo-icon, surgeries that remove all or part of the breast, can alter your body imageinfo-icon. They may make you feel less attractive or change how your body feels to you and your partner. Reconstructive surgeryinfo-icon also causes changes.

Some physical changes caused by surgeryinfo-icon may lessen, or halt, your interest in sexual activity:

  • Pain. You might feel chest wallinfo-icon pain, burning and constricting sensations, or a loss of feeling in the surgical area.
    • Sexual impact: Mild to severe pain can affect your interest in sex, limit comfortable movement or block pleasurable feelings.
  • Loss or change of sensation in breast or nipples. You may have numbness or less feeling after surgery. Reconstructed breasts do not feel the same as natural breasts.
    • Sexual impact: Breast and nippleinfo-icon play during sex will feel different. When your breasts or nipples are touched, you might not respond sexually as you did before.
  • Start of Menopauseinfo-icon. If you were premenopausalinfo-icon and had your ovaries surgically removed, you will immediately be in menopause. This cuts estrogeninfo-icon, causing hot flashes and vaginal dryness, among other menopausal side effects.
    • Sexual impact: Painful penetration is common after the start of menopause due to lack of vaginal lubrication and reduced elasticity of vaginal walls. You also may develop pain, itching and burning in your vagina as well as urinary tract infections.
  • Lymphedemainfo-icon. This conditioninfo-icon produces swelling in the arm, hand, breast or torso, caused by the surgical removal of lymphinfo-icon nodes.
    • Sexual impact: Swelling can be uncomfortable and require bandage wrapping or wearing a compression garmentinfo-icon. This limits movement and may affect your body image.
  • Scar tissueinfo-icon and cording. Surgery leaves visible scars as well as thickened scar tissue, often below the skin. Cording, or axillary web syndrome, produces ropelike structures caused by lymph nodeinfo-icon removal. These develop under the skin of the inner arm, near scar sites.
    • Sexual impact: Both scars and cording can limit your movement and affect body image. Cords tend to be painful and tight, decreasing arm mobility and creating range of motion problems that may affect sexual positioning.

Sexual Side Effects of Radiation

Radiation therapyinfo-icon directs high-energy x-rays at precise areas in your body to destroy cancer cells. Side effects occur in the area receiving radiationinfo-icon treatment.

Breast radiation does not directly decrease sexual arousal or response, but it can cause side effects that may impact your sexualityinfo-icon:

  • Breast discomfort. Radiation to the breast can create tenderness and swelling.
    • Sexual impact: Breast pain, irritation and soreness can affect your interest in sex, limit movement or block pleasurable feelings.
  • Fatigueinfo-icon. You may feel tired and lack energy during radiation treatment and for some time afterward. This is a common side effectinfo-icon of radiation.
    • Sexual impact: It’s hard to feel motivated sexually if your physical, mental and emotional strength has been drained by fatigue. You may need to modify the type or duration of sexual activity until your energy increases.
  • Scar tissueinfo-icon. Radiation can cause the formation of scar tissue. 
    • Sexual impact: Scar tissue may reduce your range of motion and cause numbness, which might affect how you can position your body and sexual activity. It also may affect your body imageinfo-icon.
  • Lymphedemainfo-icon. Produces swelling in the arm, hand, breast or torso, caused by radiation damage to lymphinfo-icon nodes.  
    • Sexual impact: Swelling can be uncomfortable and require bandage wrapping or wearing a compression garmentinfo-icon. This may limit movement and may affect your body image.
  • Skin changes – Radiation can cause dry, red, blistered or sore skin in the radiated area and may thicken breast tissue or skin. Over time, it may destroy some skin tissue.
    • Sexual impact: Redness and other changes can make your skin hurt when touched. Thickening may decrease sensitivity. Skin changes can affect enjoyment of breast and nippleinfo-icon play during sex, and make breast reconstructioninfo-icon more difficult and less natural looking.
      • You may have a partner who mistakenly believes radiation treatment will make your skin radioactiveinfo-icon. It does not.

Sexual Side Effects of Chemotherapy

Medicines used in chemotherapyinfo-icon destroy fast-growing cells all over the body. Although very effective at killing cancer cells, chemotherapy also affects healthy cells, including some that help make sex comfortable.

Whether you are being treated for the first-time or if you are being treated for advanced or metastaticinfo-icon breast cancer, chemotherapy may have physical and emotional side effects that impact your sexualityinfo-icon:

  • Hair loss. You may lose hair on your head, eyelashes, pubic hair or hair on other parts of your body.
    • Sexual impact: Losing your hair can be a shock and may cause you to feel less desirable or attractive.
  • Body changes. Your body may feel or look differently due to weight gain or weight loss, nerveinfo-icon weakness or having chemotherapy ports in place.
    • Sexual impact: These alterations, even when temporary, can negatively affect your body imageinfo-icon and cause you to feel sexually unattractive or disinterested.
  • Irritation to vaginal tissues. Chemotherapy may irritate tissues lining the vulva, the area outside the vagina, and the vagina itself. The vagina may become dry and inflamed.
    • Sexual impact: Irritated tissues may lead to pain during penetration or when the vulva is touched. Irritation can spark flare-ups of genital herpes or genital warts if you had them in the past.
  • Nauseainfo-icon, fatigueinfo-icon. Stomach upsets and vomiting can result in physical weakness and leave you feeling drained. Fatigue may feel ever-present.
    • Sexual impact: During times when you feel nauseated, lack energy or feel tired, you may not be interested in sex.
  • Low libidoinfo-icon or sexual response. Chemotherapy may reduce sexual desire or function in women and men receiving treatment.
    • Sexual impact: You may lose interest in sexual activity or have trouble achieving sexual arousal, lubrication, or orgasm.
  • Menopausal changes. You may develop hot flashes and vaginal dryness, among other menopausal side effects.
    • Sexual impact: Lack of vaginal lubrication and reduced elasticity of vaginal walls can make penetration painful. Itching, burning and urinary tract infections also affect sexual comfort.

Sexual Side Effects of Hormonal Therapy

Hormonal therapyinfo-icon, also called endocrine therapyinfo-icon, starves the cancer of the hormones it needs to grow. These medicines are used to treat hormone receptorinfo-icon-positive breast cancers.

Postmenopausalinfo-icon women may receive hormonal therapy called aromatase inhibitors, or AIs. These include

The medicineinfo-icon fulvestrantinfo-icon (Faslodexinfo-icon) is an estrogen receptorinfo-icon downregulator, or ERD, hormonal therapy also given to postmenopausal women.

Premenopausalinfo-icon or perimenopausalinfo-icon women usually receive hormonal therapies known as selective estrogen receptor modulators, or SERMs. These include

Premenopausal women may also be offered ovarian suppressioninfo-icon to stop the function of the ovaries. Because it stops the body from making estrogeninfo-icon, it is considered a form of hormonal therapy.

Hormonal therapy can impact sexual health:

  • Menopausal symptoms. May cause hot flashes, night sweats, vaginal dryness, insomniainfo-icon, fatigueinfo-icon, irritability and reduced sex drive.
    • Sexual impact: Menopausal symptoms can lessen vaginal lubrication and thin the vaginal walls, which may cause pain during penetration. They may also cause lack of sleep and a lower general desire for sex.
  • Interruption of menstrual cycleinfo-icon. Causes temporary or permanent end to menstrual periods in premenopausal women.
    • Sexual impact: Lower levels of estrogen can cause vaginal changes and sometimes a rapid start of menopauseinfo-icon and its symptoms, including those that affect sexual desire and comfort.
  • Mood swings, depressioninfo-icon. Tamoxifen may increase these mood effects.
    • Sexual impact: If you’re experiencing mood swings or depression, you may be less interested in sex.
  • Bone and joint paininfo-icon. These side effects may occur in women taking aromatase inhibitors.
    • Sexual impact: Bone and joint pain can affect interest in sex and physical comfort during sexual activity.

Sexual Side Effects of Targeted Therapy

Some medicines target changes in specific genes in cells that cause breast cancer. Instead of killing all fast-growing cells, these medicines target just the cancer cells.

We do not yet understand what impact targeted treatments have on sexual health in the absence of chemotherapyinfo-icon.

These medicines often have fewer side effects than chemotherapy, but are often given with chemotherapy. If you receive both treatments, you could have the same common side effects as with chemotherapy alone, such as hair loss, nauseainfo-icon, fatigueinfo-icon and loss of sexual desire.

Sexual Side Effects of Other Medicines

You may be taking some medicines that don’t directly treat breast cancer, but are part of your care. These medicines may have side effects on sex and intimacy.

AntidepressantsMost people with breast cancer don’t experience clinicalinfo-icon depressioninfo-icon, but if you are among the 25 percent who do, it’s important to treat it.

Antidepressants with the lowest rate of sexual side effects are:

  • Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
  • Mirtazapine (Remeron, Remeron SolTab)

Medicines called selective serotonin reuptake inhibitors, or SSRIs, are common antidepressants that can lower sexual desire and affect your ability to reach orgasm. SSRIs are also sometimes prescribed to help with hot flashes.

Some SSRIs that may cause sexual side effects are:

Different medicines have different sexual impacts, sometimes even in the same person. If antidepressants are part of your treatment and create sexual concerns, talk with your doctor about possibly switching to another medicineinfo-icon

Always talk with your doctor before stopping or changing any medicine. You might also consider counselinginfo-icon or psychotherapyinfo-icon, which can be very effective for mild and moderate depression.

Antiemetics (nauseainfo-icon control)These medicines are used to control or stop nausea during chemotherapyinfo-icon. Antiemetics have side effects that may interfere with sexual desire. These side effects include drowsiness, diarrheainfo-icon, constipation, headache and fever.

On main page/  not in accordion: Other medicines used during treatment can affect your sexual interest by making you feel tired or by causing bone pain.

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Article August 31, 2015