If you feel pain during sex

Breast cancer treatment can cause side effects that affect your sexual life, including pain during intercourse or penetration. If this is happening, it’s very important to talk with your healthcare provider.

It is important to know that there are options to address these problems and make sex pleasurable.

What can help

There are many options for making sex less painful and more comfortable.

Stretch muscles

Tight muscles can cause pain.

• If you have had pain during penetration, your pelvic muscles may tighten as you anticipate pain during sex again. This may make penetration impossible.
• Ask your provider for a referral to a pelvic floor therapist. Pelvic floor therapists can evaluate breast cancer-related sexual issues and teach you exercises and relaxation techniques. They can also use manual, hands-on therapies, biofeedback, and other approaches to help relax muscles and reduce pain.
• Vaginal dilators can help stretch your vagina and improve elasticity. This reduces pain. A pelvic floor therapist can provide dilator training.

Add moisture

Non-hormonal vaginal lubricants for sexual penetration, moisturizers for daily comfort, and other products available over-the-counter or by prescription can make penetration more comfortable.

If non-hormonal products are not working well, talk with your provider about whether low-dose vaginal estrogen (vaginally inserted creams, tablets, or rings) is an option. Low-dose vaginal estrogen is generally viewed as safe for women with a history of breast cancer. Still, it’s important to talk with your doctor about your own individual risk if you are considering vaginal estrogen.

Try different positions

What felt good before treatment might not feel good right now.

• Try different sexual positions that let you control the movement, to avoid pain.
• If deep penetration hurts, try to make the thrusts less deep.
• With a male partner, you and your partner may want to lie on your sides, either with your partner behind you, like spoons, or face to face.

Ask about aqueous lidocaine

If the pain you feel is at the opening of your vagina, this medicine — a type of anesthetic — can help.

Ask for advice

For pain that persists, talk with members of your care team, including your gynecologist and oncologist.

• Your gynecologist may check to see if you have pelvic floor muscle problems or a urinary tract or vaginal infection.
• You might want a referral to a specialist in dyspareunia, or sexual pain. That specialist may recommend muscle relaxants, physical therapy or desensitization therapy. They can teach you exercises to relax the entrance to the vagina and decrease pain.

If you and your partner avoid sex because of pain, you may also want help to improve communication and restore sexual intimacy. A counselor or sex therapist can help.

There are solutions that can help you look forward to sexual activity. These organizations provide information and can connect you to a physical therapist or sexual pain specialist:

• American Association of Sexuality Educators, Counselors and Therapists
• American Physical Therapy Association
• Maze Women’s Sexual Health