Sexual side effects

Many people are focused on getting healthy after a breast cancer diagnosis and might not be thinking about how cancer will affect their sex life. But it’s important to be able to have a good quality of life no matter where you are on your treatment path — and that can include being able to have a satisfying sex life.

It’s normal to lose interest in sex at times after diagnosis and during treatment. Breast cancer treatments or the cancer itself can cause fatigue, discomfort, pain, and other side effects that impact your sexual desire and activity. These side effects can happen during treatment, or months or years afterward.

It's important to know that you are not alone. LBBC has resources to help support and guide you as you manage side effects — and to help you stay connected to your sexual self.

Below, we'll talk about common breast cancer treatment side effects that can impact your sexual life. We'll also provide links to detailed information on maintaining your sexual health, getting comfortable with your body and body image, communicating with a partner, and more.

How breast cancer treatment can affect your sex life

Breast cancer treatments can cause side effects that interfere with sexual life. Some side effects are temporary and only last as long as treatment. Other side effects may be long term or start when treatment ends.

Treatment can bring up many emotions that can affect your sexuality. You may feel angry, frustrated, anxious, or guilty. Some people may feel a sense of loss for the life they had before diagnosis and treatment. These emotions are common among people living with breast cancer, and they are normal feelings to have.

Side effects that can affect sexuality

In women, specific side effects of breast cancer treatment that can affect sex life include:

• Fatigue
• Depression
• Anxiety
• Loss of interest in sex
• Changes in body image as a result of having one or both breasts removed
• Hair loss that can also impact body image
• Menopausal symptoms, such as change in sexual desire, vaginal dryness, and painful sex
• Bone, joint, and muscle pain
• Pelvic dysfunction, such as incontinence
• Loss of sensation where a breast was removed or reconstructed

In men, treatment side effects that impact sexual life can include:

• Fatigue
• Changes in mood
• Decreased sexual desire
• Erectile dysfunction
• Body image changes from breast surgery and/or hair loss
• Numbness or pain in the surgery site of the chest
• Bone, joint, and muscle pain

Side effects by treatment type

While there are common side effects that can affect sexuality like the ones listed above, people who are being treated for breast cancer will likely encounter different side effects depending on their treatment plan. But not everyone experiences every side effect, and there are many ways to manage them if they happen. In this section, we’ll talk about the common treatments that can cause sexual side effects.

• Mastectomy or lumpectomy can affect how secure a person feels about their body. It can reduce or alter sensation where the breast was removed. Mastectomy can also have an impact on feelings of desire and arousal, ability to reach orgasm, and sense of sexual satisfaction.
• Chemotherapy can cause vaginal and/or vulvar dryness, which could make sex painful.
• Radiation therapy can cause skin irritation and altered sensation
• Immunotherapy can cause body aches, fever, and other flu-like symptoms.
• Anti-estrogen therapy can cause different side effects, depending on the type of therapy:
  • Tamoxifen, a selective estrogen receptor modulator or SERM, may reduce sexual desire and cause vaginal discharge.
  • Aromatase inhibitors such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) can cause joint pain, headaches, fatigue, and vaginal and vulvar dryness.
  • Fulvestrant (Faslodex) and elacestrant (Orserdu), which are known as selective estrogen receptor degraders or SERDs, can cause fatigue as well as muscle, joint, and bone pain.

Your sex life is not over

We know that reading about side effects can be overwhelming. It's important to know that not everyone will experience all the side effects mentioned above. And no matter what kind of treatment you have, breast cancer does not mean an end to your sex life. There is a help available that can restore sexual enjoyment and intimacy.

Tips for getting back to your sex life

There are many things you can do that can help increase confidence as you ease back into sexual activity. Try to be patient with yourself. If you have a partner, be open and honest with them, and accept that your sex life now may be different than it was pre-treatment.

Other strategies include:

• Managing vaginal dryness with vaginal moisturizers and lubricants; if non-hormonal treatments aren't helping, talk with your healthcare team about low-dose vaginal estrogen, which shows no increased risk of breast cancer death according to 2023 research published in JAMA Oncology
• Learning about and trying new positions to ease pain you may have
• Pelvic floor therapy to help with pain from sexual touch or penetration
• Sex therapy to manage your response to these side effects and the impact on your relationship if you are partnered

For experienced, licensed specialists in pelvic floor therapy and sex therapy, ask your oncologist, nurse, gynecologist, or hospital social worker for a referral. There are also online resources that can help:

• The American Physical Therapy Association has a searchable database of pelvic health physiotherapists.
• You can visit the American Association of Sexuality Educators, Counselors and Therapists to search for certified sexuality practitioners by location.

Getting help from your care team

As you plan treatment, talk with your care team about potential sexual side effects and any steps you can take to manage them. Many healthcare professionals are sensitive to this issue and want to help. Even if they don’t have all the answers, your doctors and nurses can direct you to other professionals who can help.

Here are some questions you can ask your care team to start a conversation about sex and sexual side effects.

• Will my treatment affect my sex life?
• How long will the side effects last?
• What can I do to manage side effects?
• How can I help my partner understand what I need?
• Where can I get more information on how to manage side effects?

We know that it can sometimes feel uncomfortable to bring up sexual side effects with your oncologist or oncology nurse. But everyone managing a cancer diagnosis deserves to have the best quality of life they can, including a fulfilling sex life — and your care team can help. Here are some tips that might make it easier to start a conversation about your sexual concerns:

• When you make your next oncologist appointment, mention that you would like extra time to ask questions.
• Before your appointment, write down the symptoms you've been having, as well as any questions you have. Bring this list so you can refer to it.
• Be as specific as you can. For example, say, “I have pain during vaginal penetration. What can I do to get relief?”
• Rehearse what you want to say before your appointment. It can help to say the words out loud to a partner or friend, or in front of a mirror.

If your doctor or nurse is unsure how to help, or if they seem uncomfortable discussing your sexual concerns, ask for a referral to a specialist in sexual health, cancer survivorship medicine, or both. These professionals give specialized care to people who are living with the sexual side effects of cancer treatment.

To learn more about how to manage sexual side effects, visit our section on sex and intimacy or consult the book Woman Cancer Sex, Second Edition, by Anne Katz, PhD, RN, FAAN, our medical advisor for this page.