Sex is a physical act that’s incredibly dependent on emotion–and cancer can affect both. It’s likely that there’s not just one thing about cancer that’s affecting your sex life with your partner, it’s compounding—you’re exhausted, you’re afraid, you’re adjusting to a new body. You and your partner are navigating new roles as “caretaker” and “patient.” And in the aftermath, you’re dealing with a tricky combination of gratitude and loss.

Sex is an important part of most people’s lives, one that’s important for doctors to address as any other physical and mental health side effects would be.

Unfortunately, this absolutely doesn’t mean your doctors will take the initiative, says Nancy Gerhard, an advanced practice nurse at USC Norris specializing in cancer and communication with patients. This can be a topic that makes people, even doctors who deal with bodies all day, totally shy. “I will tell you some providers are going to be uncomfortable bringing up the topic of sex,” says Gerhard. “But that should be brought up. Because that’s really important. Especially talking about disturbances in sexual activity that is huge for our young cancer survivors, that’s very important.”

It really felt like being a virgin again... I’m very open with her. I just let her know, I’m a little insecure about my body right now. I need a certain level of patience to feel pleasure.

First, Don’t Let Anyone Tell You It’s Not Important

Prioritizing something you want is worth it; all the experts agree. There are therapies and strategies you can use to reintroduce sex back into your life. You’re allowed to grieve what you lost, and even better, you can find ways to get it back.

“You are taught that life is so precious, you got to live past this thing so you don’t get to complain. You shouldn’t want sex because that part of your life is over,” says Dana Kirkpatrick, a sex therapist who had breast cancer. This is not the case, she says, not at all.

“We can talk about what we can do about the problems rather than just hoping they’ll go away. A lot of sex issues don’t just go away with the passage of time. In fact, they may get worse,” says Dr. Amy Siston, a sex therapist at UChicago Medicine specializing in oncology (read our interview with her here). “I think it can be very empowering, too… There’s a lot of losses with cancer, so the more we can do things to help regain some of the losses, the better, and I think sexual health is a big one of those.”

Sex Can Be Painful, You Can Have a Low Sex Drive: How to Proceed

Many cancer treatments, like chemotherapy, can induce early menopause. There can be irritation, dryness, and all sorts of painful and irritable changes to your sex life.

Dr. Jessica Gorman studies improving quality of life in cancer survivorship as a behavioral scientist at Oregon State University. In her research, she’s found that pain and low sexual desire are some of the biggest challenges people face when it comes to cancer and sex. For many women with breast or gynecologic cancers, treatment triggers early menopause, which comes with symptoms like hot flashes, vaginal dryness, weight gain, mood changes, lower libido, and pain during intercourse.

The day after Amanda Fitzpatrick had a hysterectomy to treat her endometrial cancer in 2020, she started feeling the effects of menopause. At 26, she entered a life phase most women begin in their 50s—with hot flashes, mood changes, night sweats, and no sex drive. “I don’t get excited. It’s nothing. It’s more or less a shut off, like a light switch,” says Amanda. “Hopefully it’ll come back and the spark will be there, but right now, I don’t know whether it’ll come back, I don’t know how it’s going to come back. I have to wait for it.”

And it’s not just early menopause and emotional concerns that can cause low libido. Dr. Siston explains that the fatigue, stress, preoccupation, busy schedules and fear that come with treatment can all result in a lower sex drive. Some classic strategies–which is not a reason to dismiss them– are to schedule sex during times you feel most awake (like mid-morning, early evening). Scheduling sex doesn’t sound sexy, but Dr. Siston holds the belief that it’s more common than you think to plan—people plan dinners, they plan what to wear, and they plan what they’re going to do after. And during sex, Dr. Siston recommends prolonged foreplay and increased communication with your partner.

Navigating Dating With Cancer

Khrystin Motton, 38, is a self-described hopeless romantic. Dating was something she’d always prioritized before she was diagnosed with Hodgkin lymphoma in 2022. She decided to put it on the back burner during treatment–but as she started posting her story to social media, she was being pursued left and right.

She gave it a try, but found they came on strong (and savior-y) and then pulled away. “No offense to the men, but I just don’t feel like they’re usually equipped with the empathy that’s required to be with someone in treatment. It affects every part of your life. It affects your sex drive, your mood, your confidence. It’s not exactly the time where you’re feeling your sexiest or want to be intimate. You really have to have a partner that understands that,” she says.

Finding someone you feel comfortable communicating with and being vulnerable with: it’s no easy feat when you’ve just started dating them. Dating is a risk for anyone, but Dr. Siston says that dating, especially as someone who has or has had cancer can feel even more risky, with very good reason. There’s a lot of unknowns when you disclose that information, but if there’s a connection and you feel that you can trust them, you can help them to understand what you need to be intimate.

Khrystin has been in a relationship for a couple months now. She’s cancer-free and on the tail-end of her treatment. She’s had to relearn her body and be really open and communicative with her partner, and she says she’s lucky enough to feel comfortable enough with her to do that. “It really felt like being a virgin again,” Khrystin says. “I’m very open with her. I just let her know, I’m a little insecure about my body right now. I need a certain level of patience to feel pleasure.”

Cancer’s Effect on Relationships and Sex

Cancer can change the way you and your partner might relate to each other, from the anxiety, fear and sadness both you and your partner might feel, changes in your body that didn’t exist before that both you and your partner aren’t used to, and a shifted dynamic where they’ve likely been caretaking for you.

In many cases, Dana Kirkpatrick, the sex therapist, says it can bring you closer to your partner; and in many cases it can create more issues. When our partners get accustomed to treating us like patients, there's an adjustment afterwards to just treating us like romantic partners, she says. “You can include your partner in [healing] in a more loving way,” says Kirkpatrick.

“It’s all about willingness to talk about these issues, to communicate and have the space,” says Dr. Siston. “If they don’t talk about things, that’s a problem… There’s a lot of vulnerabilities, I’m afraid to ask you this, I’m not sure what to say, what if I say it wrong… there’s a closeness when a patient really feels comfortable expressing how [they feel], knowing that someone’s there to listen.”

Dr. Siston says cancer can even sometimes be a productive way to open the door to conversations about sex that you and your partner never had to have before. It may not be possible to have sex the way you did before, whether it be physical or emotional hurdles. You now might be forced to communicate about what you’re comfortable with in bed, and work together to find ways you can make it enjoyable to you both.

Returning to Sex After Cancer

Rajvee Shah, a pelvic floor therapist who has also had breast cancer, says when it comes to returning to sex, body image and medical trauma can be big hurdles for many women. These both can make sex really difficult, not necessarily just the physical act, but the intimacy aspect as well. For this, she suggests working to reconnect with yourself through breathing, mindfulness, and becoming intimate with yourself before you become intimate with someone else.

Dr. Siston agrees that mindfulness is a big part of the work. Being really present, and trying to put aside your many to-dos, gives you the best chance to really enjoy sex. “It’s like if you have a really good meal and then you’re on the computer working,” says Dr. Siston. “You’re not seeing the color, you’re not smelling how good it is. You’re just doing it as a matter of doing it. How different it is to really look at it, to see the colors, to enjoy the smell, and really savor the taste.”

For some physical strategies, Shah and Dr. Siston both recommend experimenting with vaginal lubricants, vibrators and extended foreplay to fan the flame. If you’re feeling uncomfortable in your body, you might discuss keeping the lights dim or keeping a piece of clothing on. This open communication with your sexual partner is really important, and also can be a tough and vulnerable thing to try to achieve.

All This is So Normal, And It’s Not a Lost Cause

Yes, it may never be the same as it was. “We use the term ‘new normal’ a lot, because it isn’t going back to your body at the time. It’s coming back to your body and asking, ‘what is this baseline?’” says Kirkpatrick. “New normal” might feel like it’s signaling a downturn, but it doesn’t have to be. By addressing the concerns and opening up these deliberate and honest lines of communication with your partner and yourself about sex, your sex might feel better, more intimate, and mindful. Who wouldn’t want that?