Sexuality, intimacy and cancer for women

Sexuality is an important part of a woman’s life. It involves feelings, thoughts, self-image, attractions and behaviours towards others, and includes sexual desire and function. Cancer and its treatments can unfortunately have a negative impact on a woman’s sexuality. For instance, nausea and vomiting from chemotherapy can cause discomfort and exhaustion which can in turn lead to a loss in sexual desire. One may also be less able to relax and enjoy sexual intimacy because of the emotional impact of hair loss and weight changes on her self-image.

Because the focus is usually on getting rid of cancer and coping with side effects, and because sexuality is a difficult topic for most people to bring up, this aspect is often overlooked. Not all patients’ experience will be similar, but for some people, it may result in a poorer quality of life.

What are the common problems?

Although sexuality-related problems can happen to both women and men, there are differences that need to be considered, beyond just the physical and anatomical differences of woman and man. As an example, women’s sexuality and its problems, are closely related to her psychological health and her relationship with her partner. Men in comparison, have their sexual health closely tied to their physical health and sexual function e.g. erections, ejaculations.

Some of the common sexuality-related problems faced by women include:

Decreased sexual desire or arousal (e.g. from hormonal changes, fatigue)
Lubrication problems (e.g. from radiation therapy to pelvis)
Painful intercourse (e.g. from narrowing of vaginal walls)
Change or loss of sensation (e.g. over breast and nipples with reconstructed breast)
Physical changes from surgery (e.g. shortened vaginal canal)
Concerns about body image (e.g. hair loss, scarring)
Emotional changes (e.g. anxiety, fear, stress)
Relationship problems with her partner

How it can be treated

Your doctor or nurse will give you advice depending on the problem experienced/anticipated and its cause. For instance, you will be taught on how to stretch your vaginal tissue to prevent narrowing of the vaginal walls, if you undergo radiation treatment over the area. If you experience decreased vaginal lubrication, your doctor or nurse may recommend you to use vaginal lubricants to increase comfort during intercourse. A referral to a sexual counsellor or therapist may be advised, if necessary. It is often hard to raise concerns regarding your sexuality to your loved ones and the healthcare team, but it is an important first step to getting better. If you are more comfortable raising this with another woman, speak to one of our female counsellors from the Department of Psychosocial Oncology. She can help connect you with the necessary services to help you overcome your sexual problems. You may also refer to the next section for some tips on what you can do to address specific concerns.

What you can do

Improve physical and emotional intimacy

Show your feelings towards your partner through gestures such as holding hands, hugging, and kissing

Spend more time communicating and actively listening to each other to maintain emotional closeness. This includes having open, honest talks regarding both your thoughts and feelings

Avoid keeping your struggles from your partner. This will distance yourself emotionally and physically from him or her

Avoid having assumptions about your partner’s thoughts and feelings

Manage sexual activity concerns

Be patient with each other. It may take more time and effort to keep or get back the same level of intimacy you shared before cancer. Let your partner know if you are too tired to engage in sexual activities, and be open to different ways of feeling or creating sexual pleasure such as manual stimulation

Try doing pelvic floor exercises. This may help reduce pain during sexual intercourse by relaxing and strengthening the pelvic floor muscles

Engage in exercises such as walking, dancing or gentle yoga, to help increase your energy and sexual vitality

Use the vaginal dilator regularly if instructed by your doctor or nurse. This will allow the vaginal tissues to maintain its elasticity and reduce tightness, so that pain is reduced during intercourse

Use vaginal lubricants to reduce vaginal friction and increase comfort during sexual intercourse

Practise relaxation exercise, experiment with fantasy as well as extend foreplay in order to reconnect with your partner

Don’t hide your pain from your partner. Be truthful to your partner so that he/she can avoid areas or activities that may trigger or worsen the pain

Don’t be embarrassed to ask your healthcare team if and when it’s safe to have sex, or if you need to take any precautions

Don’t be hesitant to see a sexual therapist, psychologist or social worker if recommended by your doctor or nurse. They can provide counselling and therapy to help you with sexuality-related problems

Manage body image & emotional concerns

Try to find quiet time when you can talk openly and honestly about your concerns, fears, or worries with your partner or close friend. Sometimes talking things out can make you feel better

Wear a wig or prosthesis, and dress up to make yourself look and feel good

Eat healthy meals and exercise regularly to keep your spirits up. Practising deep breathing or engaging in hobbies like listening to music can also help you feel more relaxed

Avoid keeping problems to yourself. If it is difficult for you to bring up sexuality-related issues to your loved ones, let your doctor, nurse or medical social worker know

Practical issues

Do take note that cancer is not contagious and your partner will not get cancer from kissing, touching or having sexual intercourse with you

Engaging in sexual activity does not cause your cancer to grow faster, nor does it increase the chance of cancer coming back

Don’t feel guilty or ashamed to ask for help. Your healthcare team will not judge you or provide you with less care

When to consult your cancer care team

Please inform your doctor or nurse if you feel that any sexuality-related issue is affecting your daily life, or if you experience any of the following:

Feeling sad, lonely, angry, guilty or embarrassed about your self-image
Relationship or communication difficulties over issues of physical/emotional intimacy as a result of cancer

If you are a patient with NCCS, you may also call +65 6306 1777 or +65 6436 8088 to book an appointment to speak to an NCCS medical social worker/ clinical psychologist.

If you have any questions regarding the above information, please call Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

Useful resources

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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Sex and cancer, for Her