Sexual Activity During Cancer Treatment: Information for Women

Sexual activity can provide pleasure and intimacy during your cancer treatment. The information below can serve as a guide to being sexually active during this time.

If you have any questions about this information, let your doctor or nurse know. If you have any concerns about how to follow these suggestions based on your religious observances, we advise you to speak with your religious leader.

Use Birth Control to Prevent Pregnancy

If you become pregnant with an egg damaged by exposure to radiation, chemotherapy, or other anticancer medications, there is a risk of miscarriage or birth defects. Becoming pregnant can also prevent you from receiving the best diagnostic tests and treatments for your cancer, as these may harm a fetus. If there is any chance you could become pregnant, use contraception (birth control) throughout your treatment. Do not rely on your partner withdrawing before ejaculation (“pulling out”) or on avoiding sex during fertile times of your menstrual cycle (“rhythm method”). These methods are not effective in preventing pregnancy.

It is important to pick a method of birth control that fits your lifestyle but will also be effective. Make an appointment with your gynecologist, and speak with him or her to be sure you choose an option that is successful for you. No matter what method you choose, use birth control regularly or you may become pregnant. If you have any problems with your birth control, talk to your gynecologist to find another option.

Nonhormonal Birth Control

The following forms of birth control do not contain hormones and are safe for most women:

• Diaphragm

A diaphragm is a small reusable rubber or silicone cup that you place inside your vagina each time you have sex. Your gynecologist will determine what size you need. The diaphragm is inserted 1 to 6 hours before vaginal sex, and kept in place for 6 hours after sex. It should then be removed and cleaned. The diaphragm should not be left in the vagina for more than 24 hours because this can cause an infection.

• Copper intrauterine device (IUD)

This is a small, T-shaped device that your gynecologist places inside your uterus. It can stay in place for 10 years or be removed earlier. Copper IUDs may cause heavier blood flow during your monthly periods, so check with your oncologist to see if this is safe for you.

• Tubal ligation (having your “tubes tied”)

Tubal ligation is a surgical procedure that is done by a gynecologist. It may be an option for you if you are certain you don't want any (more) children.

• Condoms (used by your male partner)

Condoms can prevent pregnancy and protect you from sexually transmitted infections (STIs), including HIV. If this is your only form of birth control, have your partner use a condom each time you have vaginal sex. See “Barrier Devices” below for information on buying and using condoms.

Hormonal Birth Control

These forms of birth control contain hormones, either a combination of estrogen and progestin, or progestin alone. Hormonal birth control is very effective. However, some medical conditions make these unsafe, so they are not right for everyone. Women who should not take hormonal birth control include those with a hormone-sensitive tumor, a personal or family history of blood clots, a history of migraines with aura, impaired liver function, and those who are 35 years of age or older and smoke. There are other medical conditions that also make it unsafe to use hormonal birth control, so talk to your oncologist and gynecologist to see if this method is right for you and which type is best. These forms of birth control do not protect against HIV or other STIs. Hormonal forms of birth control include the following:

• Birth control pill

These pills are taken once a day. Skipping a day or more may increase your chance of becoming pregnant.

• Injectable contraception (Depo-Provera^®)

This is a shot your gynecologist gives you every 12 weeks.

• Implantable contraception (Implanon^®)

This is a small rod your gynecologist implants under the skin of your arm. It can stay in place for 2 years or be removed earlier.

• Intrauterine device (LNG IUD, Mirena_®)

This is a small, T-shaped device that your gynecologist places inside your uterus. It releases the hormone progestin. The device can stay in place for 5 years or be removed earlier.

Other Considerations

If you are getting chemotherapy or radiation directed to an area near your ovaries, continue to use birth control for at least 1 year after your treatment has ended. This allows time for damaged eggs to clear from your body. If you plan to have children after your treatment, ask your doctor when it is safe for you to start trying. Depending on your situation, your doctor may recommend you wait more or less time.

Some treatments may affect your fertility (the ability to become pregnant with a biologic child). If you have questions about this, ask your doctor or nurse.

Protect Yourself from Infection or Bleeding

Patients with multiple partners are at risk for sexually transmitted infections (STIs), including HIV. In addition, certain cancer treatments can cause low blood cell counts for prolonged periods of time, which may increase your risk of infection or bleeding. Your doctor or nurse will let you know if this is a concern for you. To prevent infection or bleeding:

• Wash your hands and genitals before and after having vaginal, oral, or anal sex.
• If you have sex with multiple men, consider using a condom each time you have vaginal, oral, or anal sex throughout your treatment, even if you are using another form of birth control. Condoms protect you from STIs, including HIV.
  • Your partner can use a condom, or you can use a female condom. The female condom is a polyurethane pouch placed inside your vagina before sex. Do not use a male and female condom at the same time. Female condoms are not a very effective form of birth control, so you should not rely on them to prevent pregnancy.
• If you are expected to have very low blood cell counts for a prolonged period of time, your doctor or nurse may advise you to use a barrier device during sex—condoms or dental dams. See “Barrier Devices” below for more information.
  • In some situations, you may even be advised to avoid sex that involves penetration or contact with mucous membranes while your counts are low. This includes vaginal, oral, and anal sex or inserting fingers, vibrators, or sex toys into your vagina or anus.
  • Hugging, cuddling, gentle touching, and kissing skin are other ways you can be intimate with your partner during this time.
• Chemotherapy and radiation to the pelvis may cause your vagina to become dry and irritated. This may cause pain during vaginal sex and lead to infection. If you have vaginal discomfort, use a condom with a water-based lubricant or abstain from vaginal sex until the tissues heal. Ask your nurse for information on vaginal moisturizers and lubricants to help with vaginal dryness.
• Some women develop vaginal yeast infections during treatment, especially if they are taking steroids or antibiotics. Symptoms include vaginal itching, irritation, and white and lumpy discharge (like cottage cheese). If you suspect you have a yeast infection, avoid sexual activity and call your doctor or nurse.
• If you have had a bone marrow or stem cell transplant, you are at increased risk of infection for many months after your treatment. Until your doctor tells you that your immune system has recovered
  • Use latex condoms each time you have vaginal, oral, or anal sex.
  • Use a barrier device (condoms or dental dams) any time your partner's saliva, vaginal secretions, or semen could enter your mouth. See “Barrier Devices” below for more information.
  • Abstain from any sexual activity that could expose your mouth to feces.

Consider Steps to Avoid Exposing Your Partner to Chemotherapy and Other Anticancer Medications

There is little data about how much anticancer medication gets into a woman's vaginal fluids, and even less on whether this poses any risk to a sexual partner. If this is a concern to you or your partner, consider using a barrier device whenever your partner may have contact with your vaginal fluids—a condom for vaginal or anal sex and a dental dam when you are receiving oral sex. This will prevent your partner, regardless of his or her age or gender, from being exposed to any medication that may be in your vaginal fluids. We don't know how long these medications may be in vaginal fluids, but you could use barrier devices each day you have chemotherapy and for 1 week afterward. If you have multiple male partners, or if you could become pregnant and are not using any other form of birth control, use condoms throughout your treatment and until your doctor advises you that it is safe to attempt pregnancy. See “Barrier Devices” below for more information.

Barrier Devices

Condoms

• You can buy condoms at any drug store. We recommend latex condoms, but if you or your partner is allergic to latex, use polyurethane condoms.
• Spermicides do not provide any added protection.
• You can use lubricated condoms or a separate water- or silicone-based lubricant.
• Before you use a condom, check the expiration date on the wrapper. Expired condoms are more likely to break.
• To use a condom correctly (instructions for your male partner):

1. Be careful when opening and handling the condom. Don't use your teeth, scissors, or other sharp objects to open the wrapper. Don't use the condom if it is torn, brittle, or stiff.
2. Wait until your penis becomes firm before putting on the condom.
3. While pinching the tip of the condom, unroll it over your penis as far as it will go. The extra space at the tip is needed to collect your semen.
4. Smooth out any air bubbles—they can cause condoms to break.
5. After you have ejaculated, but before your penis becomes soft, hold the base of the condom (where the ring is) and carefully pull your penis out of your partner so that nothing spills.
6. Carefully slide off the condom and throw it in the trash.

• A condom can tear if it is too tight or it can fall off if it is too loose. If this happens while you are having vaginal sex, and you are of childbearing age, call a gynecologist as soon as possible. Ask about emergency contraception (the morning-after pill) if you are not using another form of birth control.

Dental Dams

• A dental dam is a thin, rectangular sheet of latex or silicone that covers the genitals of a woman receiving oral sex.
• You can buy these online, get them from the New York City Department of Health and Mental Hygiene, or make one out of a condom.
• If you want to make a dental dam out of a condom, you may want to avoid those with a spermicide or lubricant, as the taste may be unpleasant. Cut off the tip and cut down the side of the tube to make a sheet.
• To use a dental dam, hold the sheet over your vulva or anus while your partner is giving you oral sex.

Resources

MSKCC Female Sexual Medicine and Women's Health Program
(646) 888-5076
For help with issues related to female sexual function.

American Cancer Society: Sexuality for the Woman With Cancer
http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinWomen/SexualityfortheWoman/sexuality-for-the-woman-with-cancer-toc
Call 1-800-227-2345 to request printed material.

American Congress of Obstetricians and Gynecologist
http://www.acog.org/For_Patients

National Cancer Institute: Sexuality and Reproductive Issues
http://www.cancer.gov/cancertopics/pdq/supportivecare/sexuality/Patient
Call 1-800-4-CANCER to request printed materials.

Planned Parenthood
http://www.plannedparenthood.org/

New York City Department of Health and Mental Hygiene
http://www.nyc.gov/html/doh//html/condoms/condoms.shtml
For information on getting and using male and female condoms.