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Sexuality and breast cancer

Many women continue to have strong, supportive relationships and a satisfying sex life after breast cancer. If sexual problems occur because of breast cancer treatment, there are ways to manage them.

Some of the side effects of breast cancer treatment that can make sex painful or difficult include:

Vaginal dryness

Vaginal dryness can be caused by hormonal therapy for breast cancer. It can also be a symptom of treatment-induced menopause.

Fatigue

Fatigue is a side effect of chemotherapy or radiation therapy. A woman may feel ill or tired or not in the mood for sex.

Decreased interest in sex

Some women with breast cancer may lose interest in having sex. It is common to have a decreased interest in sex around the time of diagnosis and treatment. Treatments for breast cancer can affect a woman’s interest in sex:

  • Hormonal therapy for breast cancer can change hormone levels and can reduce the desire for sex or affect sexual function (for example, the ability to become aroused).
  • Chemotherapy or radiation therapy may cause a person to feel ill or tired and not in the mood for sex.
  • Breast cancer surgery can leave the area of the breast very tender or with less feeling. Some women like being stroked around the area of the healed scar, but others do not and may no longer enjoy any touching of the remaining breast.

When the woman first starts having sex after treatment, she may be afraid that it will be painful or that she will not have an orgasm. The first attempts at being intimate with a partner may be disappointing. It may take time for the couple to feel comfortable with each other again. Some women and their partners may need counselling to help them cope with these feelings and the effects of breast cancer treatments on their ability to have sex.

  • The woman may be worried or self-conscious about changes in her appearance, such as:
    •  scars or the loss of the breast or part of the breast
    • hair loss
    • weight gain or loss
  • The woman may be worried that her partner will not be attracted to her anymore.
  • Being tired may result in a woman not wanting to have sex, while stress or worry can reduce sexual desire.
  • The woman and her partner may also be afraid or anxious about their first sexual experience after breast cancer treatment and may avoid being intimate.
  • Breast reconstruction can improve self-image and helps some women enjoy sex more because of the boost to their feelings of attractiveness and comfort with their bodies. Breast reconstruction can also result in a loss of feeling or change in sensation because nerves that supply feeling to the breast skin and nipple are disconnected or removed during reconstruction surgery. The skin may become more sensitive over time, but it usually does not give the same kind of pleasure as it did before.
  • A woman’s partner may be worried about hurting her during sex.

A physical relationship is very important for some people and they are sad when it stops or changes. A woman with breast cancer and her partner may find that sex and intimacy change during or after treatment.

Sexual health tips

There are ways to deal with sexual problems that may occur because of breast cancer treatment. There are many things a woman with breast cancer and her partner can do to help them continue a healthy sex life during and after breast cancer treatment. Do not be embarrassed to talk to the doctor or healthcare team about worries or concerns you have about sex or if you are having problems.

  • Talking to your partner may help ease your fears if breast cancer or its treatment affects your sex life. For example, if you are not interested in sex at the moment, explain that it is because of fatigue or stress, not because you do not love or respect your partner. Knowing how each other feels may help you both feel more secure. Communication is the key to getting back into an intimate relationship and life together.
  • If talking to each other about sex is difficult, a professional counsellor may be able to help partners talk more openly. Also let a member of the healthcare team know if you are having problems. There may be medicines that can help, or other ways you and your partner can give each other pleasure. Some people also find it helpful to talk with others about how to stay close while dealing with breast cancer.
  • Hugging, touching, holding and cuddling may become more important than sexual intercourse and other forms of sexual activity. There are many ways to express sexuality and to satisfy the need for physical closeness. Find what gives you both pleasure and comfort.
  • Take steps to adjust to body image changes, such as:
    • looking at or touching yourself
    • taking part in programs that can help people deal with the effects of treatments on their appearance
  • Tell your partner about the things that are especially pleasurable, such as touching or stroking.
  • A good breast form (prosthesis) or breast reconstruction surgery can help overcome the physical and emotional distress caused by breast cancer surgery.
  • Some women who have had mastectomies wear a short nightgown, camisole or bra with the prosthesis inside it during sexual activity. Others find the prosthesis awkward or that it gets in the way. Experiment to find out what works best for you.
  • If pain is a problem, you might try the following:
    • Take pain-relieving medications before making love.
    • Support a painful arm or chest with pillows during sex. Explore positions for having sex that put as little pressure as possible on the painful area of the body.
    • Let your partner know if any kind of touching causes pain. Show them ways to caress that are not painful.
    • Make sure you feel aroused before having sex. Arousal helps the vagina expand to its fullest and produce lubricating fluid. As women go through menopause (because of aging or cancer treatment), it may take more time and touching to get fully aroused.
    • Vaginal dryness can make sex uncomfortable. Use a water-based lubricant to make sex more comfortable if vaginal dryness is a problem.

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