This article was medically reviewed by Melissa Moffitt, MD

At a Glance: Key Takeaways

Sexual function changes affect most people with cancer, yet many patients never hear it discussed. Oncologists Don Dizon, MD, and Melissa Moffitt, MD, join The Cancer News to explore how treatment affects desire and intimacy, which tools and therapies can help, and why survivorship care should include sexual health. Cancer may change intimacy, but it doesn’t have to erase it.

Sex and Cancer: Are You “Too Sick” for Sex?

The moment a cancer diagnosis lands is a heavy one—so patients, reasonably enough, don’t often find “Wait, how will this affect my sex life?” topping the list of questions to ask their doctor. That doesn’t mean it isn’t worth exploring.

People with cancer are living longer than ever,[1,2] good news that begets more good news: oncology clinicians and researchers are spending more time investigating the disease’s impact on long-term quality of life. This care framework is called survivorship. Survivorship acknowledges that having cancer is a life-changing experience. Any and all parts of a person’s life might be affected from the moment of diagnosis,[1] including sexual health. Patients’ relationship to desire, intimacy, closeness, orgasm, enjoyment—the list goes on—might change during and after treatment in response to any number of physiological and psychological changes.

“It is important that providers bring up sexual health, and the changes to it, after a cancer diagnosis,” Don Dizon, MD, FASCO, FACP, Service Line Chief of Hematology and Oncology at Tufts Medical Center, told The Cancer News. “So many people are surprised by it; it’s often an isolating experience.”

Sexual satisfaction plays a big role in emotional well-being and quality of life;[3] so when changes to sexual function impact up to 90% of female patients with cancer and anywhere from 40% to 85% of male patients with cancer,[2] sexual health earns its place in the survivorship conversation. 

And it’s because that conversation can be difficult to start that it’s important to have. Uncomfortable for the initiating party? Possibly. But that conversation allows patients to prepare to navigate the coming changes to their sexual health with a little less of that isolation described by Dizon—and that can be a powerful thing. So without further ado: What are common changes to sexual health after a cancer diagnosis? Are there any tools or resources to combat sexual dysfunction? What role do partners and caregivers play? And what does it look like to build a new normal in the bedroom?

The Birds, Bees, and Biopsychosocial Model of Sexual Health

Unsurprisingly, much attention has been paid to sexual dysfunction in people with cancers that affect sexual and reproductive anatomy. Rates of sexual dysfunction reach as high as 90% among people diagnosed with gynecologic cancer and more than 70% among those diagnosed with breast cancer.[4] For men, prostate cancer diagnoses result in the highest rate of sexual dysfunction, followed by the expected suspects: testicular, bladder, penile, and gastrointestinal cancers.[5] 

In these cancers, treatment can lead fairly straightforwardly to dissatisfaction in the bedroom: think chemotherapy, surgeries like oophorectomies (removal of the ovaries), and pelvic radiation. Plus, hormone therapies like aromatase inhibitors and tamoxifen, used to treat estrogen-driven cancers, can cause hormonal changes, including menopausal symptoms.[2] When ovarian estrogen production drops sharply, it can lead to symptoms like vaginal atrophy—the vaginal walls becoming thinner and drier, potentially causing painful sex.[6,7] 

Ostomies can also affect sexual health. A 2025 systematic review and meta-analysis of more than 27,000 patients with colorectal cancer found that those with an ostomy reported significantly greater body-image concerns and sexual dysfunction than those without one.[8]

Beyond these physical changes, cancer’s psychological tolls can be just as detrimental to patients’ sexual satisfaction. Researchers stress that sexual health is best understood through a biopsychosocial model.[2,4] This portmanteau describes the interaction of biological, psychological, and social factors—and the line between these forces is by no means impermeable. Physical changes from cancer treatment, such as alopecia, surgical scars, or weight gain, can alter a patient’s self-perception and their desire for sex,[3,5] particularly during and immediately after treatment.[5]

Finding and Building a New Normal

The interpersonal side of the biopsychosocial trifecta can be especially difficult to navigate. Romantic partners might find themselves stepping into new relational identities: patient and caregiver. This refiguring can, indeed, affect sex and sexuality.[5,2]

“It’s frustrating and lonely,” one Reddit user shared on the forum CancerFamilySupport. “I miss my wife (all of her), but also feel bad for any pressure I’d put on her by asking.”

“Tell me we get our life back,” another user added. “All of it.”

But the reality is, pre-cancer “normal” may be out of reach—and treating it as the all-or-nothing standard for sexual health might be the quickest path to disappointment. Sexual satisfaction is not one-size-fits-all; there are endless versions of healthy sexuality, and a patient with cancer might land on any number of them during different stages of treatment. Your sex life today might not resemble yesterday’s, or the one enjoyed before cancer. That’s okay.

“It’s important for people (including providers) to understand that sex and intimacy are not synonyms,” Dizon stressed.

Indeed: as one survivor-informed patient expert perspective points out, “penetrative intercourse” can be made “the primary marker of sexual health, potentially overlooking broader dimensions of sexuality.”[6] Even when penetrative sex isn’t an option, other forms of sexual intimacy and closeness remain. In one study involving 632 patients with cancer,[Dames et al., cited in 5] the majority of respondents reported “substantial alterations” in their preference for sexual positions and activities.[5] 

Plus, sex and intimacy “are experienced differently in men and in women,” Dizon said. Spontaneous sexual desire—desire that arises without an obvious external stimulus—is not necessarily the default for women. Research on female sexual response suggests that desire can instead emerge in response to sexual stimuli, particularly in established relationships.[4]

Intentionality doesn’t have to kill the mood. Whether a couple is affected by cancer or not, sometimes making space for intimacy—a non-judgemental intimacy, independent from thoughts of what things should look like—can be the very thing to get things started.

Sexual Health and Cancer: a Non-Exhaustive Toolkit

After patients have taken time to explore their bodily needs and limitations and communicate with their partner(s), there are interventions that can help with common barriers to sexual function, should patients be interested.

Screening

An established framework can help kick off the conversation between patient and provider about sexual health following a cancer diagnosis. Detailed screening tests for sexual dysfunction include the Sexual Function and Satisfaction measure developed by the PROMIS Network, the Brief Sexual Symptom Checklist for Women, the ASEX (Arizona Sexual Experience Scale), the FSFI, and the Sexual Function Evaluation Questionnaire.[4] 

Yet as Melissa Moffitt, MD, board-certified gynecologic oncologist at Legacy Cancer Institute, pointed out, these screeners see more use in research than in actual clinical contexts. “They are long and cumbersome!” she told The Cancer News.

By far more common clinic-side, Moffitt explained, are the NCCN Survivorship Guidelines, which recommend asking patients about sexual health at regular intervals. The initial screening can be as simple as two questions: Do you have any concerns regarding your sexual function, sexual activity, sexual relationships, or sex life? And are these concerns causing you distress? If a patient raises a concern and wants to discuss it further, providers can explore the issue in more detail and consider additional screening tools or referrals, such as to a pelvic floor physical therapist.[4] 

Moisturizers, Lubricants, and Dilators

There are a number of ways to address decreased sexual function associated with cancer treatment. Take, for example, vaginal dryness. Using a plant oil like coconut oil, patients with vaginas can use vaginal moisturizer for relief over time.[4] Note that despite mixed reported efficacy, the risks are low.[4] In the shorter-term, lubricants are widely available, and can be helpful in combating dryness during sex.[4] Lidocaine has been shown to decrease pain in the vaginal opening.[4] Finally, patients can try dilator therapy, the regular insertion of progressively larger devices to help with vaginal elasticity.[9]

These remedies provide symptom relief. But interestingly, vaginal estrogen is a closer-to-the-source option—even for those who might be inclined to steer clear. “Vaginal estrogen is indeed effective,” Dizon said, “and it is safe for people with breast cancer, including those with ER+ disease.”

The oncologist is backed by the literature. A November 2023 cohort study of 49,237 females with breast cancer found no evidence of an increase in early breast cancer-specific mortality among those who used vaginal estrogen therapy.[7] Because vaginal estrogen is applied locally, it results in much less estrogen entering the bloodstream compared to systemic estrogen therapy.[9] Vaginal estrogen can also help treat female urinary incontinence—also a consequence of aromatase inhibitors, and detrimental to sexual health.

Vibrators (and Recentering Pleasure)

Some researchers are worried that emphasis on these interventions makes sexual rehabilitation seem synonymous with “anatomical restoration,” centering penetrative sex to too great a degree.[6] In fact, tools like vibrators may provide “comparable mechanical benefits” to the dilators discussed above—while centering arousal, minimizing pelvic floor tension, and making space for patients’ individual preferences.[9] Either way: the restoration of a patient’s bodily trust “and the capacity for intimacy and pleasure” should be the central goals when assessing sexual function.[9]

The Take-Home: Different, But Not Gone

Life with cancer is still life. For people who experience sexual desire, being able to act on it in some way (whether through sexual intimacy, self-pleasure, or another kind of closeness) is an important part of living, regardless of age, disease stage, or marital status. 

Still, sexual health after cancer diagnosis “continues to be poorly addressed,” Dizon said; “even after ten years in this work.” 

Burying the issue can leave patients feeling isolated and helpless. And because some patients believe their provider should be the one to initiate the conversation,[4] clinicians have an important role to play: asking, listening, and helping patients find the resources that fit their needs, from communities and treatments to dedicated sexual health programs within survivorship clinics.

Cancer may change what sex and intimacy look like, but it doesn't have to erase them. The new normal may take some figuring out—but as with so many things in life, it’s a new normal worth finding.

References

  1. Cleveland Clinic. Cancer survivorship. Accessed September 25, 2026.

  2. Agrawal LS, O'Riordan L, Natale C, Jenkins LC. Enhancing sexual health for cancer survivors. Am Soc Clin Oncol Educ Book. 2025;45(3):e472856. doi:10.1200/EDBK-25-472856.

  3. Sopfe J, Pettigrew J, Afghahi A, Appiah LC, Coons HL. Interventions to improve sexual health in women living with and surviving cancer: review and recommendations. Cancers (Basel). 2021;13(13):3153. doi:10.3390/cancers13133153.

  4. Robison K, Kulkarni A, Dizon DS. Sexual health in women affected by gynecologic or breast cancer. Obstet Gynecol. 2024;143(4):499-514. doi:10.1097/AOG.0000000000005506.

  5. Rossi A, Leone AG, Lambertini M, et al; Associazione Italiana Oncologia Medica (AIOM). Sexual health in cancer care: a narrative review and position statement from the Italian Association of Medical Oncology (AIOM). ESMO Open. 2025;10(6):105311. doi:10.1016/j.esmoop.2025.105311.

  6. Cleveland Clinic. Vaginal atrophy. Updated April 10, 2023. Accessed September 25, 2026.

  7. McVicker L, Labeit AM, Coupland CAC, et al. Vaginal estrogen therapy use and survival in females with breast cancer. JAMA Oncol. 2024;10(1):103-108. doi:10.1001/jamaoncol.2023.4508.

  8. Redeker C, Grunfeld E, Miles A. The impact of an ostomy on body image and sexual function of patients with colorectal cancer: A Systematic Review and Meta-Analysis. Psycho-Oncology: 2025; e70249. https://doi.org/10.1002/pon.70249.

  9. Tóth I, Tóth R, Kirchheiner K. From vaginal morbidity to sexual health: rethinking sexual rehabilitation after gynecological cancer through a survivor-informed patient expert perspective. Int J Gynecol Cancer. 2026;36(9):104833. doi:10.1016/j.ijgc.2026.104833.