Navigating Sexual Health During Breast Cancer Treatment

Navigating Sexual Health During Breast Cancer Treatment

Breast cancer treatment can bring a lot of changes—physical, emotional, and relational. Sexual health is a common area of concern, but it’s often overlooked in the course of treatment. Understanding what to expect, communicating with your care team, and exploring practical strategies can help you maintain intimacy, while prioritizing your comfort and safety.

What to expect: how treatment can affect sexual health

Breast cancer treatments vary, but several are commonly associated with changes you might notice in sexual health:

Vaginal dryness and thinning of the vaginal walls** (atrophic vaginitis) due to lower estrogen levels from hormonal therapies or chemotherapy.

Decreased libido** influenced by fatigue, stress, body image changes, hormonal shifts, and medications.

Breast and body image changes** from surgery, hair loss, scarring, or side effects like lymphedema and neuropathy.

Pain or discomfort during sex** due to dryness, vaginal tightness, or radiation-related changes.

Hot flashes and night sweats** impacting comfort and sleep, which can affect arousal and energy.

Fatigue and reduced endurance** making sexual activity seem less feasible on some days.

Partner dynamics and communication**: emotional proximity, fear of hurting loved ones, or concerns about cancer progression can influence sexual connection.

These effects vary widely among individuals and across treatments (surgery, chemotherapy, radiation, hormonal therapy, targeted therapy). Some effects may improve with time, while others persist. Open dialogue with your oncology team, gynecology/sexual health specialists, and your partner is key.

Speaking with your healthcare team

Proactive conversations can make a big difference. Consider these steps:

Bring up sexuality early**: Don’t hesitate to mention sexual health concerns during visits. You can say, “I have questions about how treatment might affect sex and intimacy.”

Ask about vaginal health options**: Many people experience dryness. Options include water-based lubricants, vaginal moisturizers, vaginal estrogen therapies, or non-hormonal alternatives. Your clinician can recommend what’s safe given your treatment plan.

Discuss contraception and pregnancy considerations**: If applicable, discuss pregnancy planning, contraception, and potential risks with your oncologist and obstetric/gynecologic team.

Inquire about pain management and energy**: Fatigue, neuropathy, or pain can affect sexual activity. Treatments or exercises may help.

Seek referrals**: A sex therapist, counselor, or pelvic floor physical therapist can provide specialized strategies for sexual health and pelvic function.

Practical strategies for comfort and intimacy

Prioritize communication**: Honest, compassionate conversations with your partner about desires, boundaries, and comfort levels reduce pressure and build closeness.

Experiment with timing**: Some days you may feel more energetic; plan intimate moments for times when you feel best.

Use lubrication and gentle touch**: Water-based lubricants can ease dryness. Start with non-sexual touch (cuddling, massages, handholding) to rebuild comfort and connection.

Explore non-penetrative intimacy**: Kissing, cuddling, massage, and sensual touch can maintain closeness without discomfort.

Adapt positions and tempo**: Find positions that minimize pressure or discomfort. Communicate, pause, and adjust as needed.

Self-care routines**: Gentle skincare, comfortable clothing, and skincare for sensitive areas can improve body confidence.

Mental health support**: Fatigue, anxiety, or body image concerns can affect libido. Consider counseling or support groups.

Exercise and skin health**: Gentle, approved physical activity can improve energy, mood, and overall well-being. Always follow your clinician’s guidance about exercise during treatment.

Special considerations for hormonal therapies

Many people with hormone-receptor–positive breast cancer receive endocrine therapy (e.g., tamoxifen, aromatase inhibitors) that lowers estrogen levels. While these therapies help prevent cancer recurrence, they commonly cause:

Vaginal dryness and thinning of tissues

Hot flashes

Fatigue

Reduced libido

Management ideas include:

Regular, layering moisturizers or water-based lubricants during sexual activity

Short, frequent lubrication breaks if needed

Vaginal estrogen therapies may be an option for some people, but require discussion with your oncologist due to potential interactions with hormone therapy

Pelvic floor physical therapy to improve comfort and function

Scheduled intimate time to align with energy peaks

Always consult your oncologist before starting any vaginal product that could interact with cancer treatment.

When to seek help

Pain or bleeding during or after sex

Severe vaginal dryness unrelieved by over-the-counter products

Intense fatigue that limits daily life or sexual activity

Persistent low libido causing distress or relationship strain

Body image concerns affecting self-esteem and sexual connection

Your healthcare team can connect you with specialists:

Gynecologist with oncology experience

Pelvic floor physical therapist

Sex therapist or counselor

Oncology social worker or patient navigator

Support for partners and loved ones

Partners play a vital role in sexual health during cancer care. Ways to support include:

Open, non-judgmental conversations about needs and boundaries

Patience and reassurance; understand that sexual interest may ebb and flow

Being present beyond sexual activity—holding, cuddling, affectionate touch

Attending medical appointments if you’re comfortable, to understand treatment effects and timing

Respecting decisions about intimacy while you both navigate the journey together

A personal, hopeful note

Breast cancer care is a marathon, not a sprint. Sexual health is an important part of quality of life, but it’s okay if it shifts in response to treatment. Small, compassionate steps—communication, appropriate products, professional guidance, and patient-centered care—can help you maintain intimacy in a way that respects your body and your well-being.