• Do some regular light to moderate exercise. This has been shown to reduce fatigue. Even a walk around the block can help. An exercise physiologist or physiotherapist can suggest exercises suited to you.
• Plan some time to rest before having sex.
• Use memories and fantasies, or erotic material to spark your interest.
• Try being intimate at different times of the day.
• Talk to an occupational therapist, cancer nurse or Cancer Council 13 11 20 consultant about ways to manage fatigue.
• Spend time being affectionate with your partner – hugging, kissing and holding hands can help you feel close when you’re too tired for sex.
• See our Fatigue and cancer web page or listen to our “Managing Cancer Fatigue” podcast episode.

• Make time to be with your partner. Plan a “date” or a fun activity to do.
• Enjoy physical contact without sexual penetration. Try skin-to-skin touch, such as massaging each other, or having a bath together.
• Keep an open mind. You could read or watch something erotic, or try toys like vibrators or personal lubricants. These may help spark your interest in sex, or your partner can masturbate, either alone or with you present.
• Touching yourself and gently masturbating can help you learn what feels good. This can also help you explain to or show your partner how you would like to be touched.
• Change the setting. If your home reminds you of treatment, book a night away or use a different room in the house that is not associated with cancer. You could even consider going away for the weekend.
• Rearrange your bedroom or redecorate it once your treatment is over.
• If your usual positions for sex are no longer comfortable, try different ones to find something that feels better.
• Use cushions or pillows to support your body.
• Ask your doctor to check your hormone levels. This may explain some changes in your libido.
• Try different ways of getting in the mood for intimacy – whatever makes you feel sexy, relaxed and good about each other.
• You could wear clothes that make you feel sensual.
• Create an intimate atmosphere by turning off phones and minimising distractions. Or try lighting candles and playing soothing music.
• You could share an erotic fantasy.

After cancer treatment, some people experience tight vaginal muscles (vaginismus) or pain in the vulva or vagina (vulvodynia).

If this happens, a qualified pelvic physiotherapist who specialises in rehabilitation after cancer can help you learn how to relax the pelvic muscles during penetration. Ask your doctor for a referral.

Fear of painful penetration can make tightness or pain worse. You should never try to push though the pain, as this can also make the tightness worse and increase discomfort. 

After some cancer treatments, you may need vaginal moisturisers and lubricants to avoid discomfort during sex. Taking more time to become aroused before and during penetration can also help the vagina relax and lubricate.

Hormonal creams

A lack of oestrogen may cause vaginal dryness after some cancer treatments. Talk to your doctor about whether oestrogen creams or pessaries (tablets put into the vagina) are an option for you.

These may not be suitable if you are having hormone therapy for cancer. Vaginal oestrogen creams may help relieve dryness, a lack of elasticity and bladder symptoms. They are applied in the vagina or on the vulva.

Moisturisers

Non-hormonal vaginal moisturisers (e.g. hyaluronic gels) help restore moisture and lubrication. You can buy them without a prescription. They are usually applied 2–3 times a week at night.

Personal lubricants

These liquids or gels are used during sex. You can put them on the clitoris, labia and vaginal entrance – as well as your partner’s penis or a sex toy. Try applying lubricant during foreplay.

Lubricants can be water-based or silicone-based. Those with a silicone base may last longer. Do not use oil or petroleum-based products (e.g. baby oil or Vaseline), as they can cause vaginal infection and damage latex condoms.

Dryness may cause too much growth of a yeast-like fungus found in the vagina. This is called thrush. It can cause itching, burning, an unpleasant discharge, and pain during intercourse. Some cancer treatments that lower your immunity may also cause thrush.

Talk to your doctor to make sure the symptoms are not caused by other types of vaginal infections. Your doctor may suggest a prescription or over-the-counter cream or medicine. Use a condom during sex to avoid spreading thrush to your partner.

Also avoid soap, bubble bath, scented creams and lubricants with added sugar, as these can irritate your genitals and make thrush worse.

After some treatments, including radiation therapy, sex may not feel the same. Some people lose some feeling in the vagina or labia, which may be temporary or permanent.

It can make sex uncomfortable or less enjoyable, or may make you feel less interested in sex. If your doctor has checked it is not an infection or thrush, these tips may help:

• focus on other parts of the body or genitals that feel good to touch.
• try regular sexual activity of some kind to keep some interest in sex.
• use different sexual positions to find what improves sensation.
• try a vibrator to increase sensation. 
• a sex therapist can show you strategies to help reconnect to your body through sensation and pleasure.

Surgery may shorten the vagina and pelvic radiation therapy may narrow the vagina (vaginal stenosis). Scar tissue from treatments may also cause the vagina to become shorter and narrower. This can make sexual penetration difficult and painful.

These changes to the vagina can also cause thinning of the walls and dryness. Using water-based lubricants or vaginal moisturisers can help. In some cases, your doctor may recommend using an oestrogen-based cream.

A vaginal dilator may help after treatment. It may help to widen your vagina or to keep it supple after you’ve finished radiation therapy. This can make sex more comfortable, and may also make cervical screening easier.

Ask your doctor for a referral to a qualified pelvic health physiotherapist for advice before trying to use a vaginal dilator.

Other tips that may help with changes to the vagina’s size include:

• trying different positions to find what feels most comfortable
• using lubricant to make penetration comfortable 
• applying a non-hormonal vaginal moisturiser
• trying a vibrator or having regular, gentle sexual intercourse
• placing a foam ring around the base of your partner’s penis to reduce pain or discomfort during intercourse.

• Use masturbation to find what feels good for you. 
• Use stroking and massage or guide your partner’s hands or fingers to areas that arouse you.
• Try tensing and relaxing your vaginal and pelvic floor muscles in time with your breathing.
• Try reaching orgasm in other ways than penetration (e.g. oral sex, masturbation).
• Experiment with different positions, like tensing your thighs, closing or opening your legs or pointing your toes.
• Consider using an electric vibrator for the extra stimulation you need to reach orgasm. You can try clitoral stimulation during penetration by touching yourself, or try a sex toy designed for use during intercourse.

• Relaxing your body and mind can help you feel more in control. Try mindfulness, relaxation or meditation. Cancer Council’s Finding Calm During Cancer podcast includes relaxation and meditation tracks.
• Talk to your doctor about medicine to help manage your anxiety. Keep in mind that some medicines may lower your libido or your ability to have an orgasm.
• If thoughts race or are hard to control, cognitive behaviour therapy (CBT) may help. It changes unhelpful thought patterns that affect your sex life. A psychologist or counsellor can support you. Ask your GP for a referral as you may be able to get a Medicare rebate.
• Anxiety can affect sleep, and poor sleep can cause anxiety. Ask your doctor how you can improve your sleep.

After transurethral resection of the prostate (TURP) surgery, semen may go backwards into the bladder, rather than forwards out of the penis.

This is called retrograde ejaculation. It is not harmful, but it does mean that you will be infertile and unable to get someone pregnant naturally.

Some surgery, including prostate removal surgery, stops the body from making semen. This means that when you orgasm, nothing comes out (called anejaculation).

This may feel quite different. Some people say this type of orgasm doesn’t feel as strong or last as long as an orgasm with semen, while others say it’s more intense.

After some types of cancer treatment, including for testicular or prostate cancer, you may leak a small amount of urine (pee) during ejaculation. This is not harmful.

Some people with cancer may experience early ejaculation, before or just after penetration.

After some cancer treatments, including radiation therapy to the pelvic area, you may ejaculate less semen, and the semen may look slightly discoloured. If the urethra is inflamed, ejaculation may be painful for some weeks.

Radiation may also reduce sperm production, which may be temporary or permanent. If you might want to have a child in the future, talk to your doctor or nurse about saving sperm or other fertility options.

• Talk to your partner about the changes. Let them know that it doesn’t affect your enjoyment of sex and that you can still have an orgasm.
• Include lots of foreplay to build arousal and increase your satisfaction. 
• Try to urinate (pee) before sex to reduce any chance of leaking urine. 
• If you or your partner are worried about urine leaks, you can use a constriction ring (available from sex shops) at the base of the penis during sex. It puts pressure on the urethra, which stops urine from passing through.
• Use a condom to catch any urine leaks, or if your partner doesn’t like the changes to the semen you ejaculate.
• Do pelvic floor exercises to improve your bladder control.
• If you are worried about premature ejaculation, try changing to a position that reduces stimulation.
• Ask your doctor or a sex therapist about medicines or numbing gels.
• Use the stop–start technique if you are ejaculating too soon. 
• Focus on enjoying sexual activity. Worrying about controlling ejaculation may lead to erection problems or loss of interest in sex. Counselling may help if your anxiety becomes a concern.
• For men who have sex with men, changes to ejaculation may feel more significant. See our LGBTQI+ People and Cancer booklet.

It’s important not to push through pain during sex. This can often make things worse.

In the female body, pelvic or abdominal surgery, radiation therapy or treatment that affects hormones can make the vagina smaller or less moist, which can make intercourse painful.

Some people experience vaginismus, where the vagina muscles tighten during or before penetration. This is an unconscious reaction, often caused by fear that intercourse will be painful.

Vulvodynia is another condition that causes pain or a burning feeling along vaginal walls during sexual intercourse, often due to dryness or other side effects from treatments.

Ask your health care team for a referral to a qualified pelvic health physiotherapist. They can teach you ways to relax your muscles during intercourse.

Scar tissue in the penis after surgery can cause pain or bleeding, but these usually settle down in time. Surgery or radiation therapy can irritate the prostate or urethra, which can cause painful orgasms.

Anal sex can be painful after radiation treatment for prostate or anal cancer. Consider other ways to be intimate, such as oral sex.

• Plan sex for the time of day when you have the least amount of pain. If you are using pain medicine, take it about an hour before sex so it has time to work.
• Try different positions (such as lying side by side) to find one that may be more comfortable for both of you and puts less pressure on painful areas.
• Use pillows or cushions to help support your body and reduce pressure on sore areas.
• Try relaxation techniques or have a warm bath or massage before having sex.
• If pain continues, ask your doctor for a referral to a specialist pain clinic. Treating pain early and using a holistic approach can lead to better long-term results.
• See our Understanding cancer pain web page and our “Managing Cancer Pain” podcast episode.

• Avoid deep pelvic thrusts. Choose positions where you can control the depth of penetration.
• Use plenty of lubricant. A waterbased lubricant is easier to wash off but a silicone-based one will last longer. Ask your health care team which one is best for you.
• Try to be close to orgasm or very aroused before penetration.
• A women’s pelvic health physiotherapist can give you advice on using vaginal dilators and pelvic floor exercises to help with pain during intercourse. Using vaginal dilators can be challenging, but they may help over time.
• Ask an occupational therapist what products can help with positioning during sex – they may suggest wedges, pillows, electric beds or transfer boards.

• Talk to your partner about the incontinence.
• Wait at least 2–3 hours after a meal, and empty your bowel and bladder before having sex.
• After prostate surgery, try sex with you on the bottom and your partner on top.
• Use thick towels, washable blankets or sheets that wick moisture away. A waterproof mattress protector may help you feel less anxious.
• If you have a catheter for draining urine, tape the tube to your skin, remove the bag and insert a flow valve or stopper before sex. If the catheter is in the penis, fold it back against the penis and cover it with a condom to hold in place. Make sure there’s enough catheter tube for the penis to extend.
• Talk to a continence nurse about using plugs for your rectum if you have trouble with faeces (poo) leaking.

If you had a breast, penis or testicle removed, you may choose to use a prosthesis to improve your self-esteem. This is a personal decision and not something everyone wants. Your doctor can explain your options and what the procedure involves.

If you are worried about how the breast area looks, you may consider nipple tattooing. This can create the colour and shape of a nipple.

• Show your partner the changes. If it feels okay, show them how to touch the area in a way that feels good.
• Be patient with yourself. It may take time to feel comfortable about your body again. 
• Touch your genitals to work out what feels different and what feels good now. You can also explore other parts of your body that make you feel aroused when touched. This may take some time and practice.
• If you feel worried about how your partner (or a potential partner) may react, remember that talking openly can help. Sharing your feelings and keeping an open mind can help you find new ways to be intimate.
• Ask your partner to stroke different areas of your body if your usual erogenous zones have changed. This may include kissing and touching your neck, ears, inner thighs and genitals.
• Look at yourself in the mirror to get used to the changes to your body.
• If you’ve had one or both breasts removed, see our Breast Prostheses and Reconstruction booklet.
• If you’ve had a limb removed, try wearing your limb prosthesis during sex. If you prefer to take off the prosthesis, use pillows to support the affected limb.
• Try a L ook Good Feel Better workshop.
• Talk to a sexual health physician, psychosexual counsellor or sex therapist if your body changes are affecting your sex life or relationship. Visit the Society of Australian Sexologists to find an accredited sex therapist or sexologist, or explore My Cancer Guide.
• Call Cancer Council 13 11 20 to talk to someone about your feelings.

• Remember that sexual attraction is a mix of emotional and physical factors, not just how your body looks.
• Wear clothes, make-up or accessories that make you feel good or highlight your favourite features. 
• Consider showing your partner any changes to your body before sex and tell them what feels okay. Letting your partner look and gently touch these areas may help both of you feel more comfortable with the changes.
• If you feel shy or worried about part of your body, keep that area covered during sex. If you have had breast surgery, you may choose to wear a camisole. You may also want to avoid positions that show the area.
• If your hair has fallen out, you can wear a scarf, hat or wig, or you may prefer to leave your head uncovered. See our Understanding hair loss web page, and  call 13 11 20 or see My Cancer Guide to find a wig service near you.
• If your weight has changed, choose clothes that fit you well. Something too tight or too baggy may highlight changes. You may want to buy a new outfit that helps you to feel more confident.
• Try dimming the lights or using candles when you have sex, to help you feel more relaxed about your body.
• Ask your doctor about plastic surgery or a facial prosthesis if surgery or radiation therapy has affected your face. This may help you regain a more natural appearance and improve the way you speak.
• See a counsellor to help you adjust to the changes. 
• For some people, it may help to spend time looking at yourself in the mirror. This way you get used to the changes to your body. You can use a handheld mirror to see the genital area. Touch your scars so you learn how they feel now.