Many of the problems discussed in this section are common among women and men who have cancer, but some changes affect only men or only women, and others affect people who have had a particular treatment. The changes may be temporary or ongoing.

Fatigue

During and after cancer treatment, many people feel tired and have no energy. Fatigue (extreme tiredness that is often not relieved by rest) can lead to a temporary loss of interest in sex and intimacy. Any form of fatigue should be discussed with your doctor. How long fatigue lasts varies from person to person.

Tips for managing fatigue

• Plan your day so that you have time to rest. Take short naps, rather than long ones.
• Eat as well as you can and drink plenty of fluids.
• Insomnia is common during and after cancer, and can make you tired and irritable. Talk to your doctor about ways to overcome insomnia.
• Save your energy for the most important things. Allow others to help.
• Although you are tired, exercise and fresh air may make you feel more energised. Take short walks or do light exercise if possible.
• Try less strenuous activities like listening to music or reading.
• Ask for flexibility if you are working, e.g. variable starting times.
• Try to be intimate at different times of the day.

Sadness and depression

Depression is very common in cancer patients, but it can be treated. It is natural to feel down after cancer treatment. Changes to your body can be upsetting and it takes time to adjust. You may find that you have difficulty sleeping, lose interest in activities you used to enjoy, don’t feel like eating, or lack energy. Your energy and desire for sex may also be low.

If you suspect that you, or someone you care for, may be depressed, you can find a simple depression checklist and helpful information at beyondblue.org.au.

Tips for managing low mood

• Do things that make you feel good, such as watching funny movies, going for a walk or having a massage.
• Get up at the same time every morning, regardless of how tired you feel. Avoid long naps during the day.
• Try to regain parts of your life from before you had cancer.
• Be as active as possible. Plan activities for each day such as exercise, spending time with other people, or reading.
• Ask your doctor if your mood change could be related to medicines, hormone changes or another illness. Depression is a common result of low levels of sex hormones.
• If feelings of depression are ongoing, tell your doctor about it, as counselling and/ or medication may help. Let your doctor know if sex is important to you, as some antidepressants can affect sexual function and libido.

Fear

Fear is a normal reaction to cancer and its treatment. You might dread the treatment and how you will cope with it. You may be concerned about an uncertain future. People whose partners have cancer often worry that they may lose someone they love. It is difficult to be interested in intimacy when you are feeling afraid.

You may feel less fearful if you find out more about your illness and ask your treatment team what to expect. Think about how you have managed fearful situations in the past and discuss these strategies with your partner or a trusted family member or friend.

Tips for overcoming fear

• Ask your doctor if anti-anxiety medicine will help. Be aware that some medicines may lower your libido.
• Learn how to cope with fear, tension and anxiety by experimenting with different methods.
• Learn mindfulness-based techniques, including deep relaxation and meditation. Relaxing your body and mind often helps you to feel more in control.
• If you feel like your thoughts are becoming negative and hard to control, consider cognitive behaviour therapy (CBT). This can show you how to change unhelpful patterns of thinking that might be getting in the way of a fulfilling sex life. A psychologist could help you learn CBT. You can also call 13 11 20 to ask about online CBT guides.
• Seek counselling. Call Cancer Council 13 11 20, or see a social worker or psychologist.

Different levels of desire

Often in relationships, one partner is more interested in sex than the other. Cancer can exaggerate this. While it may not be a problem for some people, a loss of interest in sex (low libido) is common during cancer treatment.

Cancer treatments may leave you tired and weak, or you may be too worried about the cancer to think about sex. Low libido can also occur when cancer treatments disturb your normal hormone balance. Libido usually returns when treatment is over, but keep in mind that libido can also change with age.

If you don’t want to have sex, talk this over with your partner so you understand each other’s expectations and so they don’t feel rejected. Agree on different ways you can satisfy each other. Explore and discuss the range of videos, websites and adult enhancement products that are available (for example, personal lubricant and sex toys like dildos and vibrators), so that your partner can satisfy themselves, either alone or with you present.

If you feel you need further support or ideas on how to help your relationship get through this stressful time, consider talking to a counsellor or sexual therapist. Speak to your doctor or call Cancer Council 13 11 20 for contacts in your local area.

"My wife went off sex completely during her treatment, which was difficult for me. When we talked about it, and she told me she still loved me, it made me feel better." – David

Tips for when your libido is low

• If you have lost your desire for sexual intimacy, talk to your partner about how the treatment has affected this aspect of your relationship.
• Make it a priority to spend time with your partner. Arrange a ‘date’ or even a weekend away.
• Reconnect by initially trying skin-to-skin touch, such as massaging each other and cuddling naked.
• Suggest a quick, gentle lovemaking session rather than a long session.
• Set the scene with soft lights and music, and dress in something that makes you feel good, sensual and sexy. All of these things may help you get in the mood for sexual activity.
• Keep an open mind. See whether reading an erotic story or watching an erotic movie helps spark your interest in sex.
• Stimulate yourself so you become aware of how you like to be touched.
• Explore different ways to help you and your partner reach satisfaction.
• Try different sexual positions if your usual ones have become uncomfortable.
• Use cushions or pillows to support your weight.
• Change the venue. If your home has been where you and your partner have been coping with the side effects of treatment, book a night away or try using rooms in the house that are not associated with cancer.
• Change the bedroom around or think about redecorating once your treatment is over.
• Ask your doctor about having a hormonal assessment to check your hormone levels.

Loss of sexual pleasure

After cancer treatment, some people find that although they can still have sex, they do not enjoy it as much. This may be because worrying thoughts get in the way, or it might have a physical cause, such as nerve damage or removal of sensitive tissue during surgery. Many women and men are still able to enjoy sex after extensive surgery to their genital areas, but they often need to explore other parts of the body and new methods of stimulation.

Difficulty enjoying sex may also be caused by other types of cancer treatment (such as stem cell transplants), side effects (such as fatigue and nausea) and painful intercourse (see below).

Tips for increasing your enjoyment of sex

• Choose a time when you won’t be disturbed and set the mood with soft lighting, candles and music.
• Place your partner’s hands and fingers on the areas that arouse and excite you – or touch those areas yourself.
• Change your normal positions to more comfortable ones that heighten stimulation.
• Try using a personal lubricant with a water or silicone base, e.g. Pjur, Sylk or Astroglide.
• Use pillows to support parts of your body.
• If you are having difficulty reaching orgasm, see the tips for men and for women.
• Accept that you may not reach orgasm every time. Take the pressure off by focusing on other things that give you pleasure.
• If you find yourself getting distracted, try mindfulness techniques.

Painful intercourse

In men, irritation of the prostate or urethra from surgery or radiotherapy can cause painful orgasms. Some men may develop scar tissue in their penis after surgery. This may cause pain or bleeding, but it usually settles down in time. Anal sex can be painful after radiation treatment for prostate or anal cancer.

In women, pelvic surgery, radiotherapy or treatment that affects hormones can reduce the size or moistness of the vagina, which can make intercourse painful. Fear of pain can cause the muscles around the vagina to become tight (vaginismus), and this can make penetration difficult or impossible.

Tips for making intercourse more comfortable

• Try different positions to find what is most comfortable for both of you if pain during intercourse distracts you from reaching orgasm.
• Plan sexual activity for when your pain is lowest. If you are using pain medicine, take it shortly before sex so it will have maximum effect.
• Try new positions to control the depth of penetration.
• Find a position for touching or intercourse that puts minimal pressure on painful areas. Try to focus on your feelings of pleasure rather than pain.
• Use plenty of water-based or silicone-based lubricant, e.g. Pjur, Sylk or Astroglide.
• Talk to a doctor or sexual therapist if these methods don’t work. A women’s health physiotherapist may be able to advise on the use of vaginal dilators and pelvic floor exercises to help manage painful intercourse.

Changes in appearance

Common physical changes caused by treatment include: weight loss or weight gain; loss of hair from the head and body; loss of a body part and use of a prosthesis; lymphoedema; having a stoma; and scars.

Some cancers of the head and neck result in significant changes to your appearance. This can be upsetting because the change is visible and because kissing, speech and eating may be affected.

It is natural to focus on the part of your body that has changed. You may feel that any visible changes make you less attractive and worry that others will reject you. This, in turn, can affect your sexual confidence and body image.

Look Good Feel Better program

If the side effects of chemotherapy or radiotherapy have affected your appearance, you might want to get in touch with the Look Good Feel Better program. This free two-hour program explains how to use skin care, hats and wigs to help restore appearance and self-esteem during and after treatment. It is aimed at men, women and teens. Call 1800 650 960 or visit lgfb.org.au for more information and to book into a workshop.

"My sexual partner has always wanted to have sex with me – this made me feel good about myself after my surgery and when my head was shaved. He didn’t care – he just loved my body anyway." – Daphna

Tips for adjusting to appearance changes

• Be gentle with yourself at all times and acknowledge how you are feeling.
• Give yourself time to get used to any physical changes.
• Focus on yourself as a whole person and not just the part of you that has changed.
• Talk about your concerns with your partner or a close friend or counsellor.
• Remember that sexual attraction is based on a complex mix of emotional and physical factors, not on a single body part or another physical characteristic.
• Draw attention to your best features with clothing, make-up or accessories.
• Choose well-fitting clothes. Wearing something too
• tight or too baggy will draw attention to your weight loss or gain.
• If your hair has fallen out, you can wear a hat, wig or scarf, or you may prefer to leave your head uncovered.
• Show your partner any body changes before sexual activity. This may allow both of you to get used to how the differences make you feel.
• If you feel uncomfortable about part of your body, you can wear clothes to hide it during sex – e.g. a woman who has had breast surgery may choose to wear a camisole. You may also prefer to avoid sexual positions that leave the area exposed.
• Lower the lights when you have sex until you feel more confident about your body.
• Talk to your doctor about the possibility of plastic surgery or a facial prosthesis if you have had a significant change in your facial appearance from surgery or radiotherapy. This may help you regain a more natural appearance and help with altered speech.

Losing a body part

If your cancer treatment involved the removal of a limb, breast or part of your genitals, it will take time to get used to how your body has changed. For ideas and information on above.

• Look at yourself naked in the mirror to get used to the changes to your body (women can use a handheld mirror to see the genital area). Also show your partner the body changes. Accept that it may take time to feel comfortable about your body again.
• Touch your genitals to feel how your response has changed. Explore other areas of your body that are sensitive to touch.
• If you are worried about the reaction of your partner (or a potential partner), remember that good communication is vital. Talking openly and keeping an open mind will help you explore new ways to be intimate.
• Ask your partner to stroke your whole body. This may include kissing and touching your neck, ears, inner thighs and genital area.
• If you’ve had a limb removed, try wearing your limb prosthesis during sex. If you prefer to take off the prosthesis, support the affected limb with pillows.
• Try to reconnect sexually with your partner – this will help them understand the changes.
• Call Cancer Council 13 11 20 to talk to someone neutral about your feelings.
• Talk to a sexual therapist about the ways the change to your body may be affecting your sex life and relationship.

It is natural to feel a range of complex emotions in response to the loss of a limb or part of your genitals. Your sexual confidence can be affected. Try to remind yourself that you are loved for who you are, not for your particular body parts.

Tips for men

• If one or both testicles have been removed, a prosthesis can be inserted into the scrotum to provide a normal appearance.
• If part of your penis has been removed, you may still be able to have penetrative sex. A penile implant may help with erections.
• Men who have sex with men may face particular issues after some types of surgery. If the prostate is removed, there may be reduced sexual pleasure during anal penetration. Try focusing on pleasure around the anal area, or other erogenous zones. The removal of the anus is a major change, but many men still enjoy other types of sexual activities.

Tips for women

• See a sexual therapist before and/or after any surgery that removes part of your sex organs.
• If a hysterectomy or other cancer treatment has affected your vagina, you may need to adapt your sexual practices.
• If you have had one or both breasts removed, or have had radiotherapy to the breast, you may have to find new patterns of sexual arousal.
• After a mastectomy, the appearance of your breast can be improved with a prosthesis or you can have your breast surgically rebuilt. For more information see Breast Prostheses and Reconstruction booklet or phone Cancer Council 13 11 20.
• If penetrative sex is painful, try these strategies.

Adapting to life with a stoma

Some types of surgery for bowel or bladder cancer create a stoma – an opening in the abdomen that allows faeces or urine to flow through and be collected in a small plastic bag. Often a stoma is needed for only a short time, but in other cases it is permanent.

Different sexual positions should not affect the stoma bag, as long as you have attached it securely. Intercourse via the stoma can be dangerous, and sexually transmitted infections can be passed on through the stoma. Sexual activity for people with a stoma may need a little more planning but can still be satisfying and fulfilling.

Tips for sex if you have a stoma

• Change the bag before intercourse. You may prefer to wear a cover over your bag to prevent the plastic clinging to your skin.
• When making love, women can wear a mini-slip, short nightgown or crotchless knickers. Men can wear a cummerbund, nightshirt, specially designed underwear or boxer shorts.
• Talk to your stomal therapy nurse about whether you can use a stoma cap or a small pouch (a ‘mini’) during sex.
• After a heavy meal, wait for 2–3 hours before having sex.
• Have sex in the bath/shower.
• Use pouch deodorants or wear perfume to help control any odours.
• Allow your partner to see or touch the stoma.
• Contact a stoma association for support. Find one near you at australianstoma.com.au.

Incontinence

Incontinence means poor bladder or bowel control. Temporary or permanent incontinence can be a potential side effect of treatment for cancer of the prostate, bladder, bowel and penis, or of the female reproductive organs. The pelvic floor muscles that affect bladder and bowel control also affect sexual function and interest.

For many people, incontinence, and the impact it has on sexuality, is an embarrassing problem. However, there is help available, and ways to better manage or perhaps even cure the incontinence. Call Cancer Council 13 11 20, contact the National Continence Helpline on 1800 33 00 66, or visit bladderbowel.gov.au.

Tips for managing bladder and bowel issues

• If you have a catheter for draining urine, tape the tube to your skin, remove the bag and insert a flow valve or stopper.
• Use plugs designed for rectal use if you have faecal leakage.
• Exercise your pelvic floor muscles. If you aren’t sure how, see Exercise for People Living with Cancer or phone Cancer Council 13 11 20.
• Plan for sex, wait at least 2–3 hours after a meal, and empty both the bowel and bladder beforehand.
• Prepare your bed with large, fluffy towels.
• Women only: Talk to your doctor about whether oestrogen inserted into the vagina as a cream or tablet could improve things. This may not be an option if you are having hormone therapy, so talk to your doctor.

Fertility issues

Some cancer treatments can cause infertility (inability to conceive a baby), which can be temporary or permanent. If fertility is important to you, talk to your doctor before treatment about your risk of infertility and ways your fertility might be preserved. It may be possible to store your eggs or sperm for use in the future.

When people learn that they may be permanently infertile, they often feel a great sense of loss. You may be devastated that you won’t have your own children or additional children, and you may worry about the impact of this on your relationship or future relationships. Even if your family is complete or you weren’t planning to have children, you may experience distress.

As well as talking with your partner, it may be beneficial to discuss your situation with a counsellor, sexual therapist, oncologist, urologist or oncology nurse.

Fertility after cancer for men

Chemotherapy may lower the number of sperm produced and reduce their ability to move. This can sometimes cause temporary or permanent infertility. The ability to get and keep an erection may also be affected – this is usually temporary. If the problem is ongoing, ask your doctor about options such as sperm storage.

If you have radiotherapy in the pelvic or groin area, you may experience temporary or permanent fertility problems after treatment. If your testicles are outside the treatment area, they can usually be protected.

Fertility after cancer for women

If your cancer treatment involved the removal of your uterus (hysterectomy), you will not be able to conceive. If you retain your uterus, there may be options when treatment is completed, even if your ovaries were affected or removed. For example, you may be able to store eggs for future use before the treatment begins.

In women who are still menstruating, the ovaries produce both eggs and female hormones. This means that if your ovaries are damaged or removed during treatment, you may go through early (premature) menopause.

Tips for managing fertility and treatment

• If you think you may want to have children in the future, tell your doctor before the cancer treatment begins.
• Share your feelings about any fertility issues with your partner, who may also be worried or grieving.
• For more information see Fertility and Cancer or call Cancer Council 13 11 20 to seek information, support and counselling.
• During and after your cancer treatment, ask your doctor what precautions you have to take. You may need to
• use barrier contraception, such as condoms or female condoms, for a short time. This is to reduce any potential risk of the treatments harming a developing baby or being toxic to your partner.
• Tell your cancer specialist immediately if you or your partner become pregnant during treatment.

Erection problems

When a man has trouble getting or keeping an erection firm enough for intercourse, it is called erectile dysfunction (or impotence). For many men, erection problems are a result of anxiety about the cancer, but sometimes cancer treatment damages the nerves.

Erectile dysfunction can sometimes improve. There are also many products to treat the problem, including penile injections, penile implants and PDE5 inhibitor drugs (e.g. Cialis® or Viagra®), which you can obtain through a doctor. There are also herbal preparations, nasal sprays and lozenges that contain testosterone, but check with your treatment team before using any of these.

Tips for managing erection problems

• Try sex with a half-erect penis. Men do not need a full erection to have an orgasm. This may work best with the partner on top guiding the penis inside.
• Help satisfy your partner and yourself without using penetration. Experiment with all-over touching, oral sex, masturbation or sex aids.
• Ask your doctor about taking tablets or having injections to help with erections.
• Use a vacuum pump device, which draws blood into the penis to make it firm.
• Consider having an implant surgically inserted into the penis. A pump is placed in the scrotum and squeezed when an erection is needed.
• If your cancer specialists say it is safe to use with your type of cancer, you could consider testosterone replacement therapy. This may help if you have low testosterone levels.

Ejaculation and orgasm changes

Men who have had their prostate removed produce little or no semen. This means that they may have a dry orgasm, which can be quite a different sensation – some men say it does not feel as strong or long-lasting as an orgasm with semen, while others say it is more intense. They may also experience retrograde ejaculation, where the semen goes backwards towards the bladder, rather than forwards out of the penis. This is not dangerous or harmful.

In some cases after prostate surgery, men leak urine during orgasm. Premature ejaculation can also be a problem for men who are feeling anxious about their sex life.

Tips for adapting to orgasm changes

• Talk to your partner about the issue. Even if you feel you ejaculate too quickly, your partner may be satisfied, especially after lots of foreplay. If you have no semen, explain why and that it doesn’t affect your enjoyment of sex.
• Ejaculate often, perhaps by masturbating, to help control ejaculation and increase the amount of semen ejaculated.
• To minimise urine leakage, empty your bladder before sex. Try wearing a condom to catch any leakage. Pelvic floor exercises can help improve bladder control.
• To improve ejaculation control, explore medicines or numbing gels or talk to a sexual therapist about the stop–start technique.
• Concentrate on enjoyment of sexual activity. Worrying about controlling your ejaculation may lead to erection problems or loss of interest in sex.

Changes to your vagina

Cancer treatments may cause a variety of changes to your vagina, which can lead to discomfort and/or pain during intercourse.

Shortening and narrowing of the vagina

The vagina may be shortened by surgery, and vaginal narrowing can occur after radiotherapy to the pelvis. Doctors may advise you to use a vaginal dilator. You insert the dilator into the vagina for short periods of time to gradually widen the entrance and prevent the side walls sticking together. Although dilators are not designed specifically for use during sexual activity, some couples do incorporate them into their sexual play. Some people find it is more fun to use a vibrator to help gradually widen the vagina.

Tight vaginal muscles

After cancer treatment, some women experience vaginismus, when the muscles around the vagina become tight. This is often caused by fear that intercourse will be painful, and can make penetration difficult. Ask your doctor for a referral to a pelvic floor physiotherapist, who can help you learn how to keep the muscles relaxed during intercourse.

Vaginal dryness

A lack of oestrogen often causes vaginal dryness, which can make penetration during sex painful. You may also become prone to vaginal infections, such as thrush.

Thrush (candida)

Thrush can occur when genital dryness causes an overgrowth of a fungus that is commonly found in the vagina. It can cause itching, burning and an unpleasant discharge, and may make intercourse painful.

Loss of sensation

Some women experience a loss of sensation in their vagina temporarily or permanently, depending on the type of treatment they have had. This can make sex uncomfortable or unsatisfying, or may cause low libido.

See below for tips for coping with these vaginal changes.

Vaginal health

When treatment leads to changes in the vagina, women may need both vaginal lubricants and vaginal moisturisers to prevent discomfort and pain. Some women can also use oestrogen products. Avoid products containing perfumes, oils or glycerine.

Vaginal lubricants (personal lubricants)

These are liquids or gels that are applied around the clitoris and labia and inside the vaginal entrance during sexual activity. You can buy water-based or silicone-based lubricants at supermarkets and chemists. Lubricants with a silicone base may last longer than the water-based ones. Petroleum-based products (e.g. Vaseline) are not recommended as they can increase the chance of a vaginal infection.

Vaginal moisturisers

These non-hormonal, over-the-counter products help to restore lubrication and the natural pH level to the vagina and vulva. They are usually used 2–3 times per week.

Vaginal oestrogen therapy

Prescription suppositories or creams can help restore oestrogen levels in the vagina. These may not be an option if you are having hormone therapy for cancer.

Coping with vaginal changes

Short/narrow vagina

• Use personal lubricant to make intercourse comfortable. Choose a water-based or silicone-based gel that has no added perfumes or colouring (e.g. Pjur, Sylk or Astroglide).
• Use a non-hormonal vaginal moisturising cream several times a week to help keep your vagina lubricated.
• Try a vibrator or regular, gentle sexual intercourse. Experiment with different positions for penetration.
• Use a foam ring around the base of your partner’s penis to reduce discomfort and pain during intercourse.
• Ask your doctor about dilators to widen your vagina. Using dilators can be challenging and some women feel like giving up. Call Cancer Council 13 11 20 and ask to speak to someone who has used a dilator after cancer treatment.

Vaginal dryness

• Avoid soap, bubble bath and creams that can irritate your genitals.
• Use a non-hormonal vaginal moisturising cream several times a week.
• Talk to your doctor about whether oestrogen creams or suppositories are an option with your type of cancer.
• Apply lubricant as part of your sexual play. Choose a water-based or silicone-based gel that has no added perfumes or colouring (e.g. Pjur, Sylk or Astroglide).
• Take more time before and during penetration to help the vagina relax and become well lubricated.

Thrush

• Seek medical advice to rule out other types of vaginal infections.
• Treat thrush with prescription creams or medicines.
• Wear loose, cotton clothes. Avoid nylon pantihose, tight jeans or trousers.
• Avoid using petroleum-based products (e.g. Vaseline) as a lubricant.
• Use a condom to avoid the spread of thrush to your partner.

Loss of sensation

• Focus on other areas of your body and genitals that feel pleasurable when touched.
• Try regular sexual activity of some kind to help maintain your sexual response.
• Experiment with different sexual positions to see whether this improves sensation.
• Use a vibrator to enhance sensation in the vagina and surrounding area.
• Seek medical advice – some women may benefit from a vaginal examination to identify and treat medical conditions such as thrush.
• If your usual contraceptive device or medicine is irritating you, try alternative methods of contraception.

Difficulty reaching orgasm

A woman’s ability to reach orgasm may be unchanged after cancer treatment. However, women who have had their clitoris or other sensitive areas of the vulva removed will have difficulties. Removal of the uterus, cervix and ovaries can also change how a woman experiences orgasm.

Initially, you or your partner might feel that the activities listed below are not ‘real sex’, but if they provide sexual pleasure and connection they are not inferior to intercourse.

Tips for reaching orgasm

• Try different ways of getting in the mood for intimacy: wear clothes that make you feel sensual, shower or bathe together, or have a weekend away if you can – whatever makes you feel sexy, relaxed and good about each other.
• Use stroking, caressing and massage, or guide your partner’s hands or fingers to areas that arouse and excite you.
• Focus on your breathing. Try to tense and relax your vaginal muscles in time with your breathing during intercourse or while your clitoris is being stroked.
• Think about a past sexual experience or use erotic books, magazines or films.
• Set the mood or atmosphere with soft lighting, candles and soothing music.
• Consider using an electric vibrator, which may give you the extra stimulation you need to reach orgasm faster.
• Explore reaching orgasm without penetration. Try oral sex, masturbation or all-over touching.

Early menopause

Menopause occurs when your ovaries stop working and you have not menstruated for one year. This means you will not be able to fall pregnant naturally. For most women, this happens naturally between 45 and 55. Most menopause symptoms are associated with the decrease in your body’s oestrogen levels. These may include irregular periods, aching joints, mood changes, hot flushes, night sweats, sleep disturbance, a dry vagina, increased urinary frequency and ‘fuzzy’ thinking.

Early menopause (or premature menopause) is the term for menopause that occurs before the age of 40. When this happens because of cancer treatment, it may be called induced menopause. The sudden start of menopause can cause more severe symptoms than natural menopause because your body hasn’t had time to get used to the loss of hormones. Premature menopause may also cause bones to weaken (known as osteoporosis or osteopenia).

The loss of menstruation and fertility at a younger age can lead to feelings of grief and low self-esteem. You may feel old before your time or less feminine, and worry that you are less attractive.

A number of cancer treatments can affect your ovaries, either temporarily or permanently, and result in menopausal symptoms or early menopause. These treatments include: surgery in which both of your ovaries are removed; hormone therapy to decrease your ovaries’ production of oestrogen; and radiotherapy and chemotherapy, which may affect your ovaries’ ability to produce eggs and hormones.

If your uterus is removed (hysterectomy) but one of your ovaries remains, you will no longer have monthly periods or be able to carry a child, but you will continue to produce oestrogen and can still go through natural menopause at the normal stage of life. If both of your ovaries and/or your uterus are removed, your periods will stop and you will experience induced menopause.

If you wish to have children, it is important to talk to your doctor about your options before any treatment that may affect fertility.

Tips for managing menopause symptoms

• If your cancer treatment causes early menopause, consider seeing a menopause clinic to discuss the options for managing symptoms.
• Identify and avoid things that trigger hot flushes, such as alcohol, hot drinks, spicy foods and anxiety.
• Eat well, exercise regularly and learn relaxation techniques.
• Ask your doctor whether it is safe for you to use hormone replacement therapy (HRT) to treat menopausal symptoms. There are also non-hormonal options, such as acupuncture, that you could try.
• Antidepressants may help manage depression and/or anxiety, but can lower libido, so talk to your doctor.
• Ask your GP to arrange a bone density test to check for osteoporosis/osteopenia.
• Eat high-calcium foods and/or take a calcium and vitamin D supplement, and exercise regularly to strengthen your bones and help reduce the rate of bone loss.

Key points

• Cancer and its treatment can have a variety of impacts on your sexuality, but there are many treatment options available. It is always worth talking to your health care team about ways to manage sexual issues.
• Communicating openly with your partner may help you overcome any sexual problems brought about by cancer treatment.
• The loss of any body part can affect your sexual confidence. Take time to get used to the changes and explore how your sexual response has changed. Remember that you are loved for who you are, not for particular body parts.
• Loss of interest in sex (low libido) during cancer treatment is very common because you may feel too sick, tired, weak or worried to think about sex, or the treatments may have disturbed your body’s normal hormone balance.
• Physical changes may make some of your usual sexual practices and positions uncomfortable or painful. Try to have an open mind about exploring some new ways of giving and receiving sexual pleasure.
• Some cancer treatments can cause temporary or permanent infertility. If you may want to have children in the future, talk to your doctor before treatment begins.
• If you find that the changes after cancer are getting in the way of a fulfilling sexual life, talk to your GP or cancer specialists about seeing a sexual therapist.

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