Sexual Difficulties and Advanced Breast Cancer Treatment

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Treatment for advanced breast cancer can cause sexual difficulties. This may include:1,2

  • Loss of a desire for sex
  • Pain during sex
  • Difficulties achieving orgasm
  • Numbness or pain in the genitals
  • Problems with fertility

Having breast cancer and undergoing treatment may also cause major emotional or mental effects. This can impact your desire or ability to engage in sexual activity.1,2

Sexual dysfunction may be caused by many factors in people receiving treatment for breast cancer. It can have a big impact on quality of life and intimate relationships. Some side effects of treatment may go away after the treatment is completed. However, other sexual side effects may impact you even after treatment is complete.3

Breast cancer treatment may cause menopause

Some treatments for breast cancer can suppress natural hormones, including:4

These treatments may prematurely cause you to go into menopause. This is called cancer therapy-induced menopause. The premature loss of sexual function that comes with breast cancer therapy-induced menopause can be devastating.3,4

Menopause can cause symptoms such as:5,6

  • Hot flashes
  • Vaginal dryness
  • Vaginal atrophy (thinning of the vaginal lining, drying, and irritation of the vagina due to the loss of estrogen)

Breast cancer treatment can also increase the likelihood of vaginal atrophy. This can cause a lack of lubrication during intercourse, making intercourse painful.6

Some drugs commonly used to treat menopause symptoms in people who have had treatment for breast cancer can also cause sexual side effects. Examples include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Side effects may include reduced libido (desire for sex) and difficulty achieving orgasm. Some of these side effects may be reduced by your doctor lowering the dosage of the medicine.3

Body image challenges

Many treatments for breast cancer can negatively impact your body image. Surgery can cause scarring and discomfort. Chemotherapy can cause fatigue, nausea, hair loss, and weight gain.3

Hormone therapy and aromatase inhibitors may prematurely cause menopause, adding to a rapidly changing body. People undergoing treatment for breast cancer may no longer see themselves as sexual beings. This can compound the physical issues that also cause sexual dysfunction.3

Treatment for sexual dysfunction

While it may be difficult or uncomfortable to bring up the topic of sexual difficulties, it is important to talk to your doctor about all the side effects you are experiencing. There are many treatments to help reduce or minimize the impact of these side effects, including:3,7

  • Vaginal moisturizers or lubricants
  • Topical lidocaine for vaginal pain relief
  • Fractional carbon dioxide laser therapy, which delivers controlled energy to vaginal tissue. This stimulates the tissue to create more collagen, muscle tone, and lubrication. This may be available through a clinical trial.

Communication with your partner is also key. You may want to talk to your intimate partner about the challenges you are facing and how they can help you. Staying open to new ways of exploring intimacy can be helpful.

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