A Guide on How to Have Sex After Chemotherapy

By Dr Claire Giuliano

Are you wondering if you can have sex after chemotherapy? Well, the short answer is yes. Most individuals may feel like engaging in sexual activity during and after chemo treatment should be limited or null, though this is not always the case.

Follow the general guidelines outlined below so you and your partner can enjoy intimacy in familiar and new ways during a difficult time.

Why should you wait to have sex after chemotherapy?

Chemotherapy can be an emotionally taxing journey, and finding intimacy during this time can be helpful as a means to establish normalcy and distraction during a difficult time. In general, it is safe to have sex after chemotherapy, but certain precautions should be taken to keep yourself and your partner safe.

Risk of infection

In some cases, chemotherapy can cause a very low white blood cell count, which can in turn be a risk for infection. If this is the case, it is best to avoid penetrative sex because of the risk of infection. Your doctor may recommend waiting to engage in sexual activity until your white blood cell count has returned to a healthy level.

Tissue thinning

Chemo and radiation can also cause thinning of tissue, which can lead to bleeding during intercourse. If any pain is experienced when engaging in sexual activities during cancer treatment, then sex should be avoided.

Bodily fluid transfer

Bodily fluids can transfer chemotherapy drugs to your partner if you are engaging in penetrative sex, so it is important to use a condom or dental dam so that no fluids are exchanged.

When is it safe to have sex after chemotherapy?

Consulting with your doctor is always the first line of action so that individual concerns about sex can be addressed. In many cases of chemotherapy, doctors will recommend waiting 48-72 hours after treatment to engage in intercourse because bodily fluids will have lower levels of chemotherapy. Fluid barriers such as condoms and dental dams may still be advised for use after the 72-hour period by your healthcare provider. However, take the type of cancer and subsequent chemotherapy treatment into consideration.

Cancer of the pelvic organs

If an individual is going through chemotherapy treatment for cancer of the pelvic organs, different precautions should be taken for engaging in sexual activity. Seeing a pelvic floor therapist after chemotherapy or radiation can greatly help guide an individual in their journey to assess pelvic floor muscle strength, stability, and general tissue integrity prior to returning to sexual activity after chemo. Remember: this timeframe will be different for each person.

Prostate cancer

Prostate cancer treatment sometimes involves radiation pellets implanted into the prostate gland. In this case, radiation may be active for up to 10 months following implantation. Penetrative sexual activity during this time should be avoided for the safety of the partner.

Surgically excised cancer

If cancer was surgically excised during treatment, such as a mastectomy or hysterectomy, then physical touch to these areas should be with extreme caution or completely avoided during any kind of sexual activity for at least 8 weeks after chemo treatment.

If excision was performed in the pelvis or to a pelvic organ, then penetrative intercourse should be avoided at least 8 weeks or until the tissue has fully healed and there is no pain to gentle touch. Seeing an occupational or physical therapist who specializes in manual therapy and scar tissue healing will be of great benefit to the cancer survivor, and will ultimately make the journey to sex after chemotherapy an easier one.

Sex drive after chemo.

Chemotherapy is physically and emotionally exhausting for most individuals. Many cancer patients going through chemotherapy treatment will not have the energy to engage in sex during this time. Side effects of chemotherapy such as tissue thinning may also render intercourse as very painful, which will create a decreased desire for sex. In late-stage cancers, the body is putting energy toward survival and healing, so this hormonal and cellular effort will draw focus and energy away from one’s libido.

How to ease back into sex after chemotherapy.

Outercourse can be a safe and intimate way to ease back into sex after chemotherapy. Outercourse, or non-penetrative sex, is the act of sexual activity without penetration.

"Outercourse can increase closeness and trust between partners, while also helping partners better understand each other’s bodies and desirable ways to be touched that are non-penetrative."

Outercourse can also involve writing love letters, sending sexual text messages or emails, wearing sexy or revealing clothing, undressing in front of your partner, making erotic eye contact, or watching pornography together. Any activity that couples or individuals find arousing that are non-penetrative are optimal ways to ease into sex after chemo.

Can you have unprotected sex after chemotherapy?

Unprotected sex after chemotherapy is safe after the 72-hour period in regard to fluid exchange, but your doctor or healthcare provider may recommend a longer period depending on the type of cancer or treatment undergone. Pregnancy during chemotherapy should be avoided due to risks of birth defects from the chemo treatment. If you are planning to get pregnant after chemotherapy, this should be discussed with your doctor because the timeframe for each individual may vary greatly.

What can you do in the meantime?

Sexual activity does not always need to be penetrative! There are many other ways to express love and affection with your partner whilst waiting to have sex after chemo.

Vibrators

If you have a strong desire for penetration during chemotherapy and there is not a risk of bleeding from tissue thinning, then a vibrator can be a great option for sexual activity. This option should always be discussed with your healthcare provider first and is safest if the cancer is not in any of the pelvic organs.

Kissing and hugging

Kissing can be an act of intimacy for couples if 72 hours have passed since the last chemotherapy treatment due to fluid exchange. Hugging and cuddling can be a great means for intimacy, as well as talking about sexual fantasies with your partner or writing down sexual fantasies to plan once it is safe to resume after treatment.

Outercourse

As mentioned previously, engaging in other types of outercourse (writing love letters, sending sexual emails and texts, romantic nights in, watching porn, etc.) are also ideal ways to find intimacy with your partner while waiting to have sex after chemotherapy.

The bottom line.

The good news is you can engage in sexual activity and intercourse during and after chemotherapy, but it is important to take the aforementioned precautions seriously. Remember to always discuss any concerns with your doctor or healthcare team first, because they will be the best at answering individualized questions during your journey.

Starting slow and playing it safe is always a good rule of thumb. Using protective barriers is a good habit with penetrative intercourse during chemotherapy. Remember that many of these precautions will be temporary, and sexual intimacy is not exclusive to one method. Embrace the new change in your sex life as best as you are able and celebrate any intimacies as small victories in your healing journey.

Claire is a pelvic floor therapist with a distinct specialty certification in pelvic rehabilitation (PRPC). She is the private clinic owner of Rooted Pelvic Health & Hand Therapy in Sun Valley, Idaho. She treats all gender diversities for pelvic floor-related conditions including sexual dysfunction, gynecological cancer recovery, and chronic pelvic pain. Claire's mission is to improve overall function and quality of life with lasting results for her clients. As a contributing writer to Pepper Together, Claire seeks to provide education about a subject that deserves more attention. She hopes that by spreading the word about pelvic floor conditions she can break the stigma about conversations around sex, and provide simple solutions to improve sexual intimacy.