Sexual Health and Breast Cancer
Sexual health changes are common side effects of breast cancer treatment—but survivors and thrivers have options
Key Takeaways
- Breast cancer treatments like surgery, chemotherapy, radiation, and hormonal medications can have a negative impact on sexual health. While this is common, sexual changes related to breast cancer are often undertreated.
- Symptoms may include vaginal dryness, reduced libido, pain during intercourse, and emotional changes.
- While it can be difficult to start the conversation about sexual health with your care team, your sexual wellbeing is an important part of your health and deserves attention. Your physicians can help with next steps.
- There are several hormonal and non-hormonal options available to treat sexual health side effects, such as vaginal estrogen, non-hormonal moisturizers or lubricants, pelvic floor physical therapy, and counseling.
Your sexual health as a breast cancer survivor
Even after you finish active treatment for breast cancer, your body is still going through changes. Among the most common and least discussed of these changes are shifts in your sexual health. Surgery, chemotherapy, radiation, and hormonal medications can all have an effect on your sexual health by lowering estrogen or changing how the body responds to intimacy. You may notice vaginal dryness, reduced libido, pain during intercourse, and emotional changes. These are known and recognized side effects of cancer treatment—not personal failings—and the good news is that there are ways to feel like yourself again.
This guide will explain what sexual health changes you may encounter (physical, emotional, hormonal, and relational) after treatment, and how you can navigate them.
Sexual health after breast cancer is affected by surgery, chemotherapy, radiation, and hormone therapies that lower estrogen and alter the body’s response to intimacy. Changes may include vaginal dryness, reduced libido, pain during sex, and shifts in emotional well-being. These are recognized treatment side effects—not permanent conditions—and a range of hormonal and non-hormonal options exists to address them.
Sexual changes after breast cancer are common and often undertreated
As a breast cancer survivor, you likely have concerns about your sexual health after treatment; that is, your physical, emotional, and social wellbeing as it relates to sexuality. Sexual side effects from breast cancer and treatment are normal and well-documented.
How treatment disrupts the body’s sexual response
Different cancer therapies can affect how the body functions sexually.
Surgery: It is common to experience changes in breast sensation and pain or tightness after breast surgery. Concerns about body image and intimacy are also very normal.
Chemotherapy: Chemotherapy can cause hormonal changes such as vaginal dryness and reduced libido, plus general symptoms like fatigue and gastrointestinal pain that make intimacy feel difficult. This can affect 60-85% of women and is often worse during treatment and for premenopausal women, according to BCRF researcher Dr. Carol Fabian.
Radiation: Similar to surgery, body image concerns and changes in sensation after radiation are both well documented. But radiation doesn’t alter the body’s hormones the way chemotherapy does, so more systemic body changes are not as common.
Hormone therapies: Aromatase inhibitors and medications like Tamoxifen alter estrogen and other hormones in ways that can impact sexual response. Approximately 40-85% of women taking endocrine therapy experience sexual side effects, says Dr. Fabian, and it depends on factors such as their age, menopausal status, and medications.
Changes in the genitourinary system
Changes in the genitourinary system (which refers to the reproductive and urinary organs) are especially common during treatments that lower estrogen levels, such as chemotherapy or hormonal therapies. The most common and researched physical symptoms include:
- Vaginal dryness
- Painful intercourse (dyspareunia)
- Genitourinary syndrome of menopause (GSM)
Shifts in libido and arousal
Aside from genitourinary symptoms, other side effects can reduce sexual desire and physical arousal, including:
- Treatment-related fatigue
- Hormonal suppression
- Anxiety and depression
Breast and chest sensitivity after surgery
Having a lumpectomy, mastectomy, or reconstruction can cause reduced sensation and/or increased sensitivity in the nipple and breast.
The emotional and relational effects
Breast cancer and its treatment can cause more than just physical changes. Body image concerns, shifts in self-identity, fear of recurrence, and intimacy challenges can affect relationships with partners. These changes are equally real and equally worth addressing, and, like physical changes, can improve with time.
The vaginal estrogen conversation
Many breast cancers are estrogen receptor-positive, which means they feed off of estrogen. As a result, providers have been hesitant to prescribe estrogen (on its own or combined with progesterone) to alleviate treatment-related symptoms for fear of recurrence. However, vaginal estrogen introduces a much lower dose into the body than estrogen taken systemically (like via a pill or patch).
So far, observational research has shown no increased risk of breast cancer recurrence from low-dose vaginal estrogen. The American College of Obstetricians and Gynecologists (ACOG) says it is safe to consider when non-hormonal options aren’t enough.
There are also many non-estrogen tools that have been shown to reduce sexual side effects of breast cancer, including:
- Non-hormonal vaginal moisturizers
- Vaginal DHEA (prasterone, a steroid)
- Pelvic floor physical therapy
- Vaginal lubricants
- Counseling
Dr. Fabian says that the choice to start hormones should be “shared decision-making” between a woman and her doctor. “One size will not fit all,” she says. “In general, a weak vaginal estrogen combined with testosterone will help with most vaginal or sexual symptoms without increasing breast cancer risk.”
The good news is that different options are available. Talk to your provider to learn what might be appropriate for you.
3 common misconceptions about sexual health and breast cancer
Sexual health after breast cancer treatment can be difficult to navigate. Don’t get stuck on these misconceptions:
- Sexual difficulties are inevitable and permanent.
It is not guaranteed that you will experience sexual side effects from breast cancer and/or its treatment. Everyone’s body is different and reacts differently. - Vaginal estrogen is the only or automatic answer.
Plenty of non-hormonal options are available to support your sexuality after breast cancer. - Sexuality is too minor a concern to raise with a care team.
Your sexual wellbeing is an important part of your health and deserves attention.
Starting the conversation with your care team
It’s natural to feel nervous about discussing your sexual health with your care team. But your providers want you to feel your best during and after treatment, and your sexual health is vital to that. Being open and honest gives providers like your oncologist, gynecologist, and pelvic health physical therapist the opportunity to assist you. Be proactive: Don’t wait for someone else to bring it up.
“Women need to ask their provider up front to help them with this,” says Dr. Fabian.
You could start by saying you’ve noticed some changes in your sexual health that you would like to discuss as part of your care. Then, be as specific as possible: Describe what has changed and when you noticed it. Your provider will use that information to evaluate what might be causing the changes and how to best address them. He or she may also refer you to another specialist. You don’t have to have all the answers or a treatment in mind in order to start the conversation. Today, thanks in part to BCRF research, there are more survivorship resources than ever before—which means you have options when it comes to taking care of your sexual health after breast cancer treatment.
Supporting your whole self after breast cancer
Sexual health is a legitimate, researchable, improvable part of survivorship. Understanding how breast cancer affects your sexual health can help you feel seen, informed, and ready to advocate for yourself with your care team.
Support the research to make better survivorship outcomes possible. Donate, start a fundraiser, or explore other ways to give today.
Frequently asked questions
Yes, certain breast cancer treatments can affect fertility and the ability to become pregnant later. Some treatments, like chemotherapy and hormonal therapy, can reduce fertility and/or make it harder to get pregnant. However, many people are still able to conceive after finishing breast cancer treatment. Fertility preservation may be an option; it is ideal to discuss this with your care team before treatment starts.
Absolutely. Sexual health is an important part of your wellbeing, and your concerns can lead to depression, anxiety, and other mental health symptoms. Negative feelings around sex can in turn make intimacy feel unappealing. Sexual health isn’t just an optional part of your care—it’s essential to your wellbeing during and after treatment. That’s why it’s important to address it with your care team just like you would any other survivorship concern.
Younger women being treated for breast cancer may enter early menopause because certain treatments alter hormone production. Unlike menopausal changes that come gradually with age, medical menopause tends to develop more abruptly. However, hormonal and non-hormonal treatments can help alleviate symptoms. Younger women may also experience fertility challenges as a result of breast cancer treatment. Speaking with your care team about fertility preservation (ideally before treatment starts) can help you feel prepared and informed about your options.
For post-menopausal women, the concerns may be different, but are equally valid. While menopause symptoms may not develop as rapidly, breast cancer treatment can make existing changes more intense. Again, a variety of hormonal and non-hormonal options exist to support you through these changes.
Yes. It is not necessarily a reflection on your attraction to each other. You have been through a major life stressor and that can certainly impact intimacy. Having open conversations with your partner about how you’re both feeling, any concerns you have, and what feels right for you is a good place to start. You may also consider seeing a sex therapist or couples counselor who can further support you.
Pelvic floor physical therapy can be especially helpful for breast cancer patients and survivors experiencing painful sex and other intimacy concerns. A pelvic floor therapist can evaluate the muscles of your pelvic floor to see how they are working together and if they are too tight or weak. The therapist can then recommend exercises or treatments to improve symptoms. Pelvic floor therapy can be part of a comprehensive plan to address your sexual needs as a breast cancer survivor.
