Sexual Health and Cancer/BMT

How cancer can impact sexual health and reproductive health

We know cancer treatment or bone marrow transplant (BMT) therapy impacts many parts of your life. But what we sometimes don’t talk about is how it may even affect your sexual health.

Sexual health encompasses many different factors. It may include the way you feel about yourself, your sexual orientation or your gender identity. It may also include wanting to feel close to others, wanting to have sex and how your body responds to sex. It’s natural to have questions about how cancer and chemotherapy treatments or BMT therapy could impact your sexual health and any sexual activities you are involved in.

Sex during chemotherapy treatment

When you are undergoing chemotherapy treatment, it is possible for a small amount of chemotherapy or other medicines to pass into the fluids of the vagina or into semen. We recommend that you wait at least 72 hours after any treatment before having sex to protect your partner from exposure. It’s always best to use some type of barrier method, such as a condom.

Birth control and pregnancy for cancer patients

While some types of cancer can impact fertility, it is still possible to get pregnant or impregnate someone during treatment. But it’s important to know that chemotherapy and other cancer treatments or medications can cause birth defects or miscarriages. To prevent pregnancy during treatment, use a condom and one other form of birth control. Your care team is here to help and can prescribe birth control or answer any questions about what types might be best for you.

Infection and bleeding risks from treatment

When you are undergoing treatment, your white blood cells, red blood cells and platelets might be low. Your absolute neutrophil count (ANC) is the measure of your white blood cells, and when that is low, you’re at a high risk for infections. And when your platelets are low, your risk for serious bleeding increases. It is important to know your ANC and platelet count when considering sexual activity with your partner.

You are always at risk for sexually transmitted infections (STIs) during any sexual activity. This can include chlamydia, gonorrhea, human immunodeficiency virus (HIV), genital warts, cold sores and more.  Always use a barrier method, such as a condom, to protect yourself from these infections during penetrative sex.

STIs can feel scary, but your doctor can help. If you think you might have been exposed to an STI or are experiencing symptoms like vaginal, penile or anal discharge, redness, pains or sores, bring it to your doctor’s attention.

Sexual arousal and function

You may feel different about relationships or sex during cancer therapy or BMT therapy, and that’s completely normal. Symptoms of your treatment like fatigue and physical changes in your body may affect your interest in sex, how sex feels (including discomfort or vaginal dryness), how your body usually works (including arousal or erection) or changes in how you feel about your body image.

While these changes may get better over time, talking with your care team can help.  Even though you may feel too tired or uncomfortable for sexual activity, there are other ways to be close to someone, like touching, cuddling, holding, kissing and spending time with your partner.

Fertility preservation for cancer patients

While thinking about having children in the future may seem difficult, it’s something to consider when receiving cancer treatment. We know that cancer or BMT treatments can have a long-term effect on fertility, or the ability to have children. However, there are options for fertility preservation before, during or after treatment, regardless of risk or diagnosis. Our experts in the Fertility Preservation and Reproductive Late Effects Team, alongside your oncology or BMT team, can help you identify which options may be best for you and answer any questions about your future fertility. 

ANC and platelet count for sexual activity

It is important to know your ANC and platelet count before getting involved with any sexual activity as it can increase the risk for infection and bleeding. Learn more about sexual activities and how your counts may affect them in this table.

Activity	ANC	Platelet count	Things to consider
Kissing	No requirements	No requirements	If you have mouth sores from your chemo or an infection, wait until the sores heal. This is because kissing could give you an infection and make your mouth sores worse.
Non-genital touching	No requirements	No requirements	Can include cuddling or touching other body parts (breasts, buttocks).
Genital-to-genital touching	No requirements	No requirements	Use barrier protections, such as a condom, even if there isn't vaginal or anal penetration.
Oral sex	No requirements	No requirements	Use barrier protections, such as a condom.
Masturbation	No requirements	No requirements	If masturbation involves vaginal or anal penetration (like with a sex toy or object), refer to below.
Vaginal penetration	Less than 500	Less than 20 (10*3/mcL)	Use a condom and one other form of birth control if you are having penis-vagina penetration.  Consider using a lubricant that is made to be used with condoms. Vaseline and some lotions can break down condoms, so use a safer option like a silicone-based lubricant instead.
Anal penetration	Less than 1,000	Less than 50 (10*3/mcL)	Use a condom.  Consider using a lubricant that is made to be used with condoms. Vaseline and some lotions can break down condoms, so use a safer option like a silicone-based lubricant instead.  The risk of bleeding is less if you are the insertive partner and not the receptive partner.

Adopted from McGrady et al. Active AND Protected - Developing a "Safer Sex" Handout for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol. Published online 2020 Oct. 20 PMID: 33085558

Birth control for cancer patients

There are many different types of birth control available if you have a uterus such as pills, patches, injections, implanted devices and more. The Fertility Preservation and Reproductive Late Effects Team can help select the best form of birth control for you. It’s important to remember that birth control does not prevent against STIs and using condoms alongside birth control provides the best protection.  

While most birth control methods are safe, there are a few things to consider when choosing birth control during cancer treatment:

• Estrogen risk: Birth control that contains the hormone estrogen can increase your risk for blood clots. Because of this, it is generally recommended that you do not take estrogen-containing forms of birth control as a cancer patient undergoing treatment and for up to six months after you finish treatment.
• Using an IUD: An intrauterine device (IUD) is often safe to keep in place during many different types of cancer treatment. However, the decision to place an IUD at the time of your cancer diagnosis is between you and your doctor and based on the type of cancer.
• Emergency contraception: Emergency contraception, or the “morning after pill,” is safe to use if needed but should not replace a regular birth control method.
• Non-effective methods: Lupron (leuprolide), a medicine that stops your period during treatment, is not an effective method of birth control.

Frequently asked questions

Can I still have sex during cancer treatment?

Yes, but there are several important things for you to know. Chemotherapy may be present in your vaginal fluid or semen. It is best to wait at least 72 hours after chemotherapy to have sex. You should always use a barrier method, like condoms. Sometimes your blood counts may put you at additional risks for complications from sex. Note your ANC and platelet levels.

Can I get my partner sick if we have sex? 

Cancer is not contagious, which means your partner cannot “catch it” from being in close contact with you. However, STIs can be spread through having sex. These infections can be dangerous, so use a barrier protection such as condoms. Discuss with your partner about testing for STIs. You should also wait at least 72 hours after chemotherapy treatment before having sex.

Is birth control safe during treatment? 

It depends on the type of cancer, treatment and birth control. Your oncology care team and the Fertility Preservation and Late Effects Clinic can help you decide what is best for you.

If I have a central line, g-tube or other implanted device, can I still be intimate with another person?

Yes, you can still be intimate with another person despite implanted devices. You must still take care of these devices as you were taught. Talk with your oncology care team if you have any questions.

Why does my doctor need to know about my sex life?

Sexuality is an important and natural part of life for an adolescent or young adult. Your care team’s job is to keep you as healthy as possible during treatment and to give you information about any risks to your health, including your sexual health. Whether or not you are having sex, it is important for you to talk with your care team about any questions or concerns you have.

Helpful resources

It’s important to feel empowered during your cancer journey. Learn more about groups available to help:

• Elephants and Tea
• Stupid Cancer
• Look Good Feel Better
• BMT InfoNet