Many women find that secondary breast cancer has an effect on their sex lives. This can be due to the physical effects of the cancer or its treatment, or because of the emotions or the feelings that cancer can cause.

Our section on sexuality has detailed discussion about all aspects of cancer and sexuality which you may find helpful.

An early menopause can be caused by chemotherapy or hormonal therapy. This can lead to uncomfortable menopausal symptoms, such as hot flushes and dryness of the vagina. As the early menopause has been caused by treatment, any symptoms may appear suddenly and will be more severe than those for women who have a natural menopause. This can be very distressing.

Some of the most common effects are discussed below.

Hot flushes

Hot flushes often happen at night and can make you feel very uncomfortable. Although they don't have a direct physical effect on sex, if you are feeling irritable and uncomfortable you will obviously feel less like making love.

You may feel more comfortable if you wear loose cotton nightclothes, or sleep naked, and have cotton sheets or a light duvet on the bed. Leaving a window open in the bedroom at night may also help you to feel cooler. This distressing symptom will pass gradually as your body becomes used to the lack of oestrogen.

Lower sex drive

Changes in hormone levels can reduce your sex drive. It is important to let your partner know if you do not feel interested in sexual activity. It can help to explain how you feel so that they do not feel rejected. You can also suggest what you are happy to offer as an alternative – such as, 'I don't want to have sex but would love to give you a cuddle'. If there is tension between you, you may find it helpful to get support from a counsellor who specialises in offering help in these circumstances.

Tiredness

If you have fatigue (continual tiredness that is not relieved by rest) and do not have much energy it might help to make love differently. Less energetic positioning, where your weight is well supported, can reduce strain. You may prefer shorter sexual contact rather than longer sessions.

These are things you can talk about together. You could try identifying times when you feel most energetic and set aside some of this time for lovemaking.

Vaginal dryness

You may have vaginal dryness due to lower levels of oestrogen. This means that the vagina cannot produce enough moisture when you are sexually aroused. It may make intercourse difficult and uncomfortable.

This can be helped by a number of creams and gels that can be applied directly into the vagina. Replens® is a non-hormonal cream available from most chemists. It is applied 2–3 times per week and works for about 72 hours at a time. The cream binds to the vaginal wall and the water held within it re-hydrates the cells and boosts the blood flow in the vagina.

Ovestin®, Ortho-gynest®, and Premarin® are available on prescription from your doctor. They contain a very small amount of oestrogen and can be used as a cream or a pessary. The effect in the vagina is short lasting. Vagifem®, also available on prescription, is a tablet that can be inserted into the vagina up to twice a week. It also contains a small amount of oestrogen. Although the amount of oestrogen in these products is very small there is a small risk that they may increase the amount of oestrogen in the body. As a result, women who are taking aromatase inhibitors (such as Arimidex®) should talk to their doctor before using hormonal vaginal creams, gels and pessaries.

Water based lubricants such as KY Jelly, Senselle®, Astroglide® and Sylk® which can be brought at a chemist, can help to increase moisture levels, making sex easier. Some women prefer to use glycerine: it is cheap and not embarrassing to buy as it has many uses.

Unfortunately, since HRT contains oestrogen, which could theoretically encourage the growth of breast cancer cells, doctors generally do not recommend women with secondary breast cancer to have this treatment, although it may be safe for women with oestrogen-receptor negative cancer. Studies have shown that it is not generally safe to take HRT if you have a cancer that has oestrogen receptors (ER) on the surface (ER positive).

Drugs, such as progesterone tablets or a type of anti-depressant called venlafaxine (Efexor®), can help relieve hot flushes and are safe for women with secondary breast cancer to take. Some complementary therapies such as acupuncture or homeopathic remedies can be helpful. You could ask your doctor about medicines which may help.

Loss of their ability to have children causes a great deal of distress to many women. They may grieve deeply for the loss of their chance to have a child or to have more children. Women may also feel less feminine.

Sometimes these emotions are too strong to cope with alone. It may help to talk over your feelings with your doctor or specialist nurse. A trained counsellor can be invaluable in helping you work through emotions which threaten to get too much for you. Your partner may also have feelings of sadness and may benefit from being included in such discussions. They may want to see a counsellor on their own.

Our cancer information and support service can tell you more about counselling and let you know about services in your area.

Anxiety can make it harder for you to get aroused − worry can push everything else, including sex, to the back of your mind.

Communication is an important part of a healthy sexual relationship. It may help to overcome sexual problems if you talk about your concerns with your partner and plan ways to cope with any problems which will suit both of you.

Controlling symptoms is important. Anti-sickness drugs and painkillers are very effective and you could try to plan your doses so that they have a maximum effect when you most like to make love.

The most important thing to remember is that there is no medical reason for you to stop making love if you have secondary breast cancer. Cancer is not contagious and sex will not make your cancer worse.