Sexuality is very personal and means different things to different people. Cancer and its treatment can have a big impact on sexuality. How it affects you will depend on the type of cancer you have, as well as the treatment and its effects. But cancer does not mean an end to your sexuality. With support and clear communication, you can still enjoy a fulfilling sex life.

When someone becomes ill, it can affect their ability to feel good about themselves sexually. It might also affect their physical ability to give and receive sexual pleasure. Some changes may only be temporary, but even if the changes are long-lasting, or permanent, you can find ways to adapt sexual techniques, or discover new ones. Alternatively, you may need to focus more on sensuality than sexuality at this time. Using touch can be an important way of telling someone how you feel and help you communicate emotions which are not easily expressed in words.

Remember that you are a unique person. When considering sexuality it’s important to focus on your own needs and desires. You can change your mind, find new things pleasurable and communicate in new ways. You can aim to feel good about who you are, and how you choose to share that with others.

Cancer or its treatment can affect your:

• physical ability to give and receive sexual pleasure
• thoughts and feelings about your body (body image)
• emotions, such as fear, sadness, anger and joy
• roles and relationships.

All of these are linked, so if there is a problem in one of them it may have an impact on another.

Tiredness is a common problem and can be due to either the cancer or its treatment. Fatigue can make people lose interest in sex during and after cancer treatment.

Pain Pain can reduce sexual feelings and reduce desire.

Sexual desire varies from person to person. Often one partner may be more interested in sex than the other. Cancer can exaggerate this.

Body image is the mental picture we have of our own appearance. This image may not come from how we actually look, but rather from how we think we look. A change in body image can cause a person to feel many different emotions including, anxiety, shame and embarrassment. The reactions of a partner can influence these feelings.

Feelings can have a powerful influence on our sexuality and our sexual behaviour. Being told you have cancer often causes many strong emotions which may make you less interested in sex. You can become pre-occupied with other worries such as financial concerns. Normal, everyday feelings can be intensified. This can be exhausting and may lead to a loss of interest in sex, although some people feel an increase in sexual arousal. You may feel that you have enough to worry about without concerning yourself about sex.

Partners of a person with cancer may be afraid to touch them intimately for fear of causing pain. They may lose desire themselves as a result of changes in the person with the cancer. Partners may be afraid that they might 'catch' cancer through sexual contact.

A change in role can occur as a result of being diagnosed with cancer. You may not be able to do all the things you used to do before the diagnosis. For some people, fulfilling their role as a mum, dad or breadwinner is part of their sexual self-esteem.

The main treatments for cancer are: surgery, radiotherapy, chemotherapy and hormone therapy. They can all affect sexuality.

Surgery in the pelvic area – for example, removal of the womb (hysterectomy) in women, and removal of the prostate gland in men – can affect the nerves in that area. This can alter the sensation of orgasm for women or affect a man’s ability to get and maintain an erection (impotence).

Radiotherapy to the pelvis can cause soreness in the area. It can also cause tiredness. Pelvic radiotherapy in women may cause a narrowing of the vagina and may also lead to an early menopause. Pelvic radiotherapy in men may cause impotence.

Chemotherapy can have a temporary effect on a person’s sexuality. Tiredness can cause a lack of interest in sex; it can bring on the menopause in women and this may cause vaginal dryness; men may experience a temporary lowering of their sex drive.

It is thought that chemotherapy drugs cannot pass into semen or vaginal fluids. However, just in case, most hospitals advise that people having chemotherapy use condoms for a few days after the treatment has been given.

Hormone treatments may be given to some women with breast cancer and men with prostate cancer. They can cause menopausal symptoms in some women. In men hormonal therapy reduces the level of testosterone being produced in the body and this can have a major effect on their sex life. They may have a lowered sex drive and also have difficulty getting and keeping an erection.

There are a number of different things that can help couples to have a fulfilling sex life.

• Let your partner know if you don’t feel interested in sex.
• It is important to relax and make time for you and your partner.
• If you are very tired it might help to make love differently, for example, less energetic positioning or quicker sexual contact, rather than longer sessions.
• If you have pain or discomfort, plan to make love after taking pain medicines. Use pillows and cushions to help you be more comfortable. It may help if the person who has the pain takes control over the depth and speed of penetration.
• Medicines and other devices can help with problems such as vaginal dryness and erection problems. You can discuss this with your doctors or nurses at the hospital.
• If you’re feeling self-conscious about how you look, talking with your partner about how you feel can help you regain some confidence. Focus on a part of your body that you like and use this as a foundation to build confidence in your body. Practical ways to help might include making love while partly dressed, or keeping the lighting low.

There are a number of organisations that can help couples who are having problems with their sex life. Although it might feel embarrassing to talk about at first, most people find it helpful to get some support.

There are no right or wrong approaches – what is important is what works for you as a couple. For some, not having penetrative sex may be fine, and they will be able to give and receive sexual pleasure in other ways. How you touch and hold each other will show your feelings for each other; holding each other closely or using massage are all ways of physically showing your love.

It’s important to remember that having sex does not cause cancer and will not make the cancer worse.