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Many young adults find that keeping an active sexual relationship with a partner during breast cancer treatment is very important. However, treatments may affect your sexuality. The issues that come up may be temporary or lasting, but most are manageable. Returning to "normal" may take some time. Be patient with yourself.
Hormonal changes
It's common to experience some form of sexual difficulty during or after breast cancer treatment, especially with chemotherapy. Chemo can make the ovaries function irregularly, and lead to changes in hormone levels. These changes can cause symptoms like vaginal thinning or dryness, which may make intercourse uncomfortable or painful. You may also experience changes in libido (desire), arousal, and breast sensitivity, but there are things you can do to make intimacy pleasurable and exciting again. 

Sex during treatment 
Physically, it's usually OK to have sex during treatment. If sex is an important part of your emotional relationship with your partner, be sure to set time aside for it. Also, try some of these strategies:
  • Plan sexual activity for times when chemotherapy side effects are minimal. You may want to wait a few days after each treatment.
  • If you could get pregnant, use non-hormonal birth control, such as a condom or copper IUD.​
  • Follow our suggestions for dealing with pain and discomfort.​

Libido (desire)

Losing the desire for sex is a common experience for young adults during or after breast cancer treatment. Although it can be very distressing, you can get your groove back!

Remember that help is available for you, your partner, or both of you. Don't be afraid to talk with your doctor or a counselor about sexual issues.

A person's libido doesn't typically come back on its own; you have to nurture it. Take it slowly, and make time for intimacy. Start by getting to know your new body, and focusing on pleasure rather than sex. Explore non-sexual sensations that feel good. Notice your whole body, and introduce small pleasures like non-sexual touch into your daily life.
On your own: Many people find it helps to "practice" on their own before becoming sexual with a partner. Among other things, this can shift your attention from the things you're not feeling to the things you are feeling, and which ones are pleasurable. Many people also use a vibrator to jumpstart their libido. It gets blood flowing to the vaginal tissue and can help you identify pleasure spots. Whether you're exploring on your own or with a partner, always be sure to use proper lubrication for comfort. Water-based, unscented lubricants like Astroglide, Liquid Silk, and Sliquid Organics don’t contain perfumes or other irritants and are less likely to cause infections.

With a partner: Once you feel more comfortable with yourself, gradually return to intimacy with a partner. Be sure to share what you've learned about your new body, especially what feels good. This is also a great time to "expand your repertoire." Consider relaxation exercises, extending foreplay, and using fantasy.

Move! Feeling sexy is closely connected to an overall sense of vitality and well-being. So, get moving! Simple, regular activity increases your overall energy, and can boost your sexual vitality. Simple activities include walking, dancing, or gentle yoga.
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Mind over matter: As you re-explore your sexuality, notice negative thoughts or critical "self-talk." Both can take you out of the moment and intrude on intimacy. Be aware of these thoughts, but try not to dwell on them. If you take anti-depressants or other medications that can affect libido, talk with your doctor to see if other options are available.
Pain and discomfort
Pain during sex can distract you from enjoying the experience. To reduce your pain, try to:
  • Plan sexual activity for times when your pain level is lower than others
  • Take pain medicine an hour before planned sexual activity so it has time to take effect. (If your medicines make you sleepy, work with your doctor to adjust the dosage.)
  • Tell your partner what parts of your body are particularly sensitive
  • Find positions that put as little pressure on sensitive areas as possible

Read a Dana-Farber teaching sheet about vaginal dryness and pain during intercourse. 
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Vaginal dryness
​To keep vaginal tissue supple, healthy, and maintain a normal pH balance, consider using a vaginal moisturizer  like Hyalo Gyn or Replens two or more times a week. It is best to apply a moisturizer at bedtime for optimal absorption. In order to make sexual activity more pleasurable and comfortable, it is a great idea to use a personal lubricant. However, lubricants only provide a temporary coating, so you should use a lubricant right before sexual activity. Water-based, unscented lubricants that do not contain added coloring or flavor are less likely to irritate delicate genital tissue. Examples are Pjur, Sylk, and Sliquid Organics. Be aware that lubricants containing glycerin, which is similar to glucose (sugar) can promote yeast infections. If you are prone to yeast infections, avoid glycerin-based lube! Many people also find that pleasure is enhanced by using sexual aids such as vibrators, personal massagers and other sex toys. Sexual aids can also enhance genital blood flow and increase arousal. In addition, those who have vaginal tightness or discomfort may find it helpful to use vaginal dilators. Dilators are a set of silicone or plastic cylinders that help to gently renew vaginal size and elasticity in order to have pain-free sexual activity. You can find a range of these types of products in pharmacies, specialty stores, online or at the Friends' Place at Dana-Farber. You can also speak with your gynecologist for further suggestions. For more information on sexual health and intimacy, visit Dana-Farber’s Sexual Health Program for Cancer Patients and Survivors. 
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Contraception 
If your treatment includes chemotherapy or tamoxifen, you should not get pregnant during treatment. Chemo and hormonal therapies, like tamoxifen, can cause birth defects or miscarriage, especially during the first trimester. Treatment can cause amenorrhea (absence of periods), but you could still get pregnant even if you are getting your period irregularly or not at all. While you are being treated for breast cancer, you should use contraception whenever you have sex. Choose a contraceptive without hormones. 
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​Safe contraceptives for breast cancer patients and survivors include:
• Condom with spermicide
• Diaphragm
• Copper IUD
• Sponge
• Cervical cap
• Tubal ligation for you or vasectomy for your partner (if you're sure you don't want to have biological children in the future)

​Read a Dana-Farber teaching sheet about sexual health and dating.