This blog post was written in collaboration with Gina Franco, MSN, NP-C, Dip ACLM, Director of the Center for Integrative Oncology & Survivorship and Director for Cancer Prevention and Wellness at Prisma Health Institute in Greenville, South Carolina.
Every person’s experience with breast cancer and its side effects and aftereffects is unique. The sexual health conditions described below represent some of the more common challenges women may face after treatment. This is not an exhaustive list, nor will every individual experience all of them. All strategies or recommendations mentioned should be discussed with your doctor or healthcare team before use.
This information is intended for educational purposes only and should not be considered medical or mental health advice. If you are experiencing concerning symptoms or emotional distress, please seek medical care or mental health support. Always consult your healthcare provider about any side effects or changes you notice during or after treatment.
A breast cancer diagnosis touches every aspect of a woman’s life, including how she relates to and sees her body, her connection with herself and others, and even how she is able to experience intimacy during and after treatment.
Shifts in emotional health, physical changes, and body image, while common, can make relationships and sexual intimacy after breast cancer feel frustrating or difficult. These shifts are hard to predict and are in no way a reflection of personal failure, nor do they mean that fulfilling intimate relationships are out of reach.
With time, support, and the right tools, many women find renewed confidence, connection, and pleasure after breast cancer. In this guide, we’ll explore how breast cancer treatment can affect women’s sexual health and share practical ways to manage the changes.
Jump to:
– How breast cancer treatment affects sexual health
– Female sexual dysfunction after breast cancer treatment
– Sexual side effects caused by breast cancer treatment
– Managing common sexual side effects of breast cancer treatment
– Pros and cons of side effect treatment options
– Emotional and intimacy challenges during and after treatment
– Reconnecting with your body
– When to seek professional help
Breast cancer and its treatment can significantly impact women’s sexual health, sexual identity, and relationships. Changes in sexuality and sexual health during and after treatment vary widely from person to person, but it is a far more common issue than many people realize. Studies show that nearly 90% of breast cancer patients report moderate-to-severe changes in their sex life after treatment.
Treatments such as surgery, chemotherapy, immunotherapy, radiation, and hormonal therapy can all play a role in how your body responds to intimacy. Some breast cancer treatments may cause hormonal shifts in your body that can affect you physically and emotionally. Other treatments, such as surgery and radiation, can physically change your body and may affect the way you feel about how you look, which can negatively impact your sexual health and intimacy.
It’s important to remember these changes are not the result of you doing something “wrong” or that there is something wrong with you. They are normal biological responses to the intense cancer treatments that you experienced.
Addressing concerns surrounding sex and intimacy after breast cancer treatment is very important for the overall well-being and quality of life of breast cancer survivors. These topics should be discussed honestly and openly with your partner and your care team to help you achieve the intimate life you desire after treatment.
When a woman’s sexual health is negatively impacted by illness or treatment, it is medically referred to as female sexual dysfunction. In the context of breast cancer, female sexual dysfunction refers to persistent physical and emotional problems with alterations in sexual function as a result of the disease and its treatment.
Symptoms of female sexual dysfunction may include low libido (sex drive or desire), difficulty becoming aroused, painful intercourse, or changes in orgasm. While these symptoms are based on physical causes, they can also be influenced by anxiety, fear, or feeling disconnected from your body, potentially intensifying the problem.
While you should always ask your doctor or care team first, it is generally considered safe to have sex during breast cancer treatment. However, there may be times immediately after treatment or when your blood counts are low due to chemotherapy treatment that you should abstain until your doctor clears you. When blood counts are low, sexual intercourse and oral-genital stimulation should be avoided to help decrease the risk of developing an infection.
When considering sexual activity during breast cancer treatment, it is good for both partners to understand that it may feel different than they are used to, physically and emotionally. Some sexual side effects of treatment may cause physical pain during intercourse or initial penile penetration. Other side effects may cause soreness, vaginal burning, fatigue, or low self-esteem, which can cause you not to want to be intimate or to be intimate less often.
But with clear and open communication with your partner and a support plan from your care team, pleasurable and connective intimacy can still be achieved during treatment.
Each type of breast cancer treatment can impact a woman’s health differently. In addition to treatment side effects, some symptoms may linger even after treatment is complete; these are called aftereffects. Side effects and aftereffects vary from person to person, depending on the type of treatment received and how each person’s body responded to it.
Breast cancer surgery, such as a lumpectomy or mastectomy, is the most common form of treatment for breast cancer. Many women who have breast surgery to remove cancer may also choose to undergo additional surgery for breast reconstruction.
Breast cancer surgery often leads to physical changes in a woman’s body that can bring about emotional, psychological, and relational changes that can affect a woman’s sexual health. By understanding and preparing for these changes, many couples can find solutions that work for them.
Breast cancer surgery may cause the following side effects and aftereffects:
Some types of chemotherapy, such as those commonly used to treat breast cancer, can interfere with normal female hormone function by causing the ovaries not to function properly. This can lead to early (premature) menopause in women who had not yet gone through menopause at the time of their treatment.
Chemotherapy-induced menopause can be temporary, with some women regaining ovarian function after treatment ends, depending on their age. For others, this menopause is permanent.
Premature menopause due to chemotherapy may cause the following side effects and aftereffects:
Radiation therapy to the chest area to treat breast cancer can cause skin irritation and other changes that can negatively impact a woman’s sex life, including:
Hormonal therapy (drugs like Tamoxifen and aromatase inhibitors) can be used to treat breast cancer that is sensitive to hormones, such as estrogen or progesterone, by either preventing hormones from attaching to cancer cell receptors or decreasing the production of hormones altogether.
Many women diagnosed with hormone receptor-positive (HR+) breast cancer are prescribed a course of hormonal therapy to be taken for 5-10 years after their diagnosis. While some regimens of hormonal therapy may cause sexual side effects, it is very important that women complete the therapy at the recommended dose as prescribed to help lower their risk of breast cancer recurrence in the future. If the side effects of hormonal therapy become too problematic, ask your doctor for alternatives or solutions rather than discontinuing the medication.
Side effects and aftereffects of hormonal therapy vary based on the specific drug type and regimen, but common concerns include:
There may be additional concerns about fertility and pregnancy for premenopausal women who wish to have children after breast cancer treatment. Read Does Breast Cancer Treatment Affect Fertility? or consult with your healthcare provider for more information.
Sexual side effects after treatment can feel discouraging, especially if you are not prepared for them. Understanding these changes and knowing they are treatable can help you approach managing the side effects with more confidence.
Before trying to manage sexual side effects of breast cancer on your own, consult with your doctor and care team. Many times, they will be able to offer advice and solutions to common sexual problems caused by treatment. In some cases, medications can be changed to manage a side effect, or a new medication or technique can be introduced to help.
While it may feel uncomfortable or awkward to talk about sexual issues, it is important to remember that you are not alone. Sexual side effects are very common among survivors, and your professional care team is there to help you in every circumstance, even with concerns about sex and intimacy.
Low libido or desire is one of the most frequently reported changes. Fatigue, hormone shifts, emotional stress, and changes to your body image can all lower sexual interest. Many women find that desire returns gradually as they heal, rest, and rebuild connection with their body and partner.
To address the issue of low libido, begin by addressing any underlying psychological causes, such as anxiety and depression. While not often talked about, it is common for patients and survivors to experience anxiety and depression, which can lead to a decreased libido. Side effects of certain medications may also make you feel anxious or depressed. If you feel like you are suffering from anxiety or depression during cancer treatment, speak with your care team to discuss options for treatment.
Individual or couples counseling can also be helpful in treating anxiety and depression during and after treatment. Professional counselors can help you process through body image and self-esteem issues, as well as address any underlying issues of anxiety, depression, or fear.
For many women, it can be difficult to achieve sexual desire, sexual arousal, and/or orgasm due to hormonal changes caused by breast cancer treatment. Hormonal changes can cause decreased sex drive, mood swings, and even pain during penetrative intercourse. In short, you may just not feel like having sex or being intimate like you used to.
If you would like to try to increase sexual desire and arousal during treatment, first address any issues with physical pain during intercourse, such as finding a vaginal lubricant that works well for you, as well as discovering sexual positions and movements that are pleasurable and don’t cause pain. Consultation with your oncology team to learn if there is a professional expert to help identify products to use can also be very helpful.
Spending extra time on foreplay may also help you achieve desired arousal and make intimacy more pleasurable. Also during this time of discovery and experimentation, some patients find that introducing sexual devices, such as clitoral stimulators and vibrators, into intimacy with their partners helps them achieve sexual arousal more easily. These devices can be ordered discreetly online for home delivery.
Additionally, your care team may recommend non-hormonal drug therapy to help increase libido. Potential options include a daily pill that acts in the brain to increase sexual desire, or an injection given before sexual activity to increase sexual desire. Discuss with your provider if non-hormonal drug therapy can be tried.
Low estrogen levels as a result of treatment can lead to vaginal dryness and discomfort, especially during intercourse. Many survivors find relief through the use of vaginal moisturizers that hydrate tissues over time, as well as high-quality, water- or silicone-based lubricating gels (with no perfumes or coloring) during sexual activity.
Over-the-counter, non-hormonal vaginal moisturizers can be used regularly to replenish moisture and relieve discomfort associated with vaginal dryness. Moisturizers are typically applied at bedtime and not with sexual activity. Always consult a healthcare provider for personalized guidance on the best options for your specific situation.
Vaginal lubricants are intended for use during sexual intercourse to increase lubrication, making intimacy more comfortable and enjoyable. Choose a lubricant that is water- or silicone-based and does not include any fragrances, color, spermicides, or other irritants. Apply the lubricant on yourself as well as your partner before and even mid-way through intimacy. As with moisturizers, check with your healthcare provider for personalized guidance on lubricants.
Vaginal estrogen is a low-dose hormone therapy used to treat genitourinary syndrome of menopause (GSM) that causes vaginal dryness, itching, painful sex, or urinary issues by restoring estrogen in the vaginal and urinary tissues. Vaginal estrogen is typically applied using creams, tablets, or a ring, inserted into the vaginal with an applicator or finger, often at bedtime.
In 2025, the American Urological Association (AUA), along with the International Society for the Study of Women’s Sexual Health (ISSWSH), the Sexual Medicine Society of North America (SMSNA), and the Menopause Society (TMS), released new guideline positions on when vaginal estrogen can be used by breast cancer survivors (Guidelines 19-23).
According to the AUA, non-hormonal options, such as lubricants and vaginal moisturizers, should be considered as first-line treatment for genitourinary syndrome of menopause (GSM) in women with a history of estrogen-dependent breast cancer. But if non-hormonal measures fail to provide adequate relief, low-dose vaginal estrogen may be offered after discussing the potential risks and benefits with your care team. This applies to survivors regardless of endocrine therapy (e.g., Tamoxifen) and in women on aromatase inhibitors, with shared decision-making among the patient, oncologist, and gynecologist.
Please note that systemic estrogen taken orally or absorbed through the skin (transdermal) is not recommended for symptomatic relief of GSM in breast cancer survivors due to its known systemic hormonal effects and potential risk of stimulating cancer cells.
Most non-hormonal moisturizers and lubricants are safe to use during and after breast cancer treatment, especially water- or silicone-based options without fragrances or irritants. Check with your care team to make sure vaginal lubricants and moisturizers are right for you. They can help you choose products that will be gentle and effective.
Pain, especially during penetration, can occur due to dryness, changes in the vaginal tissues, or pelvic floor tension. A specialist can help determine the cause of painful intercourse and recommend treatments such as pelvic floor therapy, topical medications, or gradual desensitization techniques.
In the meantime, you and your partner may consider using manual stimulation techniques through external touch of the clitoris, the highly sensitive organ at the top of the vulva, as an alternative to penetrative intercourse. In addition to touching stimulation, you can also experiment with other forms of sexual pleasure, such as caressing, using a vibrator, gently hugging, massage, or oral sex. A note on oral sex: If you are receiving chemotherapy, check with your doctor before giving or receiving oral sex. Chemotherapy can cause blood levels to drop, increasing the risk of infection.
Surgery or reconstruction may cause nerve damage in the chest, thereby altering nipple or breast sensation. Relearning what feels good through gentle exploration, relaxation, and communication can help you create a new sense of sexual identity apart from the breasts.
Consider also exploring other erogenous zones (areas of the body sensitive to sexual stimulation). Areas such as the face, lips, neck, ears, abdomen, buttocks, inner thighs, and even the feet can all feel good when caressed.
While your care team can help tailor your plan to treat sexual side effects, below is an overview of commonly recommended treatments with their pros and cons:
Side Effect | Treatment Option | Pro | Con |
Low libido | Professional counseling | Addresses underlying issues of anxiety, depression, or self-image | Can take a while to process through feelings and emotions and often comes at an additional cost |
Increase foreplay | Can increase sexual arousal and natural lubrication before intercourse | Can be difficult to find pleasure in foreplay if you are not feeling well or are affected emotionally | |
Sexual devices (clitoral stimulators or vibrators) | Can increase sexual arousal and lubrication before or during intercourse, or in place of intercourse | Some women may not feel comfortable introducing devices into their sex life | |
Non-hormonal drug therapy | Can work in the brain to increase sexual desire and libido | May not be an option for all survivors; check with your care team | |
Vaginal dryness/ painful intercourse | Vaginal moisturizer | Can increase the moisture level of the vagina through gradual, long-lasting hydration | Must be used consistently for best results |
Vaginal lubricant | Can add moisture to the vagina before and during intercourse | Some lubricants may cause genital irritation; use only water- or silicone-based products that do not contain glycerin, fragrance, flavors, colors, or warming agents | |
Pelvic floor physical therapy | Can help reduce pain and tension and improve function in the pelvic and vaginal areas | Requires regular appointments, often at an additional cost | |
Other forms of pleasure (hugging, kissing, massage, oral sex, etc.) | Can provide closeness and intimacy without causing pain through penetrative intercourse | May not fully satisfy sexual drive or desire | |
Changes in breast sensation | Explore other erogenous zones (lips, neck, ears, thighs, etc.) | Can increase pleasurable sensations in other areas of the body | May still grieve the loss of breast and nipple sensation, making arousal challenging |
Sexual healing is not just physical; it is also deeply emotional. Many women experience changes in how they see themselves, how they communicate with their partners, and how comfortable they feel with intimacy.
A breast cancer diagnosis can stir up feelings of loss, vulnerability, and fear. Some women feel self-conscious about scars or changes in their breasts or bodies. Others describe feeling “out of touch” with their own bodies during this time. These feelings can create hesitation or anxiety around sex, even long after treatment ends.
Open communication is one of the most powerful tools for sexual healing available. Many couples feel closer when they speak honestly about what feels comfortable, what feels difficult, and what they both hope for moving forward. You don’t need to have all the answers; simply naming what you’re experiencing can open the door to more compassion and understanding. Couples counseling can also help facilitate open, solutions-oriented dialogue.
Relearning to appreciate and love your body after cancer takes time. Gentle practices like repeating affirmations, practicing mindfulness, wearing clothing that helps you feel confident, or exploring sensual—not necessarily sexual—touch can help you rebuild trust with your own body. Many survivors benefit from counseling or support groups, where they can talk through these feelings with others who understand.
Intimacy doesn’t always begin or end with intercourse. Many couples start with slow, affectionate moments, such as holding hands, cuddling, giving massages, or spending time together, without pressure that it will lead to a sexual interaction. As comfort grows, many women may find that their desire returns naturally and gradually.
A breast cancer diagnosis can make you feel like your body has betrayed you, and treatment can make your body feel different and foreign. Reconnecting with yourself is a gentle, intentional process that can restore your trust in your body and help you reconnect with your sensual and sexual side.
Disconnection with your body can occur due to medical procedures, trauma, and fear that create physical and emotional pain, numbness, and change. Reconnecting with your body can help you reclaim a sense of ownership and empowerment. But what does reconnecting mean?
Reconnecting means re-establishing familiarity, comfort, and compassion with your body after a time of pain or change, such as after breast cancer treatment. It’s about approaching yourself with compassion, kindness, and grace as you work to rediscover what feels good, enjoyable, and pleasurable.
Reconnecting with your body goes beyond fulfilling sexual desires and needs. It can be used to help you heal emotionally and mentally from the trauma of a breast cancer experience.
When emotions get heavy, it’s easy to feel stuck. The free Emotional Support Workbook for Breast Cancer Patients & Survivors can help gently transform negative feelings into tools for emotional healing.
Gentle movement, such as yoga, stretching, or walking, can help bring awareness back to your muscles and breathing. Mindful touch, like applying lotion or placing a hand over your heart, reminds your body that safety and comfort are possible again. Creative expression through journaling, art, or music can help integrate and reignite positive emotions and feelings in yourself. These practices can support not only sexual recovery but also your overall well-being.
You are not alone. Professional help through your medical team, professional counselors and therapists, and support groups can help you in your journey back to health—physically, mentally, emotionally, and sexually—during and after breast cancer.
You should reach out to your medical provider, oncology team, gynecologist, or pelvic floor therapist if you experience any of the following:
Professional support for patients and survivors can offer clarity, reassurance, and effective treatment options tailored to your body’s needs. Support is also available for partners of patients and survivors as they adapt to changes in intimacy during and after breast cancer.
National Breast Cancer Foundation is here for you as you navigate a breast cancer diagnosis. Visit our website to learn about NBCF breast cancer support groups, obtain free educational resources, or find a patient navigator in your area.
Sources:
Dana Farber Cancer Institute
American Cancer Society
Medscape
National Institutes of Health
MDPI
University of Michigan Health
American Urological Association
Donations are always appreciated, but there are lots of great ways to get involved.
