Sex Ed for Survivors: Safety First!

Disclaimer:  This information is not a substitute for medical care.  Always inform your healthcare team of any concerning symptoms you are experiencing, and consult with your provider before starting new treatments, therapies, or health routines.

Safer sex practices are an important part of staying healthy, regardless of your age, gender, sexual orientation, relationship status…or cancer status!  But what does “safer sex” mean in the context of a cancer diagnosis?  You might be wondering whether or not it’s OK to engage in sexual activity with your partner during treatment, or if you can resume your sex life once treatments are complete.

The good news is that most people are able to be sexual throughout and after cancer treatments.  However, there are a few important things for survivors to keep in mind when it comes to staying safe.

Could sex make me sick?

Taking steps to prevent infections that are spread through sexual contact (sexually transmitted infections, or STIs) is a part of Safer Sex 101 for everyone, but certain circumstances may put cancer survivors at an increased risk.  Why?  Well, just like your immune system helps protect against the flu and other illnesses, it also plays an important role in fighting STIs.  Different cancer therapies can affect how your immune system works and make you more susceptible to getting sick⁹.

For example, our bodies depend on healthy, intact skin and mucous membranes to create a protective barrier against germ invasion.  This means that damage to oral, vaginal, or anal mucosal tissue from chemotherapy or radiation can make it easier for all germs, including those that cause STIs, to get into your system.  And if you are going through chemo treatments or a stem cell or bone marrow transplant, your infection-fighting white blood cell (WBC) counts may be low, making it harder for your body to fight off any invaders.

Being immunocompromised or taking antibiotics or steroid medications can increase your risk of genital yeast infections, too⁸.  Although not considered an STI, yeast infections can be passed to your partner via sexual contact.  Women may experience vulvovaginal irritation, itching, pain, or a cottage-cheese like vaginal discharge.  Men may experience genital itching, irritation, or penile discharge.  If you have any of these symptoms, be sure to get checked out by your provider before engaging in intercourse.

Also, if you have been diagnosed in the past with a chronic viral infection that can be transmitted by sexual contact, such as cold sores (HSV-1), genital herpes (HSV-2), or genital warts (HPV), be sure that your oncologist is aware.  If your treatments impact your immune system, you may have more outbreaks or flare-ups⁹.  Certain antiviral medicines may be recommended to prevent this.

What can I do to protect myself?

You might be asked to avoid sex when your WBC counts are low.  But how low is too low?

Good question!  Because of the lack of research on the safer sex needs of cancer survivors, we do not have a definitive answer⁶.  This means that safety precautions pertaining to sexual activity during treatments can be vague and may even differ depending on your doctor or your treatment facility.  If your immune system is working well enough that you can be out in public, you are probably well enough to have sex².  Be sure to clarify with your provider what precautions you should be taking and when.

Since we don’t really know how low is too low, and you can’t tell what your WBC counts are at any given moment anyway (it’s not like you can request a quick blood draw when things are starting to get frisky in the bedroom!), a good rule of thumb is to always use a barrier method, like a condom or dental dam, when you are participating in partnered activity that could lead to direct contact with each other’s mucous membranes or bodily fluids^2,5,6,8.  Erring on the side of caution is always the safest bet, and making a habit of using barrier methods creates consistency and reduces infection risk.

 Could I expose my partner to chemotherapy?

After chemo treatments, your body works to break down and remove the drugs from your system.  The time this takes can vary from person to person and with different types of chemo medications.  Traces of chemotherapy have been estimated to be present in bodily fluids (including vaginal secretions and semen) for up to two weeks² after administration.

Just as the risk for infection with sexual contact has not been well studied in the cancer population, research is lacking on whether or not exposure to these trace amounts of chemo during sexual activity is potentially harmful to the partners of cancer survivors⁶.  Using a barrier method that prevents direct contact with bodily fluids each day that you are receiving chemotherapy, and for one^6,8 to two² weeks after reduces this type of exposure risk.  But again, refer to your facility’s policy and ask your provider to be sure you are following their recommendations.

Could I expose my partner to radiation?

If you are receiving external beam therapy, being near your partner will not expose him or her to radiation².  Some cancers, however, are treated with placement of small radioactive implants in or near the tumor (called brachytherapy).  In this case, you should receive specific instructions from your radiation oncologist regarding close contact with your partner and others, because as long as the radioactive substance or seed is implanted, there is an exposure risk.

Could I accidentally give my partner cancer?

Nope! You do not have to worry that your partner will become infected with your cancer cells or “catch” cancer because of close contact, including sexual contact⁹.  However, it is true that some STIs can increase a person’s risk of developing cancer at a later time.

One example is the human papillomavirus, or HPV.  Certain strains of HPV cause the vast majority of all cervical cancers, and can also cause vulvar, vaginal, penile, and anal cancers, as well as cancers of the mouth and throat¹.  You can protect yourself by using barrier methods during sexual activity and getting vaccinated.  The vaccine for HPV is safe and effective, and it drastically reduces HPV infection and its associated cancer risk (up to 90%!).  Learn more from the American Cancer Society’s website.

When might sexual activity impair healing?

You may be asked to abstain from sexual activities that include penetration if your tumor is located in your pelvic area (such as your bladder, cervix, or rectum) and is at risk for bleeding, or if you are actively undergoing pelvic radiation that has caused your skin or tissues to be damaged. If you are physically healing from a surgery, intercourse may be just one of the many more physical activities you are asked to avoid for a specified amount of time^2,9.

Your provider may also advise you to avoid penetration if your platelets are low, because this puts you at a greater risk for bleeding⁷.  Just like going through chemo or a stem cell or bone marrow transplant can decrease your WBC counts, these treatments can also decrease your platelet counts.  If you notice bleeding after sex, notify your provider.  If it is excessive or does not stop, seek urgent care.

So, what can my partner and I do together?

If you have been instructed to hold off on activities that include penetration or have the potential for bodily fluid contact to mucous membranes (such as oral sex), that doesn’t mean you have to avoid all contact with your partner!  Engaging in snuggles, hand-holding, skin-kissing, or other forms of loving touch is an important part of maintaining connection and closeness at a time when certain types of sexual intimacy may be temporarily on hold⁹.  Ask your provider what activities are safe to participate in right now, and when you can begin to engage in others.

What if I have more questions?

I’ve said it before and I’ll say it again – talk with your healthcare provider.  Don’t be afraid to bring up your questions about specific sexual activities, and if you have a regular partner, he or she may also have questions for your care team.  Taking the initiative to discuss this sensitive subject can take guts, but it’s an important part of getting the information you need to make safe, healthy decisions for you and your partner.  You won’t be the first person that has inquired about sex, believe me.  Just ask!

References:

1. American Cancer Society.  HPV and Cancer.  https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-cancer-info.html, accessed 12/30/19.
2. American Cancer Society.  Fertility and Sexual Side Effects in People with Cancer.  https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects.html, accessed 7/8/19.
3. Center for Disease Control and Prevention (CDC).  How to Use Condoms and Other Barriers, accessed 1/9/20.
4. Green, Laci. (2018) Sex Plus. New York, NY: HarperCollins Publishers.
5. Katz, Anne. (2014) This Should Not Be Happening: Young Adults with Cancer. Pittsburg, PA: Hygeia Media.
6. Kelvin, J.F., Steed, R., Jarrett, J. (2014). Discussing safe sexual practices during cancer treatment. Clinical Journal of Oncology Nursing 18(4): 449-453.
7. Macmillan Cancer Support. (2017). Sex and Relationships, accessed 1/9/20.
8. Memorial Sloan Kettering Cancer Center. Sexual Health and Intimacy, accessed 7/8/19.
9. Schover, Leslie R. (1997). Sexuality and Fertility after Cancer. New York, NY: John Wiley & Sons, Inc.

All of the posts written for Elephants and Tea are contributed by patients, survivors, caregivers and loved ones dealing with cancer.  If you have a story or experience you would like to share with the cancer community we would love to hear from you!  Please submit your idea at https://elephantsandtea.org/contact/submissions/.