Advice about sex after a breast cancer diagnosis

Sex and intimacy can be challenging during and after a breast cancer diagnosis. This article provides some insight into why it is normal to experience difficulties in area, together with some practical advice.

By Sam Evans

As someone who advises many women about enjoying sex after breast cancer I know that many are able to return to having a pleasurable sex life. It may not be the sex life they enjoyed before breast cancer, it may feel different or more intimate and pleasurable. Having breast cancer does not mean your sex life has to stop, there are so many ways to regain your sexual function and enjoy sexual intimacy and pleasure whoever you are. Sex is fun, noisy, messy, consensual and most of all pleasurable.

“Sex can feel like a work in progress during breast cancer treatment and beyond so take your time and have some fun too”

Lack of libido and interest in sex

This is a frequent issue that affects many women and their partners. Recovering from breast cancer can leave many women feeling unattractive, suffering from low libido, decreased sexual satisfaction and experiencing painful sex. Many women report sexual problems after completing their treatment, either as a result of the treatment or physical changes in their bodies. Any form of cancer can impact upon a person’s sexuality but it can be more problematic after breast cancer, because the breasts are intimately connected with sexual attractiveness and erotic play.

Being thrown into a surgical or medical menopause can be difficult to deal with as it happens overnight unlike a natural menopause whereby the symptoms slowly impact upon your wellbeing.

Oestrogen plays an important role in our sexual function and libido so any decrease or loss impacts upon our sexual wellbeing in a variety of ways. These include physical symptoms such as night sweats or itchy skin, leaving you with little desire to be touched or feel sexual, vaginal dryness and tightness which makes sex fell less pleasurable, decreased sexual sensation which may leave you struggling to orgasm or find it takes longer and psychological issues about the way your body looks or how your partner views you.

Fatigue can take its toll on your body too. The key is to take things at your own pace: you can take a less active role during sex. Taking it slowly may increase your sexual arousal more, and by exploring new sexual techniques you may discover areas of sexual pleasure you have never experienced before.

If you feel physically drained in the evening, try having morning sex or sex during the day. Spend the afternoon in bed rediscovering each other or yourself.

This is why it is important to realise that getting back to sex after treatment is a gradual process and cannot be rushed. Taking your time, going at your own pace and exploring new ways to enjoy sexual intimacy and pleasure will help you to discover your libido.

Communication

As in any relationship, long term or new this is important. The way in which you communicate with each other is important: often, one partner will highlight a problem or issue that the other partner has never considered or may consider to be trivial. It is not always easy to talk about sex, but finding the right environment for both of you is essential. You need to consider how you share sexual pleasure and what has changed within your relationship.

You may find your sex life changes for the better as you become more intimate. You may find sex becomes more pleasurable as you explore different ways to enjoy sexual intimacy. Couples often say they enjoy more intimacy because they have had to be more creative with the way in which they now enjoy sex, from spending more time on sex play, intimate touch, talking about intimacy and pleasure, exploring sex toys and enjoying different sexual stimulation.

Good communication can help allay any negative feelings either of you are having about sex and your relationship. If you find you are continuing to struggle, speak to your GP or clinical nurse specialist about being referred for psychosexual therapy or couples therapy. but some women still experience sexual problems.

Boosting your libido

Being about to take hormone replacement therapy ( HRT) can help boost your libido but not everyone can or is able to post treatment. Exploring new ways of sexual intimacy, such as sex without penetration ( if this is how you enjoy sex), using sex toys or bondage to explore each other’s bodies, read erotic fiction or watch films to increase arousal. Tell each other what feels good and what is uncomfortable.

Breasts play an important part during sex, especially if you enjoy having them stimulated. Losing a breast (or both breasts) or changes to your breast can impact upon the way you feel about being a sexual being and your sexual satisfaction. Your partner may be affected by the way in which you look if they gain sexual pleasure from the look or feel of your breasts which is why you both need to talk to each other.

Following surgery, your breast may feel more sensitive or may have areas of numbness. It can be helpful to your partner who may be worried about hurting you if you tell them where and how you would like to be touched, or even guide their hand so they know how to touch you and what pressure they can use. Scar tissue may feel very sensitive or numb so guide your partner in how you want to be touched and let them know if you would prefer no to be touched in this area. They may be concerned about hurting you if they touched you so giving them guidance helps.

If you do not like having your breasts touched, try other parts of your body such as neck, ears, lips, thighs and genitals for sexual stimulation. You may find that you experience decreased sexual sensation in your clitoris and vagina so using a simple sex toy and a good sexual lubricant can help. Try massaging each other with scented oils or take a long, hot bath, soaping each other all over. Sex toys, feathers, silky scarves, textured gloves, ice cubes are all great ways to create different sensations across your skin, on nipples, on the back of the neck, up and down the spine.These simple techniques can help you to reconnect sexually.

Regular orgasms

Masturbating and regular orgasms can help increase your arousal, either alone or with a partner, in addition to your own natural lubrication which helps to keep your vagina happy and healthy. Orgasms help you to relax, boost our happy endorphins, can alleviate pain and help couples enjoy intimacy together. If you find you are struggling to orgasm, try incorporating a small bullet vibrator or pebble style toy into your sex play or enjoy it for solo pleasure. It is an inexpensive and discrete way to take that first step back to enjoying sexual intimacy and pleasure especially if you feel nervous about using a sex toy alone or with your partner.

Try playing with the bullet vibrator/pebble toy alone even if you do not feel sexual because it will feel pleasurable, it takes little effort just to lie back, relax and gently play the vibrator over your clitoris. You can even use it whilst relaxing in the bath. Once you feel more confident you can introduce your bullet to a partner, show them how you like to use it, let them use it on your clitoris, play it over their body, nipples, penis, clitoris and have some fun.

Using an air pulse or sonic wave toy can really help if you experience decreased sensation or your orgasms no longer feel as strong. They do not vibrate, they use air pulse and sonic wave technology which gently teases and caresses your clitoris. I always recommend starting on the lowest level and increasing it slowly as your arousal grows. They promote blood flow to your vulva and vagina, engorging the tissues and boosting your arousal. Being waterproof, you can enjoy a very relaxing soak in the bath or an invigorating shower to start your day. Some are App controlled, so you can play with them with a partner or let them take control if you’re feeling adventurous.

Always buy a sex toy made with skin-safe materials such as silicone, glass, metal or ABS plastic but not jelly, latex or rubber (porous materials absorb bacteria and are difficult to clean). And always buy from a reputable retailer whom you can phone, email or DM for advice.

Look after your vaginal health

Decreased lubrication and the thinning of the walls of the vagina can and do make sex feel uncomfortable or painful. The lack of natural lubrication makes the tissues of the vagina feel dry which can lead to friction during penetration and cause pain, soreness and discomfort. This can also increase your risk of getting thrush too.

The decreased oestrogen levels cause the walls of the vagina to thin and lose their elasticity, so they become tight which can make any form of penetration feel painful or uncomfortable.

Even if you cannot use HRT many people can use vaginal oestrogen (please check with your medical team) which can improve your genitourinary health: this is your vulva, bladder and urethral to prevent infections such as thrush and bacterial vaginosis (which is a fishy smelling discharge), irritation, soreness, itching, thinning skin (especially at the entrance to the vagina), urinary tract infections, cystitus and urethral irritation. You can use this in combination with an irritant free sexual lubricant and vaginal moisturiser such as YES which is made with organic and botanical ingredients. YES is available on prescription. SUTIL Luxe and RIch are longer lasting water-based lubricants, made with botanical and organic ingredients. They can be used as a vaginal moisturiser too. They both contain hyaluronic acid which features in many skincare products.

It’s really important to be aware of the ingredients of your lubricant as not all sexual lubricants and vaginal moisturisers are the same. Many products, including some available on prescription, contain irritating ingredients including glycerin, glycols and parabens, in addition to dyes, perfumes, flavouring, cooling and warming ingredients. Glycerin is a common lubricant ingredient but it can cause thrush, often prevalent post cancer treatment. It is essential that you only use a product that is designed for internal use, not something from your kitchen or bathroom cupboard such as olive oil, coconut oil, baby oil, vaseline or almond oil. These will increase the risk of infection and irritation and destroy condoms.

Be aware that the lubricant on some condom brands contains these ingredients and many do not list the lubricant ingredients on the packaging.

Flavoured lubricants with natural flavouring are great for oral sex but not recommended for any penetrative sex as they can disrupt vagina pH.

Ditch feminine hygiene products we really do not need as the vagina is self cleaning. This includes intimate washes, douches, sprays, wipes and bath bombs as they all contain ingredients that can cause irritation and thrush.

There are guides on our blog at Jo Divine about how to use your lubricant or vaginal moisturiser.

Which lubricant should I use?

People are often put off from using sexual lubricants because many contain irritating ingredients like those mentioned above. They can cause stinging, itching and even thrush (an infection) whatever your gender. A sexual lubricant should feel natural, not intrusive. We always recommend you check the ingredients label before you buy or use a lubricant or ask your GP what ingredients are in a lubricant before they prescribe a product. Always do a patch test first on the inside of your arm or thigh.

Sexual lubricants come in different formulations, water based, oil based and silicone based.

Water based lubricants:

These are closest to your body’s natural lubrication and are great for any form of sex play, including all sex toys and are condom compatible. They are not as long-lasting as oil-based or silicone lubricants but can be reapplied or reactivated with water during sexual activity. However, SUTIL Luxe and Rich are longer-lasting water-based lubricants which interact with your natural lubrication to make you feel more lubricated and natural. SUTIL Rich has a thicker formulation which some people prefer.

The vast majority of water-based lubricants contain irritating ingredients so be a detective and check the label.

Oil based lubricants:

Oil-based lubricants such as YESOB are long-lasting as they are thicker and more creamy in consistency. They are great to use for any sex play including with good quality skin safe sex toys. They are not condom compatible. All oil-based products will destroy condoms. Many toy manufacturers advise not to use oil-based lubricants but this refers to cooking oils, baby oil and coconut oil, not YESOB.

YES water-based lubricant and SUTIL Luxe and Rich can be used with YES oil-based lubricant to create a “Double Glide” effect which is long lasting.

I often recommend using a little oil-based lube on your vulva if your swimming in the sea or in chlorinated water to protect the tissues from chlorine and sea water.

Silicone lubricants:

These are very slippery and long lasting so great for sex play, including anal pleasure. They cannot be used with silicone sex toys but are suitable with glass, metal or ABS plastic sex toys.

Vaginal moisturisers:

These are designed to be used around every three days to keep your vagina moisturiser and improve the elasticity of the walls. They also help to maintain the pH of the vagina too.You can also pop a little on the vulva to help keep the tissues moisturised too. It is important to use a product free from the ingredients mentioned above.

YES Vaginal Moisturiser ( on prescription) is free from irritating ingredients and which is bio-adhesive which means it releases moisture where needed so is ideal for restoring moisture and the pH balance of your vagina.

Sex should never be painful

Vaginal tightness is a common issue and you may be prescribed medical dilators made from hard plastic to help stretch the tissues of the vagina.These can be uncomfortable to use so some people prefer to use silicone dilators or slim sex toys which feel gentler on the delicate tissues of the vulva and vagina.

Our Inspire Silicone Dilator Kit offers 5 graduated dilators made from velvety soft silicone which are extremely flexible and gentle on the delicate skin of the vulva and vagina. The easy to use loop handle makes them comfortable to hold, and the gentle tapered shape and varied sizes allows you to increase the insertion size at a rate that is comfortable to you.

Many women combine the use of the Inspire Dilators with the Jo Divine IMMY, our slimmest sex toy powered by a small bullet vibrator as it can be used for clitoral stimulation to help relaxation of the vagina whilst using the dilator and it slips into the loop handle which in turn, makes the dilators vibrate. The vibrations promote blood flow to the tissues of the vagina and stimulate the nerves to help sexual sensation and it is great to use with a partner too.

Using a slim vibrator is a great alternative to dilators to help stretch the vagina, promote the blood flow to the vagina and increase sexual sensation. It is great to use when masturbating to enjoy an orgasm or with a partner to maintain intimacy. There are plenty of sex toys designed for someone with a penis so you can both enjoy playing with sex toys together.

It is important to use skin safe sex toys made from silicone, glass, metal or ABS plastic to protect your intimate health. Products made from jelly, latex and rubber are porous and absorb bacteria, are difficult to clean and will degrade over time which is why I never recommend them.

Clearly not everyone has penetrative sex, however if penetration feels painful, focus on pleasuring each other in different ways. Try different sexual positions to avoid deep penetration. Being on top will help you to control the depth of penetration and go at your own pace, a snuggly/spooning position feels really intimate, can prevent deep penetration and gives your partner access to your clitoris for pleasurable masturbation. It is also a great position if you are just feeling tired or lazy!

It is a good idea to ask to be referred to a women’s health physiotherapist (WHPT), experts in pelvic health. They can assess your pelvic floor and teach you how to do your pelvic floor exercises (PFE) correctly. Some women may find that their pelvic floor is tight which can make sex feel painful so a WHPT can teach you how to relax the PF muscles too.

About the author

Samantha Evans co-founded Jo Divine, an online sex toy company, with her husband Paul in 2007 which only sells skin safe sex toys and sexual lubricants. Having a professional background in nursing, she is a features writer and sexual health and pleasure expert for Jo Divine. With an extensive knowledge about sex toys and sexual lubricants, she enjoys creating informative, practical articles about sexual health and pleasure which endeavour to normalise sex, help people to talk about it and discover ways to enjoy sex in whatever way they want to or are able to. Samantha works with many healthcare professionals in the NHS and private practice to help them advise their patients about regaining sexual function and enjoying sexual intimacy and pleasure through the use of suitable skin safe sex toys, silicone dilators and irritant free sexual lubricants. She also advises people going through natural menopause or as a result of medical or surgical treatment and post cancer treatment, about ways to enjoy sexual intimacy and pleasure. She passionately believe that it is always possible to enjoy pleasurable sex and going through the menopause or post cancer treatment doesn’t mean your sex life has to stop.

Further information

Future Dreams hold a range of support groups, classes, workshops and events to help you and your carers during your breast cancer diagnosis. These are held both online and in person at the London-based Future Dreams House. To see what’s on offer and to book your place, see here. for more information and to book your place.

Sam’s website is www.jodivine.com

Sam’s instagram account where she posts short videos and via which you can DM Sam for advice.

Sam recorded an IG Live with Davina McCall last year which may be of interest.

These podcast episodes may be helpful:

Sam chatting to Liz O’Riordan

Sam chatting to RadChat

To return to the homepage of our Information Hub, click here where you can access more helpful information, practical advice, personal stories and more.

Reviewed July 2024

The information and content provided in all guest articles is intended for information and educational purposes only and is not intended to substitute for professional medical advice. It is important that all personalised care decisions should be made by your medical team. Please contact your medical team for advice on anything covered in this article and/or in relation to your personal situation. Please note that unless otherwise stated, Future Dreams has no affiliation to the guest author of this article and he/she/they have not been paid to write this article. There may be alternative options/products/information available which we encourage you to research when making decisions about treatment and support. The content of this article was created by Sam Evans and we accept no responsibility for the accuracy or otherwise of the contents of this article.