What to Know about Your Sexual Health after Breast Cancer

A breast cancer diagnosis is not just about your physical health. It also affects how you feel in your body, your intimate relationships, and your sense of self. And yes, that includes your sexual self.

Many people are surprised to discover that breast cancer and sex are closely linked, with treatment often impacting sexual desire, arousal, and pleasure. In fact, sexual problems are one of the most common side effects experienced by breast cancer survivors. Yet, they often remain overlooked in treatment conversations — what’s sometimes called “a forgotten aspect of survivorship.” Over 75% of breast cancer survivors describe experiencing some degree of sexual dysfunction, and most say they weren’t adequately informed about these risks before treatment.

If you’re navigating these changes, know that you’re not alone. It’s completely understandable if sexual well-being feels far down the list right now (recovery is the most important priority). At the same time, the impact of cancer on your sexual health shouldn’t be ignored. Arming yourself with information and support can help you address these changes and get your sex life and intimacy back on track as you recover.

How breast cancer treatment affects sexual health

Sexual changes after breast cancer are common, and they can happen whether or not you had sexual difficulties before receiving a cancer diagnosis. Between 23% and 64% of breast cancer survivors experience decreased libido, and 20% to 48% report concerns with arousal or lubrication, according to the American Society of Clinical Oncology (ASCO) and the American Cancer Society (ACS). 

Cancer treatment can impact your sexual wellbeing in many ways:

• Chemotherapy can have a significant effect on sexual function. Many who go through chemotherapy share that they experience more sexual concerns, like a decrease in libido and challenges with arousal, compared to those who have surgery or radiation alone. This treatment can lead to sudden changes in ovarian function, resulting in lower levels of estrogen and testosterone. As a result, some may notice a drop in desire, experience vaginal dryness, or find it harder to feel aroused. These effects can be particularly noticeable in younger, premenopausal people and may last for some time after treatment is over. 

• Hormone therapy can come with its own set of challenges, especially when it comes to sexual health. Those using aromatase inhibitors (hormone therapy drugs that treat and prevent estrogen-fueled breast cancers) often report experiencing higher levels of sexual side effects, particularly regarding desire and arousal. These medications work by lowering estrogen levels significantly, which can sometimes result in issues like vaginal dryness, discomfort during intercourse, and changes in sexual desire. 

• Radiation therapy can sometimes have an impact on sexual health, but it usually happens less often than with chemotherapy or aromatase inhibitors. When it does affect someone, it's often linked to changes in the skin and sensitivity in the chest area, which can make sexual response a bit slower.

• Combination therapy (receiving chemotherapy, radiation, and hormone therapy together) further increases both the risk and severity of sexual difficulties. Research shows that these effects add up over time, meaning that those undergoing multiple treatments are more likely to experience significant declines in desire and arousal.

• Surgery options like lumpectomy, mastectomy, or reconstruction can affect people differently. Because breasts are an important erogenous zone for many, surgery can significantly change how touch feels, from loss of sensitivity to altered sensations. For some, these physical changes may be subtle, but for others, they can deeply impact sexual arousal and pleasure. On top of that, shifts in body image and self-confidence after surgery can also play a big role in how comfortable someone feels with intimacy.

It's common to notice physical changes soon after starting treatment, especially during the first year, when things can feel quite intense. Research shows that many experience a significant drop in desire and arousal, as measured by tools like the Female Sexual Function Index, during and after chemotherapy. Factors such as age, pre-existing health conditions, and undergoing multiple treatments (like chemotherapy, radiation, and hormone therapy at the same time) can make these changes feel even stronger. 

The emotional side of intimacy after breast cancer

In addition to the physical toll that a diagnosis can have, there is a significant psychological toll as well. Sexual health involves more than just hormones and physical changes; it is also closely linked to emotional well-being. Sexual desire and arousal stem not only from hormones or physical touch, but also depend significantly on your mental state. 

Desire starts in the brain, where feelings of safety, relaxation, and connection enable your body to respond with arousal. A cancer diagnosis, however, can introduce fear, uncertainty, and stress, which interrupt that mental “spark.” After all, if a bad day at work can ruin the mood, imagine what going through cancer treatment will do to your libido. Long-term studies show that over half of breast cancer survivors are sexually inactive, citing lack of sexual interest as the most common reason.

When your thoughts are consumed with treatment decisions, body image changes, or worries about the future, it becomes much harder for your brain to send the signals that trigger desire and physical arousal. In this way, the emotional weight of breast cancer can directly interfere with your ability to feel pleasure, even if your body is otherwise ready.

Many report that changes to body image, anxiety, and fatigue make intimacy difficult. Even those who had no sexual difficulties before diagnosis may notice new challenges.

It’s important to remember: these feelings are valid, and they do not mean you cannot experience pleasure or closeness again. Sexual health after breast cancer is a journey, and there are ways to nurture intimacy that go beyond physical desire, through touch, communication, and redefining what intimacy looks like for you and your partner.

It’s also completely okay to put sex on the back burner while you heal (physically and emotionally). Placing pressure on yourself to “perform” often makes intimacy feel even more stressful. While resuming a sexual relationship can feel intimidating, there’s no need to rush; your comfort and readiness matter most, and it’s perfectly valid to take things at your own pace.

Breast cancer also affects relationships, not just individuals. Partners are often the main source of emotional and practical support, but the stress of diagnosis and treatment can create communication challenges, role changes, and even “protective buffering,” where one or both partners hide worries to avoid upsetting the other. While this may seem helpful, it can actually increase stress and reduce intimacy. Research shows that couples who communicate openly, share problem-solving, and support each other as a team tend to adjust better, feel closer, and maintain higher relationship satisfaction. 

Support and treatment options

Sexual health is complicated, and there’s rarely a one-size-fits-all solution, especially after breast cancer. Because sexual difficulties often come from a mix of physical, emotional, and relational factors, the first step is figuring out what’s really driving the problem. 

Many benefit most from a team-based approach, bringing together gynecologists, oncologists, pelvic floor therapists, sexual health experts, and sex therapists to create a personalized recovery plan. The key is having a care team that looks at the whole picture and tailors support to your unique needs.

If you’re experiencing changes in your sexual health after breast cancer, there are several ways to get support and improve your comfort, confidence, and intimacy:

• Nonhormonal lubricants and moisturizers: These are often the first step for easing vaginal dryness and discomfort. Using them regularly can make sex less painful and more enjoyable, helping you feel more relaxed and confident during intimacy.

• Hormonal treatments: In some cases, low-dose vaginal hormones (estradiol or DHEA) may be considered to address severe vaginal dryness or pain. These can improve blood flow, sensitivity, and overall comfort during sex, though their safety for women on aromatase inhibitors is still being studied. Several studies have shown the safety of these medications in people with a history of breast cancer. Your doctor can help determine if this is an option for you.

• Pelvic floor physical therapy: A pelvic floor therapist can teach exercises to strengthen the muscles that support sexual function, improve flexibility, and reduce pain during intimacy. Therapy can also help ease anxiety about returning to sexual activity and make touch feel more pleasurable.

• Counseling and support groups: Talking to a certified sex therapist, participating in couples counselling, or joining supportive groups can help you and your partner navigate emotional challenges, body image concerns, and communication around sex. Couples who work together in therapy often find they reconnect emotionally, improve intimacy, and feel more confident exploring sexual activity after treatment.

• Holistic wellness: Managing fatigue, stress, and body image through exercise, mindfulness, and self-care can have a big impact on your sexual well-being. Feeling healthier and more present in your body can make you more open to sexual intimacy and enjoyment.

Combining these approaches — physical, emotional, and relational — can make a real difference in their sexual health and intimacy after breast cancer. If you’re experiencing sexual changes, it’s okay (encouraged, even) to bring it up with your care team. 

The connection between breast cancer and sex can feel overwhelming, but it doesn’t mean the end of intimacy or pleasure. Many find new ways to connect with themselves and their partners after treatment, and there are safe, supportive options to improve sexual health.

If you’re struggling, remember: you’re not alone, and asking for help is a powerful step. Talk to your oncology team, a gynecologist, or a sexual health specialist who understands the unique challenges of breast cancer recovery. Your sexual health is an important part of your overall well-being, and cancer doesn’t change that. 

FAQ

Is it normal to experience changes in sexual desire after breast cancer treatment?

Yes, changes in sexual desire are very common after breast cancer treatment, and you’re not alone if you notice a shift in libido. Cancer treatment can directly affect hormone levels, which play a key role in sexual desire and arousal. Beyond the physical effects, emotional and psychological factors, including stress, fatigue, body image changes, and anxiety about your health, can also reduce your interest in sex. These changes are a normal response to both the treatment and the life changes that come with a cancer diagnosis, but many women find that sexual desire gradually returns over time and with the right support. Understanding that fluctuations in libido are expected can help reduce pressure and guilt, making it easier to focus on healing and reconnecting with intimacy at your own pace.

Can breast cancer treatments cause vaginal dryness or discomfort?

Yes, vaginal dryness and discomfort are common side effects of many breast cancer treatments. Hormonal therapies like aromatase inhibitors significantly lower estrogen levels, which can thin vaginal tissues and reduce natural lubrication. Chemotherapy may also contribute by inducing early menopause or lowering estrogen and testosterone levels, making sexual activity uncomfortable or even painful. Radiation therapy and surgery can sometimes affect sensitivity and blood flow in the pelvic and chest areas, adding to discomfort. Luckily, there are effective ways to manage these symptoms. Lubricants and moisturizers are often the first step to make sex more comfortable. In some cases, low-dose vaginal estrogen may be considered under medical supervision. Pelvic floor therapy can improve blood flow, flexibility, and reduce pain during intimacy. 

Will I be able to have sex during or after breast cancer treatment?

Yes, although the timing and comfort level vary widely. Physical side effects such as fatigue, pain, vaginal dryness, or changes in breast sensitivity may make intimacy more challenging, while emotional stress, anxiety, or shifts in body image can affect desire and arousal. Give yourself permission to take things slowly and communicate openly with your partner about what feels comfortable. Lubricants, moisturizers, and pelvic floor therapy can make physical intimacy more pleasurable, while counseling or couples therapy can help you navigate the emotional and relational aspects of sex. Resuming sexual activity doesn’t need to be rushed, and it often requires patience and experimentation to find what feels good again.