Sex After Cancer

Despite how common these changes are, nearly half (48%) of breast and gynecologic cancer patients and survivors in one study had never discussed their sexual or vaginal health with a healthcare provider—and only 7.4% of gynecologic cancer survivors in another study had been offered sexual-health counseling. [5,6]

Cancer can change a woman's sex life even when the cancer was nowhere near her reproductive organs. Surgery, chemotherapy, radiation, hormone-blocking therapy and other cancer treatments can affect hormones, blood flow, nerves, genital tissue, the pelvic floor, energy, body image and the way the brain and body respond sexually.

These changes can begin during treatment, appear afterward and continue long into survivorship. Breast and gynecologic cancers deserve particular attention because of the treatments commonly involved, but women treated for colorectal, anal, bladder, blood and many other cancers can also experience significant sexual changes. What matters is not simply where the cancer started. It is what the cancer and its treatment changed.

Libido, Arousal & Menopause

Cancer treatment can cause temporary or permanent menopause, sometimes years earlier than it would have occurred naturally. Chemotherapy, removal or suppression of the ovaries, pelvic radiation and hormone-blocking treatments can all affect hormone levels.

For some women, desire decreases dramatically. Others still want sex mentally but find that their body no longer responds the same way. Arousal may take longer, genital blood flow may decrease and lubrication can decline.

Women taking tamoxifen, aromatase inhibitors or ovarian suppression for hormone-sensitive breast cancer may experience vaginal dryness, painful sex, decreased desire and other menopausal symptoms. These are medical consequences of treatment and deserve to be addressed.

Vaginal Dryness, Tissue Changes & Painful Sex

Lower estrogen levels can make vaginal and vulvar tissue thinner, drier and less elastic. Women may experience burning, irritation, tearing or pain with penetration. Pelvic surgery and radiation can create additional changes, including scar tissue and shortening or narrowing of the vagina.

These issues matter whether or not a woman is sexually active. Healthy vaginal and vulvar tissue also affects everyday comfort, urinary health and the ability to undergo comfortable pelvic examinations.

Sensation & Orgasm

Cancer treatment can change genital sensation and orgasm. Hormonal changes, decreased blood flow, nerve injury, pelvic surgery, radiation, medications, pain and changes in pelvic-floor function can all interfere with sexual response.

A woman may notice that she needs more stimulation, has less sensation, takes much longer to orgasm, experiences weaker orgasms or can no longer orgasm at all.

Sexual response involves the brain, hormones, blood flow, nerves, tissue health and the pelvic floor. That is why simply treating vaginal dryness may leave much of the problem untreated.

Pelvic Floor & Urinary Changes

The pelvic floor contributes to urinary control, vaginal support, sexual comfort and orgasm. Cancer treatment can contribute to urinary leakage, urgency, frequency, pelvic-floor weakness or muscles that become overly tight and painful.

These problems are not limited to pelvic cancers. A meta-analysis found bladder disorders in 38% of women with breast cancer, demonstrating that pelvic and urinary symptoms can occur even when the original cancer was outside the pelvis. [9]

Breast Cancer, Gynecologic Cancer & Other Cancers

Breast cancer treatment can alter sexual health through chemotherapy, endocrine therapy, ovarian suppression, surgery, early menopause and the physical and emotional effects of breast surgery.

Cervical, ovarian, uterine, vaginal and vulvar cancers may directly affect the pelvis through surgery, radiation, brachytherapy and changes in reproductive anatomy. Pelvic radiation can cause vaginal dryness, scarring, shortening and narrowing that can persist after treatment.

Women who have survived colorectal, rectal, anal, bladder, hematologic and other cancers may also experience changes in hormones, nerves, pelvic function, energy, sensation, desire and sexual response

Cancer does not have to involve a woman's reproductive organs to change her sex life.

How This Affects Both of You

Cancer can affect a relationship as well as a body. Pain, low desire, vaginal changes, fatigue or difficulty reaching orgasm may cause a woman to withdraw from sex, while her partner may interpret that as rejection.

Sometimes neither partner realizes that a medical problem is contributing.

Addressing sexual health after cancer can mean improving physical function while also helping a couple understand what changed and what may be improved. A partner can and should be included in that process when the woman wants them involved.

At Bawa Medical in Boca Raton, Dr. Kanwal Bawa uses the Bawa Method to determine what actually changed and develop a treatment plan around that woman rather than treating every cancer survivor the same way.

One woman may primarily need help with vaginal tissue and pain. Another may be struggling with blood flow, sensation or orgasm. Another may have pelvic-floor dysfunction, urinary leakage, loss of libido or treatment-induced menopause. Many women have several issues occurring at the same time.

A woman's cancer history matters. Dr. Bawa considers the type of cancer, treatments received, whether the cancer was hormone-sensitive, current medications, radiation history, whether the uterus and ovaries remain, menopausal status and the woman's individual goals before recommending treatment.

Hormones are also considered individually. A history of estrogen-positive breast cancer does not automatically mean that estrogen can never be used. Recent studies involving tens of thousands of breast cancer survivors have found reassuring safety data for low-dose vaginal estrogen, including women with estrogen-receptor–positive breast cancer. [10,11]

Hormonal treatment may be used together with other therapies when appropriate, but it is not required for every treatment plan. Dr. Bawa may also use options such as BawaRF®, BawaWave®, the BawaShot®, BawaTone® and CO₂ laser treatments to address tissue health, blood flow, sensation, pelvic-floor function, urinary symptoms and sexual response. These treatments can be incorporated with hormones or without them, depending on the woman's cancer history, symptoms and goals.

Women who cannot or should not use hormones still have meaningful treatment options.

The goal is not simply to make sex possible. It is to improve comfort, tissue health, function, sensation, sexual response and quality of life whenever medically appropriate.

• BawaRF®
• BawaWave®
• BawaShot®
• BawaTone®
• BawaLift®
• CO₂ Laser
• Hormone Therapy 

Cancer treatment can affect hair during treatment and long afterward. Some women experience significant shedding or thinning, while others find that their hair grows back with less density, a different texture or continued weakness. Hormonal changes and endocrine therapies can also contribute to ongoing hair loss.

At Bawa Medical, the goal is not simply to restore hair once it has been lost. Hair preservation is equally important. Dr. Bawa develops individualized plans designed to protect existing hair, improve scalp health, support healthier follicles and stimulate growth whenever possible.

There is much more that can be done for thinning hair after cancer than women realize. Addressing hair loss earlier may also provide an opportunity to preserve more of the hair that remains.

For many women, hair represents much more than appearance. Losing it—or continuing to watch it thin after treatment—is another reminder of what cancer changed. Helping preserve and restore it can be an important part of moving forward.

Depending on the woman and the cause of her hair loss, treatment may include:

• HydraFacial Keravive®
• PRFM with Scalp Microneedling
• Laser Hair-Growth Therapy
• Prescription and Over-the-Counter Topical Treatments
• Oral Medications When Appropriate
• Supplements

Cancer is often associated with weight loss, but many women gain weight during or after cancer treatment. Premature menopause, hormonal changes, medications, changes in activity, loss of muscle, sleep disruption, stress and other metabolic factors may all contribute.

At Bawa Medical, weight management is medically guided and individualized. For appropriate candidates, treatment may include GLP-1 medications such as semaglutide or tirzepatide, other medical weight-loss options, medically guided nutrition plans and strategies designed around the woman's medical history, metabolism and goals.

The goal is not simply to lower the number on the scale. Preserving muscle, improving body composition and creating a sustainable approach to weight management are also important.

Body Contouring, Muscle & Skin Tightening

Cancer treatment, menopause, weight gain, weight loss and changes in muscle mass can all change the way a woman's body looks and feels. Bawa Medical offers multiple options for body contouring, muscle stimulation and skin tightening that can be incorporated into a broader treatment plan.

These treatments can be used to address concerns such as unwanted fat, decreased muscle tone, loose or lax skin and changes in body contour after treatment or significant weight change.

1. Liu Y, et al. “The prevalence and risk factors of female sexual dysfunction in breast cancer survivors: a systematic review and meta-analysis.” The Journal of Sexual Medicine. 2026;23(2):qdag005.

2. Qian M, et al. “Prevalence of sexual dysfunction in women with cervical cancer: a systematic review and meta-analysis.” Psychology, Health & Medicine. 2023;28(2):494-508.

3. Chang C-P, et al. “Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study.” Supportive Care in Cancer. 2023;31(1):51.

4. Nowosielski K, Kacperczyk-Bartnik J, Bizoń M. “Patient preferences for sexual health counseling across the Gynecologic Cancer Care Continuum: the sexual health integration in treatment of gynecological oncology (SHIFT-GO Study).” International Journal of Gynecological Cancer. 2026;36(8):104817.

5. Stabile C, et al. “Sexual health needs and educational intervention preferences for women with cancer.” Breast Cancer Research and Treatment. 2017;165(1):77-84.

6. American Cancer Society. “Managing Sexual Side Effects as a Woman With Cancer.”

7. National Cancer Institute. “Sexual Health Issues in Women With Cancer.”

8. Bryl K, et al. “The relationship between anxiety and vaginal-related sexual health in postmenopausal breast cancer survivors on aromatase inhibitor therapies: a cross-sectional study.” Breast Cancer Research and Treatment. 2023;200(2):257-264.

9. Colombage UN, Lin K-Y, Soh S-E, Frawley HC. “Prevalence and impact of bladder and bowel disorders in women with breast cancer: A systematic review with meta-analysis.” Neurourology and Urodynamics. 2021;40(1):15-27.

10. American College of Obstetricians and Gynecologists. “Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-Dependent Breast Cancer.” Clinical Consensus No. 2. 2021; reaffirmed 2024.

11. Carter J, et al. “Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation.” Journal of Clinical Oncology. 2018.

12. Dulmage B, et al. “Hair loss during and after breast cancer therapy.” Supportive Care in Cancer. 2023.