One symptom that people living with breast cancer sometimes struggle to talk about is lowered sex drive (libido). Breast cancer and its treatments can take an emotional and physical toll so large that it often takes great effort to enjoy sexual intimacy again. It can be difficult to give and receive pleasure while focusing so much on fighting cancer. Sometimes, it is a struggle to be emotionally vulnerable with a partner, let alone be sexually intimate.

Luckily, there are ways to manage low sex drive with breast cancer. Communicating with your partner, addressing your physical and emotional needs, and focusing on building confidence can help you enjoy sexual intimacy again and improve your well-being and quality of life.

What Causes Low Sex Drive in Breast Cancer?

According to a study published in the Journal of Sexual Medicine, approximately 70 percent of women with breast cancer reported experiencing difficulty having sex (sexual dysfunction). A low sex drive can include a lack of interest in sexual activity, trouble relaxing and enjoying sex, difficulty becoming aroused, and the inability to achieve orgasm.

Many different aspects of breast cancer and its treatments can affect the libido and make physical intimacy a challenge.

Breast Cancer Diagnosis

Being diagnosed with breast cancer can elicit many emotions. Fear, anxiety, and feelings of numbness are common reactions. These overwhelming feelings, as well as the many adjustments that must be made after a cancer diagnosis, can put sex at the bottom of your priority list.

A cancer diagnosis might also alter the dynamic of a romantic relationship. Your partner’s roles can shift from lover and romantic partner to caregiver. One MyBCTeam member described this shift: “My cancer diagnosis changed us both. I am not the same woman he married.” Another member agreed: “I have no sex drive, and my husband doesn’t want to hurt me.”

Breast cancer itself also alters estrogen and androgen hormone levels, reducing sexual desire, physical arousal, and the ability to reach orgasm.

Breast Cancer Treatments

Although treatments help rid the body of cancer, breast cancer treatments can often cause many unwanted side effects. One review revealed that 64 percent of women with breast cancer who had undergone surgery, chemotherapy, and radiation therapy experienced a loss of sexual desire. Another 38 percent experienced dyspareunia (vaginal pain), and 42 percent had trouble with self-lubrication.

One member shared that her side effects are “joint pain, hot flashes, and loss of libido.” Another described the side effects of her treatment: “I have been on exemestane for two and a half years and had my ovaries out last year. Now, I’m experiencing vaginal atrophy.”

Hormone therapies can also lower libido. Tamoxifen and aromatase inhibitors are known to cause lower sexual functioning and diminished sexual enjoyment. Hormone therapies can also affect a woman’s sex drive by causing menopausal symptoms such as vaginal dryness.

As one member wrote, “I’m on tamoxifen now, which took my sex drive away.” Another member explained, “Tamoxifen kills your sex drive because it is an anti-estrogen. Estrogen is needed for sex drive and lubrication.”

Antidepressants are sometimes prescribed to those with breast cancer to manage the emotional disturbances caused by cancer and cancer treatments and to help with hot flashes. Over half of women treated with antidepressants experience sexual problems. As one member described, “My frustrating low sex drive was from taking Cymbalta for depression.”

Emotional Changes and Depression

Being stressed and preoccupied while battling cancer can take a toll on your emotional and mental health, as can the side effects of breast cancer treatments. The stress and fatigue of undergoing cancer treatments can decrease sexual interest and inhibit a woman’s natural lubrication. Many people with breast cancer also deal with depression. Depression significantly lowers sexual arousal and creates problems achieving orgasm.

One MyBCTeam member described these challenges: “I can relate to the sexual intimacy problem. I’ve come to loathe sex. I feel broken and bad for my husband.” Another member reported experiencing anxiety, depression, and changes in libido while taking tamoxifen.

For some women, a lack of interest in sex can lead to feelings of guilt or frustration. It can also have an impact on her relationship with her partner. “I have no sexual desire or libido,” wrote one member, “and it’s causing problems between me and my hubby!” Another member shared similar concerns: “Much to my husband’s dismay, my sex drive is deader than dead.”

Physical Changes and Body Image

Body image issues are linked to lower sexual interest and desire. Breast cancer treatments can cause hair loss and weight gain. They may also involve body-altering surgeries or procedures, like mastectomies and chemotherapy ports. These changes affect a person’s sense of body image, as well as their mental and emotional health.

One MyBCTeam member was honest about struggling with low self-esteem: “Chemotherapy made me feel ugly, no matter what everyone said.” Another member shared the difficulty she experienced being nude around her partner: “It’s hard for me to show my husband my body now with the scars and the extra 50 pounds I have gained.” Another member shared similar feelings. “I was a sexually confident woman, but the weight gain has changed that,” she said.

Early Menopause

Chemotherapy can induce menopause in premenopausal women, causing symptoms such as vaginal dryness. Early menopause can make sex less enjoyable and even painful. Menopause can also negatively affect body image.

Women with breast cancer who experience menopausal symptoms are twice as likely to experience sexual dysfunction. One member wrote, “Menopause is a big problem together with all the surgeries and treatments, leading to feelings of being de-womanized.”

Managing a Low Sex Drive With Breast Cancer

According to a 2010 Livestrong report, 43 percent of 3,000 women with breast cancer reported experiencing sexual dysfunction. Of those women, just 13 percent sought and received help for this symptom. There are many approaches that may help you boost your sex drive, however.

Talk To Your Doctor

You may be embarrassed or have reservations about discussing sex with your oncologist. However, talking to a health care provider is one of the first steps to take when dealing with sexual concerns regarding breast cancer. Your doctor may refer you to a specialist, make adjustments to your treatments to reduce side effects, or offer solutions to specific causes of your low sex drive.

Communicate With Partners

It is also important to communicate with your sexual partner(s) about the issues you’ve been facing. Open communication is a vital part of all sexual relationships, but it is especially important if you’re dealing with physical issues (such as vaginal dryness) or facing feelings such as guilt, frustration, or sadness concerning sex.

Sharing libido issues with your partner(s) will help you to work together to improve your sex life. Open communication can facilitate adjusting your sexual activity to fit the new circumstances.

One member shared her approach to sex after her diagnosis: “My husband is patient, and I let him know when I’m ‘in the mood’ now,” she said. Another explained that sharing her emotional needs with her partner helped her feel more interested in sex: “My physical desire has decreased. I tell my husband I feel more affectionate when I feel loved and appreciated. So more thoughtful acts lead to more sex. It’s a win-win.”

Ease Vaginal Symptoms

Symptoms like vaginal dryness can make penetrative sex uncomfortable or painful, leading to a low sex drive. Using vaginal lubricants and vaginal moisturizers can be of great help. These products come in liquid or gel form and can be silicone-based or water-based. One MyBCTeam member even suggested using coconut oil to improve sex drive: “Coconut oil helps with dryness, and it’s safe.”

Using a vaginal dilator can also help alleviate painful sex. This tool slowly dilates (stretches) the vagina. As one member shared, “My gynecologist suggested vaginal dilators to help make the tissue pliable and lubricated.”

Topical anesthetics can also be used when vaginal pain is severe. One member reported using an arousing oil per her doctor’s recommendation. “My oncologist’s office recommended Zestra oil that you put in the vaginal area to increase sensation, which might lead to more desire,” they said.

Low-dose vaginal estrogen therapy can help with both pain and dryness. One member shared this tip: “My oncologist recommended estrogen cream that is safe because it’s external. You will feel like an 18-year-old.” Another commented, “My oncologist recommended DHEA vaginal suppositories for libido, dryness, and atrophy.”

Spice Things Up

Introducing new activities to your sex life can help shift the focus away from your struggles with sex and make improving your libido fun. One member recommended that those looking to explore new sexual activities could use a sex toy. Another member agreed: “My husband and I have become creative with massage and toys. It is different than before but mutually satisfying.”

Use Natural Aids

One member suggested cannabis to help improve sex drive: “The only thing that has helped me is marijuana.” Another wrote, “Ginseng is good for sex drive.”

Boost Confidence

Anything you can do to feel good, boost your confidence, and lift your mood may have a positive effect on your sex drive.

Confidence-boosting activities can take many forms. One member explained: “It’s important for you to feel attractive again. Get a makeover and a facial or do yoga. Do anything to get your confidence back.” Another member wrote, “I’m going to get a beautiful tattoo to cover the majority of my scars once I get my revision reconstruction completed.”

One member raved about breast implants following surgery for breast cancer: “Just because you had breast cancer doesn’t mean you stop being a woman. I had ‘gummy bear’ implants put in, and I have my body back. I didn’t go bigger because I wanted to look like myself, but my man gets excited seeing me naked again.”

Explore Your Own Body

Masturbating builds confidence by helping you determine what feels good before engaging with a partner. It can also help boost your mood and promote sleep through the release of chemicals like oxytocin and prolactin.

As one member wrote, “Sex is healthy and prolongs your life. Sex doesn’t have to be only intercourse — you can help yourself as well.” Another member agreed: “Remember that if you don’t use ‘it,’ you lose ‘it.’ Most holistic doctors recommend masturbation. It is good for the mood, good for the body, and you can take your time.”

Exercise and Physical Therapy

Another mood-boosting activity is regular physical exercise. Exercise releases endorphins to improve mood and sex drive, with the added benefit of managing weight.

One member shared that she adjusted her exercise routine after her diagnosis: “I no longer had the energy for the gym, so now I do aqua classes that are easier on my body.” Another member wrote, “Physical therapy exercises for the pelvic floor helped me.”

Take Baby Steps Toward Intimacy

Slowly building your sex drive and building intimacy with your partner(s) can lower pressure and create long-term success. One member shared this strategy: “The diagnosis and treatment mess with our mindset and feelings of intimacy. Take it a step at a time — start with a hug a day and increase from there.”

Another member shared that she keeps it light with her partner: “We just aim for ‘quickies’ that keep it fun and light with less pressure on us.”

Be Kind To Yourself

Being patient and kind to yourself is important to help in managing low libido. One member shared: “Be patient and don’t be hard on yourself. Remember, the drugs lower your libido, so don’t blame yourself. Your body has been through a lot, so give it time to recover.”

Another agreed: “When you look in the mirror and don’t recognize yourself, remember that what is important is that it is still you in there!”

Get Support

Breast cancer symptoms and treatment side effects are easier to manage when you can talk to other people who understand. On MyBCTeam, the social network and online support group for those living with breast cancer and breast cancer survivors, intimacy issues are one of the most discussed topics.

One member was relieved to feel less alone: “Glad you ladies have let me know that I’m not alone because no one ever talks about this.”

Members were grateful to have MyBCTeam for support on this sensitive topic. One member explained, “It really does help to have regular contact with a group that gets it.” Another member agreed: “There are women on this site who can offer you their perspective on intimacy during and after treatment for breast cancer.” Another wrote that “It’s really a blessing to be able to discuss these issues with women who really understand what all of this is like!”

Have you noticed changes in your sex drive with breast cancer? How do you cope? Share your thoughts in the comments below, or start a conversation on MyBCTeam.