Lymphoma and its treatments can have an impact on your sexuality and emotional, physical and sexual intimacy. This page will give you information on some of the changes that can happen, and practical advice on how to maintain or develop a fulfilling sex life and other intimate relationships.
What is sex, sexuality and intimacy?
Intimacy is the physical and/or emotional closeness to another person and can be expressed in different ways. It is not just physical but rather, it is a deep trust and comfort in one another. Intimacy can be between friends, family members or partners.
Sexuality is the way we express ourselves sexually. This includes the way we feel about ourselves, the way we dress, the way we move, the way we have sex and who we have sex with.
Sex is the physical way we express our sexuality.
Whether you’re single or in a relationship, sexuality, intimacy, and sexual health is an important part of who you are.
What sort of changes can happen?
Many people living with lymphoma report changes in sexuality and intimacy.
All treatments for lymphoma, and supportive medicines may decrease your:
- libido (sex drive)
- ability to become sexually excited (aroused)
- ability to orgasm
- desire for physical and/or emotional intimacy.
What causes these changes?
Lymphoma can cause a physical and psychological imbalance. These imbalances may impact your sexuality and intimate relationships.
Physical changes may include:
- changes in hormone levels
- erectile dysfunction
- vaginal dryness or changes to the strength of vaginal wall
- flare ups of previous sexually transmitted infections (STIs)
- pain
- nausea and vomiting
- nerve damage (usually affects hands and feet but can also affect your genitals)
- skin sensitivity
- sleeping problems
- fertility issues
- difficulty reaching an orgasm
- changes in how your body looks and how that affects your confidence. This can impact how you feel about your own sexuality or intimacy with others. Some side effects from treatment that may affect your appearance includes weight loss/gain, hair loss, or scars from surgery and other procedures.Â
Psychological changes may include:
- role changes in a relationship – going from partners to patient and carer
- being a provider of finances or support, to needing help with finances and support
- fatigue
- loss of confidence
- anxiety, stress, worry and fear
- changes in your appearance may change the way you feel about yourself, sexually and socially. This can impact your sex life and other intimate relationships
- new equipment or devices you need to have with or attached to you may affect your confidence.
Risk of infection and flare ups of previous infections
Treatment for lymphoma will usually lower your immune system. This can put you at increased risk of infections, including sexually transmitted infections, as well as other infections.
If you have ever had a sexually transmitted infection such as genital warts, genital herpes or Human immunodeficiency virus (HIV), these can all ‘flare up’ or get worse during treatment. You may need some antiviral medicine (or changes to medicine) to prevent them causing you problems during treatment.
If you have ever been diagnosed with a sexually transmitted infection let your doctor know. There is no need to be embarrassed, because these can be common. Your doctor will be able to give you medicine to prevent or lessen a flare up during treatment.
What can I do? Adapting to my ‘new normal’ sexuality
How lymphoma and its treatments affect your sexuality and sexual intimacy, and how long these changes last will be different for everyone. For some it’s a short-term disruption, but for others it can mean needing to adapt long-term.
Accepting that things have changed, and focusing on how you CAN be sexual and intimate can help. Things don’t need to be the way they always were, to still be good – or even great!
Some suggestions that may help you adapt to your new normal sexuality and sexual intimacy include:
- Allow yourself to grieve the loss of familiar sexuality and sexual response.
- Practice talking openly about sex, sexuality and intimacy with your partner or someone you trust. It may take practice. It may be embarrassing at first. But, if you and your partner commit to making a safe space for each other, to share how you’re feeling and what feels good, you may reach new levels of intimacy. And remember, everything gets easier with practice.
- Consider using sexual aids or toys such as vibrators, dildos and lubricants.
- Focus on pleasure not performance.
- Consider pain relief before sex. If pain is often a problem, aim to take pain relief 30-60 minutes before sex.Â
- Try different positions, or support your body with pillows to take pressure off areas that may be sore or uncomfortable.
- Create a relaxing environment (soft music, meditation and relaxation techniques may help).
- Try exploring sexuality on your own through self-touch and masturbation.
Not all lubricants are equal!
It is a good idea to use lubricants while having treatment. Lubricant can help prevent any small tears that often happen during sex. When you have lymphoma, or are having treatment, these small tears could lead to infection and bleeding.
There is a general rule to consider. If you are:
- using silicon-based toys or condoms, use an oil or water-based lubricant.
- not using condoms or toys, use an oil or silicon-based lubricant.
Condoms and dams
If you or your partner have had chemotherapy in the past 7 days, you need to use a condom or dental dam with lubricant every time you have sex (including vaginal, anal and oral sex).
External condom to be used over the penis during sex.
Dental dam to be used over the genitals during oral sex.
Internal condom to be placed into the vagina and worn during sex.
I’m not having sex, do I still need lubricant?
Vaginal dryness is a common and uncomfortable side-effect of many lymphoma treatments. If you have this side-effect, you may be more comfortable if you use a water-based lubricant even if you are not having sex.
Who can I talk to about changes affecting me?
Of course, you can talk to your friends, family and partner if you are comfortable. But some changes may be better managed with the advice of a healthcare professional.
Most doctors and nurses are comfortable talking about sex and the changes that happen, but they may worry about embarrassing you if they bring it up. Others may talk about it openly. If your doctor or nurse hasn’t asked you about your concerns, ask them. You will not embarrass them by asking, and they will not think less of you for asking.
Be confident knowing that changes you have in your sexuality and intimacy are just as important as any other side-effects you may get; And can be managed and improved!
Any member of your healthcare team should be able to help you with any questions you have. If they don’t know the answer, they can help you find the answers or refer you to the right person.
If there is a particular person you’re more comfortable talking to, whether it’s your doctor, nurse, physiotherapist, occupational therapist, dietician or other member of your team, talk to them.
Physiotherapists can help with some sexual changes. They are able to assess your strength and provide exercises or activities that can help improve your sexual function.
Some hospitals have sexologists or nurses that specialise in the sexual changes that happen during illness or after injuries. Ask your doctor, nurse or other team member about who you could be referred to.
You may also consider counselling – as a couple or on your own. This can be helpful if you and your partner have not previously spoken openly about sex, or are struggling with changes in your relationship. Ask your General practitioner (GP or local doctor) for a referral. Counsellors can help by listening to your concerns and goals and help you to find strategies to reach those goals.
Psychologists can diagnose some mental health conditions and look at how these may impact your feelings, thoughts, behaviours and responses to different situations – including your sexual responses. They can help you to understand why you’re feeling and responding the way you are, and provide strategies that may help.
Adapting to your new 'other' intimate relationships
As mentioned above, intimacy is not just about romantic or sexual relationships. Intimacy can also be between close family members and friends. It is about the closeness, comfort and trust you have with another person.Â
Many people notice changes in their friendships and family dynamics when living with cancer. Some people find that those closest to them become more distant, while others they have not been close with, come closer.
Unfortunately, many people haven’t been taught how to talk about illness and other difficult things. When people back away, it is often because they don’t know what to say, or are scared anything they do say, will upset you or make things worse.
Some may worry about sharing their own good or bad news, or feelings with you. They may not want to burden you while you are unwell. Or, they may even feel guilty when things go well for them when you have so much going on.
Tips on how to maintain intimate relationships with friends and family
You can help your friends and family understand that is ok to talk about your lymphoma or treatment if they want. Or even talk about what is happening in their life. If you are comfortable talking about your lymphoma and treatments, ask questions like:
- What would you like to know about my lymphoma?
- What questions do you have about my treatment and side-effects?
- How much do you want to know?
- Things are going to be different for me for awhile, how can we stay in touch?
- I might need some help over the next few months with things like cooking, cleaning, taking care of the kids and lifts to my appointments. What can you help with?
- I still want to know what is happening with you – Tell me the good the bad and the ugly – And everything in between!
- I don’t want to talk about my lymphoma but ask me about (whatever you would like to talk about).
- Know any good jokes? I need a laugh.
- Can you just sit here with me while I cry, or think or rest?
- If you have the energy, you could ask them – What do you need from me?
Let people know if it is ok to visit, or how you would prefer to stay in touch
Your lymphoma and its treatments can lower your immune system. It is important to let people know that it may not always be safe to visit, but that when they do they can still hug you.
- Let them know to stay away if they are sick. Consider other ways stay in touch.
- If you are comfortable hugging people and they are well, let them know you need a hug.
- Watch a movie together – but in your own homes on a zoom, video or phone call.
- Open up a group chat on one of the many messaging or video services available.
- Start a roster, for when visiting is welcome and what you need done. Check our Practical things page under planning for treatment. You will find some useful apps that can help your friends and family roster help for you.
And finally, if you notice the relationship is changing, talk about it. Let people know they still matter, and you still want to maintain the closeness you had before.Â
Summary
- Sex, sexuality and intimate relationship can all be impacted by life with lymphoma.
- Some changes are temporary, while others may need you to adapt long-term.
- Different doesn’t have to mean worse – You can still reach new and better levels of intimacy and pleasure.
- Be open to talking about sex and how you feel – with your health professionals and with your trusted friends/family or partner – This may take practice, but it can be worth it in the end.
- There is help available. Talk to your doctor about a referral to another health professional if you would like more help, advice or strategies to manage the changes to your sexuality and intimate relationships.
- Use the right lubricant for the right activity.
- Maintaining other intimate relationships is important too.
- Let people know what you are comfortable talking about.
- Set boundaries when needed.
- Ask for help and let them know you still want them in your life.
- Call our Lymphoma Care Nurses if you would like more information. Click the Contact us button below for contact details.
