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Sex and treatment

 

When you are receiving treatment for a serious illness, many questions come to mind. Some may be about how your lifestyle will change. It is very normal to have questions about sex during treatment, even if you are not sexually active. You might not feel comfortable bringing up the topic of sex or masturbation. Even so, the St. Jude staff wants you to know that they are here to talk to you about anything that affects your health and well-being, including sex.

You can talk with a member of your medical team in private or with a support person (like a parent, friend, nurse, child life specialist, or social worker). It is your choice. The staff members will not share your comments with anyone else unless there is a medical concern that involves your treatment or personal safety.

This information includes common questions about sex asked by patients, along with answers from the staff. Please talk to someone on your medical team about any questions or concerns you may still have about sex and your specific treatment plan.

What level should my platelets be if I am going to have sex (including masturbation) and why?

Platelets are cells in your blood that stick together or “clot” to stop bleeding. Platelets help heal injuries by forming bruises and scabs. Some diseases and treatments, such as chemotherapy (chemo) and radiation, lower platelet counts. When the platelet count is low, your body will have a much harder time stopping or controlling bleeding. When your counts are low, with most sexual activities (masturbation, intercourse: vaginal, anal, oral) you run the risk of causing some bruising or bleeding. When the platelet count is normal, bleeding that occurs during sex is usually small or not even noticeable. However, this bleeding can be dangerous if your platelet count is low. It is important to wait until your platelet count is at least 50,000 before you have sex or masturbate.

What level should my ANC be if I am going to have sex and why?

ANC stands for Absolute Neutrophil Count. A “neutrophil” is a type of white blood cell that is one of the body’s main defenders against infection from bacteria and other germs. Some diseases and treatments, such as chemotherapy and radiation, lower the ANC. Doctors suggest that you wait until your ANC is at least 1000 to have sex.

This will help your body fight infections that could result from having sex. Two common infections that can occur after sex are yeast infections and urinary tract infections. When treated, these are minor problems in healthy people. But these infections can be more serious in those who have an ANC below 1000. If you have a central line to receive treatment, keep it covered with a “dressing” during sex to avoid infection and possible pulling. If you have had a stem cell transplant, please talk with your medical team for more details about your ANC level.

Sexually transmitted diseases (STDs) are always a risk for anyone who has unprotected sex. Your ANC, at any level, does not protect you from getting an STD. When your immune system is weak, an STD is even more dangerous for your health.

If you plan to have sex while receiving treatment, you and your partner should use a form of barrier protection to lower the risk of STDs and pregnancy. We recommend latex condoms with nonoxyl-9 spermicide.

How long should I wait after receiving chemo or radiation to have sex?

Doctors suggest that you wait at least 72 hours after receiving chemotherapy (chemo) to have sex (including vaginal, oral, and anal sex). This is the average amount of time that it takes chemo to leave your system. The chemotherapy is present in our bodily fluids. So, having sex within 72 hours after chemo might expose your partner to these drugs, which could be dangerous to that person. Talk with your medical team for more details about your specific treatment.

There are different types of radiation used at St. Jude. With external beam radiation, a machine sends invisible rays to the tumor site. For this type of radiation, the doctors have no set amount of time you should wait between radiation treatments and having sex.

Brachytherapy is another type of radiation therapy. Small tubes, called catheters, are placed at the tumor site during surgery. Radiation is loaded into the catheters during a 3–5 day hospital stay. You should not have sex until the doctor removes the catheters, and brachytherapy is over.

If you still have questions about the type of radiation you are receiving, talk to your medical team.

The St. Jude staff wants you to be aware of the dangers that radiation therapy can pose to an unborn child. Please read the answer to the next question if you are sexually active while having treatments.

Can I get pregnant or cause pregnancy while receiving chemo or radiation?

Yes; but there are serious risks if you become pregnant or cause your partner to become pregnant while you are receiving either type of treatment.

  • Both chemo and radiation attack fast dividing cells in your body that are both sick (like cancer cells) and healthy (like sperm cells and eggs). For this reason, some of your sperm or eggs can be damaged during treatment. Creating a baby with these damaged cells could lead to birth defects. Doctors suggest waiting to have a baby to avoid the risk of birth defects. To be safe, talk to your doctor about how long you should wait after treatment is completed to become pregnant or cause your partner to become pregnant.
  • If you become pregnant while receiving treatment, doctors may have to stop therapy or change your treatment plan. This could affect how well your cancer responds to treatment.

If you are still thinking about becoming pregnant during treatment, it is important to first talk with your doctor. Your St. Jude doctors strongly suggest that you and your partner use a reliable form of birth control to lower the risk of pregnancy during treatment. If you decide to have sex, we recommend latex condoms with nonoxynol-9 spermicide. Radiation and chemo will not damage this form of birth control.

Will sex feel different while I am receiving treatment?

Many patients report feeling tired and nauseated during treatment. Others say they are more self-conscious about their bodies because of physical changes caused by treatment. Those changes may include hair loss, skin changes, scarring, weight gain, or weight loss. Being nervous about these changes can affect the way you feel during sex. These feelings are all normal. Sometimes feeling nervous or anxious can cause a person to want to have sex less often or to have trouble having an orgasm or maintaining an erection.

If surgery is part of your treatment plan, talk with your doctor as you heal. The doctor can tell you when it will be safe for you to have sex again, so you can avoid pain or slow healing in the area of your surgery. If you are receiving treatment for cancer to your testes, prostate, pelvis, hypothalamus, or pituitary gland, your doctor can talk to you about possible sexual side effects. Women receiving cancer treatment sometimes report feeling more “dry” during sex, which can be uncomfortable. Treatment can affect a women’s natural vaginal lubricant (moisture). To help with this, you can purchase a water-soluble lubricant (like K-Y® Jelly) to use during sex.

Otherwise, there is no medical reason that sex will feel any different than before treatment. You should wait until you are physically and emotionally ready to have sex, so you will be more comfortable. Remember: There are many ways to remain close to and affectionate with your partner that don’t include sex.

Will my partner get cancer or lose any hair if he or she has sex with me while I am receiving treatment?

No. Cancer is not an illness that can be passed to another person in any way. Even so, you should follow the guidelines above that explain how long you should wait to have sex after receiving each treatment. After that time, treatment that you receive for cancer cannot affect your partner, causing them to have side effects that you might have like hair loss. Although cancer and treatment side effects cannot be given to your partner through sex, we suggest using barrier protection (latex condoms with nonoxynol-9 spermicide) to lower the risk of sexually transmitted diseases (STDs) and pregnancy.

I’ve had many blood transfusions. Could I have contracted diseases from the transfusions that I could transmit to someone else?

The blood given during transfusions is kept safe in many ways. Volunteer donors give blood, but they must be healthy. They are asked many questions before donating to be sure they do not have common risk factors for diseases that can be transmitted by blood. The blood that is donated is tested for signs of infection, virus, and other diseases before it is given to patients. Ask your doctor if you have more concerns about blood transfusion risks.

Your doctors still strongly suggest that you and your partner use a reliable form of birth control to lower the risk of pregnancy and STDs during treatment. If you decide to have sex, we recommend latex condoms with nonoxynol-9 spermicide. Radiation and chemo will not damage this form of birth control.

After treatment, why should I bother to use a birth control method if I am sexually active?

We recommend that you always use a form of barrier protection (like condoms) if you are sexually active.

Even if your doctors have already told you that your treatment might affect your ability to have children, keep in mind that each patient reacts differently to treatment. Each person’s eggs or sperm can be more or less sensitive to the effects of chemo and radiation. For this reason, you should always assume that you could become pregnant or cause a pregnancy if you are having sex.

What if the doctors tell you that you are sterile or infertile (unable to become pregnant or cause your partner to become pregnant)? In this case, using a form of barrier protection (like condoms with spermicide) during sex will still help prevent sexually transmitted diseases (STDs).

All sexually active women should be seen regularly by a gynecologist (a doctor who specializes in the female reproductive system). If you have been taking medicine during treatment to control your menstrual periods or to prevent pregnancy, your gynecologist may stop that for a short time to make sure that you start having regular periods. If you have not had a menstrual period 6 months after treatment, please call your gynecologist or talk to your St. Jude medical team. Even if you have not had a menstrual period, you could still become pregnant if you are having unprotected sex. Doctors strongly suggest that you use a form of barrier protection (like condoms with spermicide) to lower the risk of STDs and pregnancy.

How will I know if I am still able to have children after chemo, radiation, scans, or X-rays?

Patients receive different types and amounts of chemo and radiation depending on diagnosis and the stage of the disease. If you have concerns about whether you will be able to have children after having chemo or radiation, please talk to your medical team about risks from your specific treatment. Testing can be done both before and after treatment that may help with family planning. If you want to know more about this type of testing, ask your medical team about resources in the area.

Scans and X-rays use low levels of radiation to reduce the risk of harming healthy tissues in the body. Also, “shields” are worn sometimes (depending on the area of the body being scanned) to help protect your body and your ability to have children in the future.

Before scans or X-rays, staff members will often ask a female patient (starting at 11 years old) if she is pregnant or ask her to take a pregnancy test. We do this because scans and X-rays can harm a baby that already exists inside a mother.

Even if your doctors have already told you that your treatment might affect your ability to have children, keep in mind that each patient reacts differently to treatment. Each person’s eggs or sperm can be more or less sensitive to the effects of chemo and radiation. For this reason, you should always assume that you could become pregnant or cause a pregnancy if you are having sex.

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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