Intimacy & Sexual Health After Cancer Surgery

This page is about the practical part. When is it safe to have sex again after surgery? What is physically different, and what can you do about it? For the broader picture of how treatment affects desire, fertility, and body image, see sexual health during and after cancer treatment.

Your surgeon's instructions override anything you read here. The answer depends on which operation you had and how you healed. Standard discharge instructions give a sense of the scale.

After an abdominal hysterectomy, MedlinePlus instructs: "Do not have sexual intercourse until you have had a checkup after surgery." It adds that "this takes at least 6 to 12 weeks for most people." For six weeks the same instructions say not to use tampons, not to douche, and not to take baths or swim. Showers are fine.

After a radical prostatectomy, MedlinePlus sets general healing limits. No driving for the first 3 weeks. Nothing heavier than a 1-gallon milk jug lifted for the first 6 weeks. On sexual function, it notes that erections may be less rigid or absent. Orgasm may feel less intense. Ejaculation is permanently absent. Recovery of erections is slow — described as taking months to over a year.

If you had a different operation, ask for the number. Your surgical team has one.

Radical hysterectomy. The American Cancer Society explains that this removes the uterus, cervix, and surrounding ligaments. It may include 1 to 2 inches of vagina around the cervix. The vaginal opening is closed and sealed with scar tissue. The practical results are a shorter vagina and less natural lubrication. There is also numbness in the genital area, which typically resolves in 6 to 12 months. Some people find orgasm hard to reach at first. ACS is clear on two points. Vaginal intercourse remains possible with proper lubrication. And orgasm is still achievable without a uterus or cervix.

Vulvectomy. This removes vulvar tissue, sometimes including the clitoris and nearby lymph nodes. ACS describes a changed appearance of the external genitals, with visible scarring. Scar tissue may narrow the vaginal entrance. Irritation is common because the protective padding is gone. Lymphedema (swelling caused by trapped fluid) can occur. And if the clitoris was removed, the effect on sexual pleasure is significant.

Prostate, rectal, testicular, penile, and other pelvic surgery in men. NCI states that surgery for these cancers "may affect the nerves, making it difficult to get and keep an erection," and that "nerve-sparing surgery can be used to prevent these problems." Treatment options are covered in our article on erectile dysfunction after prostate cancer treatment.

Breast surgery. ACS notes "there may be a loss of sensation in the affected breast." A breast that was a source of pleasure before may not register touch the same way. Tell a partner rather than enduring it. You may have reconstruction, wear a prosthesis, or do neither. The choice is yours, and ACS treats all three as normal.

ACS is specific: "Sex is safe and most often will not hurt your stoma." Partners often worry about causing injury. That risk is minimal. Practical steps ACS gives:

• Check the seal and empty your pouch before sex.
• Choose positions that keep your partner's weight off the ostomy.
• Use a pouch cover, wrap, or specialty underwear if the appliance makes you self-conscious.
• "Try to be patient with each other" while you both adjust.

Sexual function may change for a while after ostomy surgery. It typically improves over time.

Is the vagina shorter, drier, or scarred? Use a water-based or silicone lubricant every time. ACS says lubrication during vaginal sex helps. If scar tissue has narrowed the vaginal entrance, ACS notes dilators can stretch it. Positions that let you control the depth of penetration matter more after pelvic surgery than before it. Depth is exactly what has changed.

ACS gives the timing: "Before you have surgery, ask how the surgery could affect sex for you in the future." Worth covering:

• Will this change vaginal length, lubrication, or the vaginal opening?
• How likely is nerve damage or numbness, and is it usually temporary?
• Will I still be able to have an orgasm? Will I still ejaculate?
• How many weeks until I can have sex again, and what defines "healed"?
• Is nerve-sparing or reconstructive surgery an option for me?
• Which of these effects are permanent and which should improve?

And if the conversation never happens on its own, ACS says why it matters: "Don't assume your cancer care team will ask you about sexual problems. Remember, if they don't know you have a problem, they can't help you manage it."

ACS does not publish a universal number of weeks before sex is safe after cancer surgery. It depends on the operation. The timeframes above come from discharge instructions for hysterectomy and prostatectomy. They do not transfer to other surgeries. Ask for yours.

• Call 911 or go to an emergency department if it becomes hard to breathe, or you get chest pain, in the weeks after pelvic surgery.
• Call your care team the same day if one leg turns swollen, red, or painful, or your temperature climbs above 100.4°F (38°C) when you are not on chemotherapy, or the incision bleeds or drains thick yellow, green, or milky fluid. Same day too for vaginal bleeding heavier than light spotting, or a discharge with a bad odor.
• On chemotherapy that temperature is an emergency. CDC says to treat a fever during chemotherapy as one. Ring your care team as soon as it appears, at any hour, and go to an emergency department if you cannot reach them.
• Call your care team within a day or two if your urine stream weakens, passing urine burns, or pain during sex is new and is not settling as you heal.

• American Cancer Society: How Cancer Surgery Can Affect Sex for Women. https://www.cancer.org/cancer/managing-cancer/side-effects/sexual-side-effects/pelvic-surgery.html
• American Cancer Society: Intimacy and Sexuality When You Have an Ostomy. https://www.cancer.org/cancer/supportive-care/ostomies/intimacy-and-sexuality.html
• American Cancer Society: Body Image, Sexuality, and Intimacy After Breast Cancer. https://www.cancer.org/cancer/types/breast-cancer/living-as-a-breast-cancer-survivor/body-image-and-sexuality-after-breast-cancer.html
• MedlinePlus (National Library of Medicine): Hysterectomy - abdominal - discharge. https://medlineplus.gov/ency/patientinstructions/000275.htm
• MedlinePlus (National Library of Medicine): Radical prostatectomy - discharge. https://medlineplus.gov/ency/patientinstructions/000301.htm
• National Cancer Institute: Sexual Health Issues in Men and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-men