CHEMOTHERAPY
( By JASCAP )

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Changes due to chemotherapy

Most changes that occur are temporary, and should not have a long-term effect on your sex life. There may be times when you just feel too tired, or perhaps not strong enough for the level of physical activity you are used to during sex. If your treatment is making you feel sick, you may not want to have sex at all for a while. Remember that most side effects from chemotherapy that may affect your sex life, such as tiredness or sickness, will gradually wear off once your treatment is finished.

Anxiety may also play a part in putting you off sex. The anxiety may not be directly related to sex; you may be worried about your chances of surviving your cancer, or how your family is coping with the illness, or about your finances. Stresses like these can easily push everything else, including sex, to the back of your mind.

There is no medical reason to stop having sex at any time during your course of chemotherapy. It is perfectly safe, and the chemotherapy drugs themselves will have no long-term physical effects on your ability to have and enjoy sexual activity. Cancer cannot be passed on to your partner during sex and it won't make the cancer worse.

Contraception

It is very important to take effective contraceptive precautions when having chemotherapy, as the chemotherapy drugs might harm the baby if pregnancy occurs. For this reason, your doctor will advise you to use a reliable method of contraception (usually 'barrier' methods – such as condoms or the cap) throughout your treatment and for a few months afterwards.

If you are taking the contraceptive pill, you need to check with your doctor if it is all right for you to continue using it. The side effects of chemotherapy, such as sickness and diarrhoea, can make the pill less effective.

Protecting your partner

It is thought that chemotherapy drugs cannot pass into semen or vaginal fluids. However, just in case, most hospitals advise that people having chemotherapy use condoms for up to a few days after the treatment has been given.

Talking about sex

It is not always easy to talk about sex, but it can help to know what effects the chemotherapy treatment may have on your sex life. Your doctor or nurse at the hospital who should be able to tell you about this. If the idea of talking to them about these things is too embarrassing, you could contact our nurses. They will talk through any concerns you may have in complete confidence.

It may also help to discuss your feelings and worries with your partner. Perhaps your partner could join you if you decide you want to talk to your doctor or nurse.

Early menopause

In some women, chemotherapy brings on an early menopause (see below for more about infertility). This may cause symptoms such as dryness of the vagina and a decreased interest in sex.

Hormone replacement therapy (HRT) can be used by women with most types of cancer to prevent or reduce menopausal symptoms. However, doctors have concerns about using it for women who have had breast cancer or cancer of the womb (uterus). Some doctors feel that HRT may increase the risk of these cancers coming back, but others do not.

If vaginal dryness is making sex uncomfortable, your doctor may be able to prescribe a cream or ointment to help. You can also use KY Jelly® or other creams such as Replens® to moisten the vagina. These are available from your chemist without a prescription.

How chemotherapy might affect your fertility

Unfortunately, some chemotherapy treatments may cause infertility. Infertility is the inability to become pregnant or to father a child. This may be temporary or permanent, depending on the drugs that you have. It is strongly advised that you discuss the risk of infertility fully with your doctor before you start treatment. If you have a partner, they will probably wish to join you at this discussion. Then you can both be aware of all the facts and have a chance to talk over your feelings and options for the future.

Although chemotherapy can reduce fertility, it is quite possible for a woman having chemotherapy to become pregnant during the treatment. Female partners of a man having chemotherapy may also become pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the baby.

Female fertility

Some drugs will have no effect on your fertility, but others may temporarily or permanently stop your ovaries producing eggs. If this happens, it means that you can no longer become pregnant and it will also bring on the symptoms of the menopause. During chemotherapy your periods may become irregular or stop. You may also have hot flushes, dry skin and vaginal dryness.

In about a third of women, once the treatment ends, the ovaries start producing eggs again and their periods return to normal. It may be a few months before this happens. In this case, the infertility will have been short-term.

Usually, the younger you are, the more likely you are to have normal periods again and still be able to have children once the chemotherapy has ended.

Depending on the type of cancer you have, your doctor may be able to prescribe hormone replacement therapy (HRT) to help relieve the menopausal symptoms. However, HRT cannot prevent infertility.

Male fertility

Some chemotherapy drugs will have no effect at all on fertility, but others may reduce the number of sperm produced or affect their ability to reach and fertilise a woman's egg during sex. Unfortunately, this means you may no longer be able to father children. However, you will still be able to get an erection and have an orgasm.

You should use a reliable barrier method of contraception throughout your treatment

If you want to have children after your treatment you may be able to ‘bank’ some of your sperm for later use, before you need to start chemotherapy. If this is possible in your case, you will be asked to produce several sperm samples over one or two weeks. These will then be frozen and stored so that they can be used later to try to fertilise an egg and make your partner pregnant. You may be charged a fee for sperm storage. You should be entitled to one course of infertility treatment on the NHS.

Some men will remain permanently infertile after their treatment has stopped, while others will find their sperm count returns to normal levels and their fertility comes back. Sometimes it may take a few years for fertility to return. Your doctor will be able to do a sperm count to check your fertility when your treatment is over.

Teenage boys should also be aware of the infertility risk so that, if possible, their sperm can be stored for later years.

Feelings about infertility

It can be devastating to learn that the treatment you need for your cancer may also mean you can no longer have any children. If you had been planning to have children in the future or to have more children to add to your family, infertility may be very hard to come to terms with. The sense of loss can be very painful and distressing for people of all ages. Sometimes it can feel as though you have actually lost a part of yourself. You may feel less masculine or less feminine because you can't have children. Women may be especially distressed that the drugs may bring on the menopause, which can further undermine their self-confidence.

People vary in their reactions to the risk of infertility. Some people may shrug it off and feel that dealing with the cancer is more important. Others seem to accept the news calmly when they start treatment, and find that the impact doesn't hit them until the treatment is over and they are sorting out their lives again.

There is no right or wrong way to react. You may want to discuss the risks and all your options with your doctor before you start treatment. You may also find it helpful to talk to a trained counsellor about any strong emotions which threaten to become too much for you.

Your partner will also need consideration in any discussions about fertility and future plans. You may both need to speak to a professional counsellor or therapist specialising in fertility problems. They can help you to come to terms with your situation.

Your doctor may be able to refer you to a specialist.

Pregnancy and cancer

If you are pregnant before your cancer is diagnosed and your chemotherapy starts, it is important to discuss with your doctor the pros and cons of continuing with your pregnancy. It is sometimes possible to delay starting chemotherapy until after the baby is born, or, sometimes, chemotherapy can be given in the later stages of pregnancy. It will all depend on the type of cancer you have, the extent of the disease, how advanced the pregnancy is and the particular chemotherapy you will be having.

You will need to talk to your doctor about your pregnancy and be sure you are fully aware of all the risks and alternatives before making any decisions.

Feelings and emotions about having chemotherapy

Many people find that having cancer, needing chemotherapy treatment, and the effect that this has on their lives can sometimes make them feel anxious, afraid or depressed. Often these feelings can be triggered by something seemingly trivial, such as having to change your usual daily routine to fit in with the treatments. It may also be caused by something more obvious, such as particular side effects of the treatment, or the risk of infertility.

It is important to know that you are not alone. It is natural to have these feelings from time to time during your treatment.

Some people may feel low or depressed due to side effects such as hair loss and tiredness. Certainly it can be discouraging if the cancer is taking time to respond to the drugs.

Your emotional well-being is as important as your physical health. Everyone needs some support during difficult times and having cancer is one of the most stressful situations you are likely to face. You might find it helps to talk over your feelings with someone you feel close to who is a good listener. Some people find it helpful to discuss their feelings with a professional counsellor, a spiritual leader or member of their religious faith, or a social worker. If you feel comfortable discussing your worries with your doctor or nurse, they can be good at helping you to bring your feelings out into the open and can find you further help if necessary.

Sometimes a doctor may suggest some medicine to help with depression or anxiety, such as a course of anti-depressant drugs. These drugs can be useful to help you cope with what is going on.

Our booklet on the emotional effects of cancer may help you cope with your feelings and emotions.

Helping yourself when you're having chemotherapy

There are things you can do which may make your course of chemotherapy treatment easier to cope with.

People often talk about having a positive attitude. This does not mean being cheerful and happy all the time. Everyone feels down and worried now and again, and accepting that you will have these feelings is part of being positive.

It can help to know what your treatment involves; what side effects to expect; what can be done about them; and what should be reported to your doctor or chemotherapy nurse.

Finding information

Knowing more about your disease and its treatment can often help you to feel more in control of your life.

You may have questions about the effect the chemotherapy is having both on the cancer and your life in general. Getting information and answers to these questions can help to reduce anxiety.

If you don't understand the explanation, then keep asking until you do. Most doctors and nurses are very willing to answer any questions and to keep you up-to-date on your progress. You may find you have different questions each time you visit the hospital.

Keeping a journal

Some people find it helpful to keep a diary, journal or blog (online journal) of their treatment. This can have a practical use, as well as letting you express your feelings. If you record any side effects you have, you can see how things change if a different medicine is used to help. Changes to reduce side effects can often be made by using information of this kind.

As your journal develops, you may find it encouraging to look back at how you coped during previous difficult times. A private diary also allows you to put in writing anything that may be difficult for you to talk about. Sometimes it can be used to help you prepare to speak to someone about a problem, or it can be used to describe anger or sadness that you feel you cannot express in any other way.

Planning

Try to plan your time so that you can still do the things that are important to you. Although it is helpful to try to keep up with your social life, don't be afraid to rest if you need to. Taking some gentle exercise can raise your spirits and help get rid of tension.

How others can help you when you're having chemotherapy

There may be times when you want to be alone with your thoughts. However, at other times being able to share your feelings can be a relief.

Support groups

Patient support groups can put you in touch with other people having similar treatment. Talking with other people can be a good way of discussing feelings, and you can also pick up some useful coping tips.

Our booklet on talking about your cancer may also help you to find ways of discussing your cancer.

Family and friends

Family and friends often want to help you. However, they may find it difficult to grasp exactly what you are going through. Good communication is really important. Just at a time when you feel your friends and family should be helping, they may stand back and wait for you to make the first move. This is often because they are worried they may say the wrong thing, or they think you may want to cope alone. They may also be feeling quite emotional themselves.

Be open and honest about how your treatment is going and how you feel about it. In that way, misunderstandings can be avoided and others are given the chance to show their love and support.

Our booklet on talking to someone with cancer looks at the difficulties people may have when talking about cancer.

Counselling

Many people find that counselling can help them to face the problems of living with cancer. Counsellors help people talk through and sort out problems and confusion. Emotional difficulties linked to cancer are not always easy to talk about and are often hardest to share with the people you are closest to. Talking with a trained counsellor who is not personally involved in your situation can help to untangle thoughts, feelings and ideas.

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