Chemotherapy and Low Libido: What to Expect and How to Cope

Chemotherapy can contribute to a decrease in sexual desire (low libido) for many people, often temporarily, due to a combination of physical, hormonal, and emotional changes. Fatigue, nausea, pain, mood changes, and body image concerns can all reduce interest in sex, and certain drugs may affect hormone levels and sexual function. ^[1] Emotional stress or depression during treatment can also lessen enjoyment and desire. ^[2] In women, chemotherapy can sometimes lead to irregular or stopped periods, vaginal dryness, discomfort, and changes in arousal, all of which can reduce libido. ^[3] In men, chemotherapy can cause reduced sex drive and may affect erections or sensitivity. ^[4]

Why Chemotherapy Can Lower Libido

• Physical side effects: Fatigue, pain, and general malaise can reduce interest in sexual activity. ^[1]
• Hormonal changes: Some regimens influence hormone levels, which can affect desire and arousal. ^[1]
• Emotional factors: Anxiety, stress, and depression commonly arise during cancer care and can dampen libido. ^[2]
• Body image and confidence: Hair loss, surgical scars, or weight changes may affect how someone feels about intimacy. ^[2]
• Treatment-related sexual symptoms:
  • Women: Irregular or absent periods, vaginal dryness, pain with intercourse, and reduced arousal or orgasm. ^{[3] [5]}
  • Men: Difficulty with erections or ejaculation, and decreased sensitivity in erogenous zones. ^[4]

Is Sex Safe During Chemotherapy?

For many people, sexual activity can be OK during chemotherapy if you feel up to it, but it’s best to discuss your specific situation with your oncology team. ^[6] Certain cancers or treatments involving the genital, urinary, or rectal areas may require temporary caution until healing occurs. ^[7] Fatigue and side effects may naturally reduce interest, and intimacy can be expressed in nonsexual ways like cuddling or kissing. ^[1]

Practical Ways to Cope and Improve Intimacy

• Open communication: Talk with your partner about fears, pain, or fatigue; understanding reduces pressure and helps maintain connection. ^[8]
• Manage physical symptoms:
  • For vaginal dryness or discomfort, consider regular vaginal moisturizers and lubricants; nonhormonal options can be effective. ^{[9] [10]}
  • If bleeding, pain, or unusual discharge occurs after sex, notify your care team. ^[11]
• Emotional support: Counseling or sexual therapy can address stress, anxiety, and relationship concerns during and after treatment. ^{[12] [2]}
• Gradual intimacy: Start with nonpenetrative affection and increase as comfort improves; pacing reduces performance pressure. ^[1]
• Medical review: If symptoms persist, ask your clinician about tailored strategies such as pelvic floor therapy, nonhormonal vaginal treatments, or (when appropriate and safe) hormone-based interventions. ^{[9] [13]}
• Safety considerations: Depending on your regimen, contraception may be advised during treatment to prevent pregnancy and potential fetal exposure to chemotherapy drugs. ^[6]
• Recovery timing: As treatment stress eases and energy returns, libido often improves naturally; patience and self‑care help this process. ^[14]

Women-Specific Considerations

Abrupt or treatment-related menopause can intensify vaginal dryness and discomfort, which often contributes to lower desire; improving dryness and comfort frequently improves desire and arousal. ^[9] Structured programs and clinical support focused on women’s sexual health after cancer can enhance quality of life. ^{[15] [16]}

Men-Specific Considerations

Men may experience reduced libido, challenges with erections or ejaculation, and lower sensitivity; discussion with a clinician can help identify reversible causes, optimize medications, and consider supportive therapies. ^[4]

When to Seek Medical Help

• Persistent pain, bleeding, or unusual discharge after sex. ^[11]
• Ongoing severe dryness or dyspareunia despite moisturizers/lubricants. ^[9]
• Significant mood changes, anxiety, or depression that affect daily life and intimacy. ^[2]
• Questions about fertility, contraception, or timing of sexual activity during specific treatments. ^{[6] [7]}

Quick Comparison: Common Issues and Helpful Strategies

Issue	Possible Cause	What May Help
Low desire	Fatigue, stress, hormone shifts	Rest pacing, counseling, nonsexual intimacy, symptom control. [1] [2]
Vaginal dryness/pain	Treatment-related menopause or mucosal changes	Regular moisturizers, lubricants, tailored vaginal therapies. [9] [5]
Erectile or ejaculation problems	Drug effects, fatigue, stress	Medical review, stress reduction, graduated intimacy. [4]
Body image concerns	Hair loss, scars, weight changes	Partner communication, counseling, gentle reintroduction to intimacy. [2]
Safety during sex	Treatment type/site considerations	Clinician guidance, contraception as advised. [6] [7]

Bottom Line

Chemotherapy can lower libido due to physical side effects, hormonal changes, and emotional stress, and this is a common and often temporary experience. ^[1] Compassionate communication, symptom management, targeted sexual health strategies, and guidance from your care team can help restore comfort and intimacy during and after treatment. ^{[8] [9] [16]}