Is low libido a common symptom of cancer? Causes and management

Low libido (reduced sexual desire) is very common during and after cancer treatment for people of all genders. Many individuals notice changes in desire, arousal, orgasm, and comfort with sex, and these can appear during treatment or months later. ^[1] Loss of libido is frequently reported by women after abrupt menopause caused by therapy and by men receiving treatments that lower testosterone. ^[2] In large survivorship assessments, more than half of women report decreased libido alongside vaginal dryness and pain. ^[3]

How common is it?

• Sexual changes after cancer are widely reported across cancer types and treatments. ^[1]
• Women treated for gynecologic, breast, or pelvic cancers often experience reduced desire, vaginal dryness, and discomfort. ^[2]
• In a survey of cancer survivors focused on women’s sexual health, 51% reported loss of libido. ^[3]
• Men can experience decreased libido due to hypogonadism (low testosterone) from treatments like chemotherapy, radiation, or androgen deprivation. [PM13]

Why does low libido happen?

• Hormonal shifts

  • Treatments can trigger abrupt menopause in women, reducing estrogen and androgens and causing dryness and reduced desire. ^[2]
  • In men, therapies can suppress testosterone (hypogonadism), reducing desire and energy. [PM13]

• Physical side effects

  • Vaginal dryness, narrowing, and pain after pelvic surgery or radiation make sex uncomfortable and can reduce desire. ^[4]
  • Neuropathy, numbness, and changes in sensitivity can disrupt arousal and orgasm. ^[5]

• Psychological and emotional factors

  • Anxiety about cancer, body image changes, relationship stress, and fatigue can dampen sexual interest. ^[6]
  • Concerns about survival often push sexual health to the background until later, when issues surface more clearly. ^[1]

• Medication effects

  • Endocrine therapies (e.g., aromatase inhibitors) and anti-androgens reduce sex hormones and desire. [PM18] [PM20]

What can help: practical management

Step 1: Talk openly and assess

It’s important to bring up sexual health just like any other side effect; your care team can guide safe, tailored strategies. ^[7] Regular check-ins normalize the topic and help identify treatable causes (hormonal, pain, mood). ^[8]

Step 2: Address comfort and pain

• Vaginal moisturizers and lubricants can reduce dryness and pain; improving comfort often improves desire and arousal. ^[2]
• After pelvic radiation or surgery, pelvic floor physical therapy and, when advised, vaginal dilators can help tissue flexibility and reduce pain. [PM13] ^[4]

Step 3: Consider targeted medical therapies

• Women with treatment-induced menopause may benefit from nonhormonal measures first; some may be candidates for low-dose local hormonal options under oncology guidance. [PM13]
• In select breast cancer survivors on ovarian suppression and aromatase inhibitors, carefully supervised low-dose topical testosterone has been explored to improve sexual function; decisions must be individualized with the oncology team. [PM18]
• Men with confirmed hypogonadism may improve with testosterone therapy if not contraindicated; this requires specialist evaluation. [PM13]

Step 4: Support arousal and orgasm

• For men with erectile dysfunction, medications like PDE5 inhibitors, vacuum devices, injections, or implants can be considered. [PM13]
• Sensory changes can be worked around with focused sexual aids, gradual stimulation, and patient education. ^[9]

Step 5: Psychosocial support

• Counseling, sex therapy, and couples therapy can address anxiety, body image, communication, and relationship concerns, which often restore desire. [PM13]
• Many people feel “changed” after cancer; guided support helps rebuild intimacy step by step. ^[6]

Step 6: Lifestyle and pacing

• Manage fatigue, pain, and stress first; schedule intimacy when energy is higher, explore non-penetrative intimacy, and use mindfulness to reconnect with pleasure. ^[8]
• Educate yourself and your partner about expected changes; knowing what’s normal reduces pressure and helps desire return. ^[8]

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Quick reference: causes and supports

Area	Common issues	Why it lowers libido	What can help
Hormones	Low estrogen/androgens	Reduced desire, dryness, low energy	Nonhormonal moisturizers; consider local hormones or topical testosterone only with oncology guidance; assess for hypogonadism in men
Pelvic effects	Dryness, narrowing, pain	Sex becomes uncomfortable	Lubricants, moisturizers, pelvic floor therapy, dilators
Nerve/sensory	Numbness, neuropathy	Difficult arousal/orgasm	Sexual aids, gradual stimulation techniques, education
Emotions	Anxiety, body image, relationship stress	Reduced interest and confidence	Counseling, sex therapy, couples therapy
Medications	Endocrine therapies, anti-androgens	Lower sex hormones and desire	Symptom-focused strategies; discuss risks/benefits of hormone-modulating options with oncology

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When to seek help

• If low libido persists or is distressing, speak with your oncology or survivorship team; they can coordinate medical treatments and refer to sexual health specialists. ^[8]
• Ask directly about sexual side effects and safe options in the context of your specific cancer and therapies. ^[7]
• Access to support and education is part of survivorship care, and many resources exist to help you return to satisfying intimacy. ^[10]

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Key takeaways

• Low libido during or after cancer care is common and multifactorial, involving hormones, physical changes, medications, and emotions. ^[1]
• Improving comfort (dryness and pain) often improves desire; layered approaches medical, physical therapy, and counseling work best. ^[2] [PM13]
• Management must be personalized and coordinated with your oncology team to ensure safety with your cancer type and treatments. ^[8]