Is low libido a common side effect of cancer treatment, and how can it be managed?

Low libido (low sexual desire) is quite common after cancer treatment, affecting many people of all genders due to physical, hormonal, and emotional changes related to therapy and recovery. ^[1] Low desire often arises alongside symptoms such as vaginal dryness, pain with sex, erectile difficulties, fatigue, mood changes, and body‑image concerns. ^[2] Emotional stress, anxiety, and depression during and after treatment can further reduce sexual interest. ^[3]

How cancer treatments affect libido

• Chemotherapy: Can trigger premature menopause in those with ovaries, leading to vaginal dryness and pain that make sex less comfortable and can lower desire. ^[4] Chemotherapy-related fatigue, pain, and mood changes also reduce libido. ^[2]
• Radiation and surgery: May cause local tissue changes (tightness, dryness, fibrosis), nerve injury, scars, and altered body image, all of which can reduce arousal and interest. ^{[1] [2]}
• Endocrine therapies (hormone treatments): Medications like aromatase inhibitors or tamoxifen can worsen menopausal symptoms and decrease sexual desire in some. [PM20]
• Androgen deprivation and other systemic therapies: In men, treatments that lower testosterone can lead to hypogonadism (low testosterone) with reduced libido and energy. [PM19]

Sexual concerns are highly prevalent after cancer: up to 90% of women and 40–85% of men report sexual changes including low libido, pain, erectile dysfunction, and relationship impacts. [PM19] These effects can span all domains of sexuality arousal, desire, comfort, and intimacy. ^[1]

Signs and related symptoms to watch for

• Reduced interest in sexual activity or intimacy. ^[1]
• Difficulty with arousal, vaginal dryness, or pain during sex (dyspareunia). ^{[4] [5]}
• Erectile difficulties and reduced pleasure. ^[6]
• Fatigue, mood changes, anxiety, or depression accompanying sexual changes. ^[3]

Evidence-based management options

Improving comfort, reducing pain, and addressing emotional wellbeing often help desire recover; a biopsychosocial approach works best. ^[4] [PM19]

1) Address vaginal dryness and pain (for those with a vagina)

• Nonhormonal moisturizers and lubricants: Regular moisturizers for daily comfort and lubricants before sex can reduce pain and improve desire. ^[5]
• Low-dose local estrogen or other local hormonal therapies: In selected cases, local therapy can relieve genitourinary syndrome of menopause and improve sexual function; discuss safety with your oncology team. [PM19]
• Pelvic floor physical therapy and vaginal dilators: Help with tightness, stenosis, and pain after radiation or surgery. [PM19]

2) Manage erectile dysfunction (for those with a penis)

• PDE5 inhibitors (e.g., sildenafil, tadalafil): First-line for erectile difficulties. [PM19]
• Other options if pills are insufficient: Vacuum erection devices, urethral suppositories, intracavernosal injections, or implants. [PM19]
• Evaluate for hypogonadism: If testosterone is low after treatment, carefully considered testosterone therapy may help when not contraindicated. [PM19]

3) Treat menopausal and vasomotor symptoms

• Nonhormonal medications: SSRIs/SNRIs, gabapentin, and clonidine can relieve hot flashes and improve sleep, which may support sexual interest. [PM20]
• Lifestyle strategies: Regular exercise, sleep optimization, and stress reduction can reduce vasomotor symptoms and fatigue. [PM20]

4) Pain, fatigue, and mood

• Pain control and fatigue management: Better symptom control can restore energy and desire. ^[2]
• Psychological support: Individual counseling, sex therapy, or couples counseling addresses anxiety, depression, body image, and relationship strain that often suppress desire. [PM19] ^[3]

5) Communication and care coordination

• Talk with your care team: Ask about expected sexual side effects, duration, and tailored treatments; sexual health should be part of survivorship care. ^{[6] [7]}
• Specialty sexual health clinics: Oncology programs often provide integrated sexual health and fertility services. ^[8]

Practical tips you can try now

• Use lubricants and moisturizers regularly to improve comfort and spontaneous desire. ^[5]
• Plan intimacy for times of lower fatigue and fewer symptoms; shorter, more frequent moments of closeness can help rebuild desire. ^[2]
• Focus on nonpenetrative intimacy (touch, massage, sensual play) to reduce pressure and enhance arousal. ^[1]
• Seek counseling or sex therapy if stress, trauma, or relationship changes are prominent; this often improves desire. [PM19]
• Review medications with your clinician to optimize symptom control and consider adjustments that may ease sexual side effects. ^[7]

When to seek professional help

If low libido persists, is distressing, or occurs with pain, erectile difficulties, or significant mood changes, ask for a structured evaluation and a personalized plan; sexual health after cancer benefits from early, open conversations and multidisciplinary care. ^{[1] [8]}

Key takeaways

• Low libido after cancer treatment is common, and often linked to pain, dryness, fatigue, hormonal shifts, and emotional stress. ^[4] [PM19]
• Treating comfort issues and emotional wellbeing frequently improves desire, and multiple effective options exist for both women and men. [PM19] ^[4]
• Speak up early: Your oncology team can guide you to targeted therapies, sexual health resources, and counseling that match your situation. ^{[7] [8]}