# Sexual health after cancer: assessment and interventions for women and men

Source: https://onco.cc/protocols/sexual-health-assessment-and-interventions/  
OnCo record `sexual-health-assessment-and-interventions` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer and its treatment often change sex, desire, body image and relationships, for women and men. Guidelines say your team should raise it so you do not have to. Help includes counselling, alone or as a couple; moisturisers, lubricants and then low-dose vaginal oestrogen for dryness; dilators and pelvic floor physiotherapy; and tablets, devices or injections for erection problems.

## Summary

The Cancer Care Ontario guideline (2016, published 2017), adapted by ASCO in 2018 with added statements, makes one overarching recommendation: a member of the healthcare team should start a discussion about sexual health and dysfunction caused by the cancer or its treatment, ideally including a partner, at diagnosis and periodically through follow-up. ASCO adds that medical and treatable contributing factors should be found and addressed first, and that psychosocial or psychosexual counselling should be offered to all patients.

For women, CCO recommends psychosocial counselling for problems with sexual response, body image, intimacy and overall function (couples-based where partnered), with exercise or pelvic floor physiotherapy as possible additions; vaginal moisturisers and lubricants first for vaginal atrophy, then vaginal oestrogen, which can be considered after discussion in hormone-receptor-positive breast cancer when conservative measures fail and is of uncertain safety with aromatase inhibitors; vaginal dilators for vaginismus or stenosis, and to prevent stenosis after radiotherapy for cervical cancer; and pelvic floor physiotherapy for pain. For men, PDE5 inhibitors first for erectile dysfunction regardless of type of surgery, then a vacuum device, urethral medication or intracavernosal injection; counselling combined with PDE5 inhibitors, ideally for the couple; and daily vacuum device use to prevent loss of penile length. The evidence is mostly low to moderate quality.

A 2025 comparison of ASCO 2018, ESO-ESMO 2022, NCCN 2024 and SOGC 2024 for women found consensus on non-hormonal moisturisers and lubricants first and low-dose vaginal oestrogen second, and on multidisciplinary and psychological care; ESO-ESMO alone did not include recommendations on drugs for low desire, for which the data are limited.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: sexual dysfunction after cancer; sexual problems in people with cancer; vaginal dryness after cancer treatment; erectile dysfunction after cancer; psychosexual counselling; vaginal dilators; penile rehabilitation
- Tags: protocol; survivorship; sexual-health

## Connected records

- protocols: [Fertility discussion and preservation before cancer treatment](https://onco.cc/protocols/fertility-preservation-before-cancer-treatment/), [Hot flushes on breast cancer endocrine therapy and prostate cancer hormone therapy: non-hormonal options](https://onco.cc/protocols/hot-flushes-on-endocrine-therapy-non-hormonal-options/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Menopause brought on by cancer treatment, and the options for it](https://onco.cc/technologies/menopause-after-cancer-treatment/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees](https://onco.cc/technologies/vaginal-oestrogen-after-breast-cancer/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Ontario Health (Cancer Care Ontario)](https://onco.cc/institutions/ontario-health-cancer-care-ontario/)
- terms: [Erectile dysfunction after prostate cancer treatment](https://onco.cc/terms/erectile-dysfunction-after-prostate-cancer/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Sexual function, fertility and body image after bowel cancer](https://onco.cc/terms/sex-fertility-after-bowel-cancer/)

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