If you’ve had a bone marrow or stem cell transplant, it’s likely you’ll have some changes to your sexual feelings or function.
Having a transplant can affect:
It can feel difficult to talk about sex, but sexual difficulties are common after a transplant. If your transplant team don’t ask you directly about it, then they won't mind you raising the issue. They can make sure you get the support you need.
Many people only start to notice or worry about sex once they’re feeling better. For some people, sexual desire and function will return naturally after a period of time. For others, problems with sex may hang around for longer.
If you are in a sexual relationship, it is important that you practice safe sex and always use a condom, even if you or your partner is taking the contraceptive pill. This is because the chemotherapy drugs you have been taking could be passed on to your partner during sex. This also applies to oral sex. Using a condom also reduces the risk of picking up a sexually transmitted infection (STI).
There are many different reasons why you might have sexual problems after your transplant. The cause is often a combination of factors:
Fatigue is very common after a stem cell transplant. It’s often difficult to feel enthusiastic about having sex when everything else takes such a lot of effort! Finding ways to manage and improve your fatigue may also help your sex life.
You may look and feel quite different in the early months after a transplant. This can affect the way you see yourself.
Some of the changes may be caused by things such as hair loss or weight changes. Graft versus host disease (GvHD) can cause some physical changes, as can some of the treatments for it.
GvHD can affect the vagina and the penis. Read our booklet The Seven Steps: The Next Steps for more information about specific treatments.
It’s common to lose or put on weight during and after a transplant, and for a while, you might be less physically fit than before. Looking after yourself and taking up physical activity could help you feel more confident in your body.
‘I’ve got scars from all the various things I’ve had done, like my Hickman line, and they bother me. I don’t care too much about the look of them, but they’re obvious, so people ask questions about them.’
Read Emma’s blog about sex and relationships after a transplant
Your hormone levels
It’s extremely common to have low levels of the main sex hormones (testosterone in men, oestrogen in women) after your transplant.
In men, the symptoms of low testosterone include low sex drive and difficulties getting or maintaining an erection. Women may have premature menopause, which can affect your sex drive and cause vaginal dryness.
Hormone replacement treatment can help with these symptoms.
Your emotions and relationships
Many relationships change during a serious illness – you might find that yours becomes stronger, or that it becomes strained. You might be less physically close, but closer emotionally. Your partner may be the one who has stopped initiating sex because they are worried about hurting you or tiring you out. If you’re feeling anxious or down you might not feel up to sex either.
‘I have found that after treatment like a transplant, communication about relationships gets buried. Often the partner takes on the role of being the strong one.’
For tips about relationships and information about sex therapy, read our blog with psychosexual therapist Krystal.
Sexual problems can also have a big impact on you if you’re single. Read Emma’s blog about her experiences with dating post- transplant.
Talking things through with your transplant team or a health professional is a good place to start. They should be able to refer you to specialist professionals and clinics. Understanding that these are common problems and that there are solutions can be a relief.
Talking to your partner about how you’re feeling can help.
You might find it helpful to talk to a relationship or psychosexual counsellor, perhaps with your partner. The charity Relate provides tips on communicating, as well as relationship counselling and a range of other relationship support services.
Sex therapy is available on the NHS or privately. You can look for private, qualified and accredited psychosexual and relationship therapists in your area, on the College of Sexual and Relationship Therapists website.
Your sex life might not be the same as it was before you had a transplant – but you don’t have to give up on pleasure, closeness or fun. If you’re in a relationship, keeping some kind of physical closeness alive, in whatever ways possible, can protect or even improve your connection.
There are treatments available for both men and women, and many centres have a specialist clinic that they can refer you to.
If you’re a man, you may find that your testosterone levels increase back to normal with time, but you may also be able to have testosterone replacement through injections, patches or gels.
There are also a number of treatments you can try. Finding what works for you can be a process of trial and error, if one treatment doesn’t work, there are often others available.
A group of medicines called phosphodiesterase type 5 (PDE5) inhibitors can help men get erections. The names of some of these drugs are:
If you’re a woman, sexual problems may be linked to early menopause. These symptoms may be improved by hormone replacement therapy, oestrogen cream, or creams or gels to help with vaginal dryness.
If you can, regular sexual intercourse after transplant can help to improve or regain sexual function, and prevent some problems.
Macmillan Cancer Support has more information about treatments for sexual problems. Whether you’re in a relationship or single, a good approach may be to combine medical treatment for sexual problems with support for the emotional impact of a transplant or your relationship.
Information published: 10/10/16
Next review due: 10/10/19