Sex and Relationships

Sex is often a big part of our lives, whether we’re comfortable admitting it or not. It provides pleasure, releases stress, and can help to create a deeper intimacy with a partner.

It’s therefore entirely normal to be concerned about a stem cell transplant affecting your sex life. But it’s also entirely normal to feel awkward and a bit embarrassed talking about this topic with anyone, from a partner to a medical professional. It’s personal, after all.

That’s why we’re here, and we’re so pleased you are too. It’s great that you’re looking for information and support on this topic. On this page, we'll cover:

• Will having a stem cell transplant affect my sex life?
• When can I have sex after my stem cell transplant?
• How will I know when I’m ready to have sex after my transplant?
• I feel awkward talking about sex with my transplant team
• How can I talk to my partner about sex after transplant?
• I'm nervous about dating after transplant
• Where can I find more information and emotional support?

We’re going to be frank yet sensitive on the topic of sex and stem cell transplants, and give you the tools, information and support to feel empowered to take control of your sex life and relationships.

So, let’s start with the big question…

Will having a stem cell transplant affect my sex life?

Yes, having a stem cell transplant may affect your sex life, both physically and emotionally. In fact, approximately half of all stem cell transplant patients experience issues with their sex life after transplant. You may experience some post-transplant side effects which can cause sex to be painful or a bit awkward, and you might feel anxious.

Here are the main difficulties you may find between 6-12 months after your stem cell transplant:

• You might experience a lower sex drive thanks to high dose steroids used to relieve graft versus host disease (GvHD) symptoms, as they can also supress the production of sex hormones.
• You may feel fatigued during recovery after your conditioning therapy and stem cell transplant. This can make the most basic daily activities difficult to achieve, let alone having the energy for sex.
• Genital GvHD can cause vaginal dryness and irritation, as well as the narrowing of the vagina and even ulceration in severe cases. It can also cause inflammation or a rash on the penis and scrotum.
• An irregular or absence of your menstrual cycle can cause vaginal dryness and hot flushes.
• You may have difficulty achieving and sustaining a full erection, known as erectile dysfunction.
• Narrowing of the urethra, the tube in the penis which carries urine and sperm, can cause discomfort. You may also have an inability to ejaculate.

Are there any treatments to ease these symptoms?

Your transplant team will provide you with the best possible treatments based on your medical situation. It’s likely that your treatment plan will include a combination of the following medications:

• Immuno-suppressants that can be applied to areas of the skin showing signs of inflammation.
• Steroids can be given in a response to inflammation, and calcineurin inhibitors (drugs to suppress the immune system) can be given to replace long-term steroid use.
• Oestrogen, the female sex hormone, causes the lining of your vagina to thicken and become more resilient, and can be given in forms of creams, capsules or release rings.
• Hormone replacement therapy (HRT) can alleviate menopausal symptoms, make sex less painful and can increase your sex drive.
• Testosterone, the hormone associated with our sexual desire, can be offered to men and women to increase libido and sexual desire.
• PDE-5 inhibitors, such as Viagra, can increase blood flow to the penis and help to sustain an erection. You can discuss more at an erectile dysfunction clinic which you can be referred to via your transplant team, or read our blog on men’s sexual health after transplant for more information.

When can I have sex after my stem cell transplant?

Your transplant team will know your situation best, and can give you personalised advice on when it’s safe to have sex after your transplant. Generally, the consensus will be that you can have sex when you’re comfortable enough to.

Key facts

• You must use a condom during sex until one week after your chemotherapy has stopped, as the chemo could be passed to your partner during sex – including oral.

• Avoid any sexual practices that put you at risk of infection, such as oral exposure to faeces, as your immune system is weaker.
• You may need to experiment with positions which are comfortable with a central venous catheter (CVC, sometimes called a Hickman line). Try positions where you’re on the bottom or lying side-by-side. Mutual masturbation may be a less strenuous option to start with, or having sex for a shorter amount of time. These positions may also help if you’re struggling with fatigue.

It’s hard to feel attractive when you’re recovering from a transplant, especially when your skin doesn’t react well to make-up and you have no hair to style. 

Tara, who had a stem cell transplant to treat AML. She shares her experience in her blog.

How will I know when I'm ready to have sex after my transplant?

There is no right or wrong time to feel ready to have sex again after your stem cell transplant. Everyone is different. It is entirely up to you and how you are feeling. Nobody should pressure you into having sex before you’re ready.

You’ll have been through a whirlwind of emotions and changes post-transplant. Your body has been through a lot! From hair loss and weight changes, to having a central venous catheter (CVC) inserted, there is a lot to deal with both physically and emotionally. It’s common to struggle with this, and to feel unsexy after transplant. You can find more information and support on body image after transplant in our Recovery: Mind section.

Give yourself time to feel comfortable in your body again before you think of having sex. Feeling confident and empowered in yourself and your body is the most important thing. Many patients talk about their sexual desire returning as their recovery progresses. Try to be patient and kind with yourself. You are still you, and your body is still fantastic.

Changes in how someone’s body looks can have a knock-on effect on their confidence – for men and women. A positive body image is key to self-esteem, confidence, and maintaining relationships.

Hayley, Anthony Nolan Lead Nurse (2017-2021)

How can I reintroduce sex?

It’s a great idea to start slowly when you want to start having sex again, both for mental and physical reasons. Perhaps you could:

• Cuddle, have a massage, or cook a romantic dinner together. Intimacy doesn’t just have to be about sex, so go back to basics first.
• Take a love languages test with your partner. These can be fun and interesting to find out how you give and receive love best, which can be helpful when re-building intimacy.
• Try out less energetic acts or positions, like mutual masturbation, spooning or oral sex. You’ll likely be struggling with fatigue, so low-energy sexual acts are best.

It can help to have open and honest conversations with your partner, friends, family and/or transplant team about how you’re feeling, both about your body image and sex life. Getting your worries and feelings out in the open can help you to feel more in control of them, and allow you to seek any necessary support.

I feel awkward talking about sex with my transplant team

Talking about sex with anyone, even a partner or friends, can feel awkward and embarrassing. Thankfully, medical professionals are very used to having these kinds of conversations. They’re trained in this, so there will be no embarrassment on their end. They’ll want what’s best for you, and knowing exactly how you’re feeling will help.

I think people have to do what's right for them, but I'd say having good communication with your clinicians about the ways in which your body will change can be helpful. Let your team know if there are things concerning you.

Louise, who had a transplant in 2014

Usually taking the first step is the hardest part, so let’s come up with a plan:

1. Plan a time to talk to them. Would you rather chat about this over the phone? Or in-person at your next appointment?
2. Prepare notes. Write down what you want to bring up. This will help you feel organised when speaking, and you can always hand them your notes if you end up too embarrassed to speak!
3. Feel empowered. It’s brilliant that you’re thinking about this. It’s great that you’re right here reading up on advice! Feel proud of yourself. You want what’s best for you, your body and your sex life, so go and get it. (But it’s also OK to acknowledge your vulnerability – you don’t have to feel super confident to talk about something sensitive!)

It is understandable that people with sexual concerns are not used to talking about something that is usually a very private aspect of their lives. However, always remember that your sexual recovery after your transplant is just as legitimate an aspect of your recovery as any other.

Dr Isabel White, Clinical Research Fellow in psychosexual practice. Read her advice on men’s sexual health after transplant in her blog.

How can I talk to my partner about sex after transplant?

Having sex and talking about sex are two very different things. No matter how long you’ve been together or how close you are, talking about such a personal topic with your partner can feel awkward. That’s ok.

It’s important to chat about your sex life, both to navigate any physical side effects and to acknowledge any worries. A great sex life comes with great communication! Your partner will want the best for you, and could well be worried about this too.

I didn’t want to hurt him. Even now if I roll over and give him a cuddle in the night, it’s so easy for me to hurt him. It’s very difficult knowing every time you try and show affection to someone you love, you hurt them.

Jo, whose partner Simon had a stem cell transplant in 2013. You can read their very honest blog on how Simon’s transplant affected their relationship.

It all begins with taking that first step. Let’s come up with another plan:

1. Where and when is best to chat? It’s definitely not during sex, or just after. You’re both too vulnerable in those moments. Pick a neutral time and place, maybe when you’re in the car, out for a walk, or cooking together. Doing another activity can help to lessen the intensity of the conversation.
2. Is there something specific you want to talk about? There might be lots of things on your mind, but you don’t have to talk about them all at once. That’s exhausting. Perhaps pick one thing to introduce the topic. It may then feel easier to have further conversations.
3. Write down what you want to say. If you’re prepared, you’re less likely to stumble over your words and maybe feel embarrassed. Write down some notes to remember important points. You might even feel more comfortable writing a letter to your partner before chatting.
4. Remember ‘I’ statements. If you want to bring up anything your partner has said or done, start with ‘I’ instead of ‘You’, as ‘you’ can sound accusatory. Instead of ‘You make me feel’, say ‘I feel this when this happens and need this to happen going forward’.
5. Ask questions and listen too. As well as spilling your own thoughts, ask your partner if they have any thoughts or worries too. Make this a conversation and not a speech. You’re working through this together.

Try to talk about how you feel, rather than making any assumptions about how your partner might be feeling. Sit down with them and say, “I’m feeling this about my body, I wonder how this is affecting you?” You could start by talking more generally – about how you’re feeling about treatment and your relationships – before diving straight into talking about your sex life.

Krystal Woodbridge, Psychosexual and Relationship Therapist. You can read more of her advice in her blog.

Fertility is also a big topic which can be sensitive to talk about before and after stem cell transplant. But it’s a necessary one to have with your partner and transplant team. You can read more about this topic on our Bigger Issues page.

I’m nervous about dating after transplant

Dating can be nerve-wracking at the best of times, let alone after going through a stem cell transplant. You’ve been through a lot and may have lost some confidence. It’s very normal to be nervous.

There’s no right time to date again after transplant. You should only date again when you feel ready to, and should work on your own relationship with yourself first and foremost.

I started to put myself out there more. I started to feel more confident about my body and a bit more confident about who I am. I felt like I’d beaten the MDS and it was behind me.

Emma, who’s had two stem cell transplants. Read her blog.

If you want to date again but are anxious, how about going about it in one of these ways?

• Meet new people through a hobby, social group or volunteering. This is a much more relaxed situation in which to get to know someone new. There’s much less pressure.
• Ask friends and family for their help. Maybe they can set you up with a trusted friend of theirs. They could even talk to them about what you’ve been through before you meet so you don’t have to worry about bringing it up, if that helps.
• Join a support group, through your hospital or charities such as Macmillan, to meet new people going through similar experiences. You’ll all have a better understanding of each other and could open up more easily.

Should I tell a new partner about my transplant?

It’s entirely up to you what you tell new people about what you’ve been through, and when you tell them.

There might not be an obvious time to bring it up with a new partner, but it’s probably best to talk about your history before things get too serious. This is especially important if you have concerns in areas like fertility. Follow the steps above to help you have these conversations.

If you feel comfortable with this person and trust them to be supportive, it can help to tell them. And if their response isn’t supportive, they’re probably not the right person for you. A loving partner will accept you for who you are and will want to work through any issues. Don’t settle for less than you deserve.

If it's someone you know, it's a bit different - if it's a friend of a friend, someone who knows some of your back story, it's not too much of an issue. But if it's a new person, at what point do you tell them about this baggage you've got?

Emma, who’s had two stem cell transplants. Read her blog.

Where can I find more information and emotional support?

It’s brilliant that you’re looking for information and support on this topic. Hopefully you’ve found some helpful facts and advice on this page, but there are lots of other places you can turn to for extra support.

You may feel that you (and your partner) would benefit from talking to a counsellor. They can help to explore the cause of any problems and suggest ways of resolving them. You can find the right counsellor for you:

• through Relate, the relationships charity, who offer specialist counselling and have lots of tips and tools on their website;
• through the NHS’ Improving Access to Psychological Therapies (IAPT) programme, where you can self-refer to receive free counselling sessions;
• through private counselling services in your area found on the College of Sexual and Relationship Therapists (COSRT) website.

You might feel a little nervous speaking to a counsellor, but the thought is often worse than actually doing it. Counsellors are trained to help you feel as comfortable as possible and to facilitate tricky conversations. It might also take a few counsellors to find the right one – that’s OK too. It’s a bit like dating!

Extra support from Anthony Nolan

• Our Patients & Families Forum and Facebook page are full of stories, information, and other people who are going through similar experiences.
• You can listen to our podcasts, read our blog or watch our patient & family stories.
• Call 0303 303 0303 or email patientinfo@anthonynolan.org to speak to our lovely, supportive team. We’re here for you.

Other useful contacts

British Association for Counselling and Psychotherapy
Information about counselling and therapists in your area.

Daisy Network
A large support group for women suffering with Premature Ovarian Insufficiency (POI), also known as the early menopause.

Macmillan
Macmillan Cancer Support has more information and support on cancer treatment and your sex life.

NHS
Information about treatments, conditions and lifestyle. Support for carers and a directory of health services in England.

The Institute of Psychosexual Medicine
Lists all UK doctors that are trained in psychosexual medicine.

Switchboard
Free and confidential support and information for lesbian, gay, bisexual and transgender people in the UK.

Look Good Feel Better
Providing practical and effective free services for patients struggling with the visible side effects of cancer treatment.

The Samaritans
Confidential, non-judgemental emotional support 24 hours a day, by telephone, email, letter or face-to-face.

Self Management UK
Free self-management courses to help you take control and manage your condition.

Teenage Cancer Trust
Support to improve the lives of teenagers and young adults with cancer.

Terrence Higgins Trust
Information, support and advice on all aspects of sexual health and HIV.

Information published: 27/04/2021
Next review due: 27/04/2024

Related links

Physical symptoms and treatments

Recovery: Body

Recovery: Mind

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