This section focuses on how some of the physical side effects of a stem cell transplant can affect women and men and hinder the enjoyment they get from their sex lives. The possible treatment options are also listed along with handy tips thet you can try yourself to help relieve your symptoms.
Following your transplant you might have developed GvHD related side effects that hinder your ability to have and enjoy sex. High dose steroids that are used to relieve GvHD can also supress the production of sex hormones, which lowers your sex drive. Even if you are not particularly affected by GvHD, your conditioning therapy and stem cell transplant can still leave you fatigued during your recovery. This can make the most basic of daily activities difficult to achieve, let alone summoning up the energy for sex.
Depending on your situation, you may have experienced one or more of the following side effects that could affect your enjoyment of sexual activity. They usually appear between six and 12 months after your stem cell transplant:
- Genital GvHD can cause vaginal dryness and irritation, as well as narrowing of the vagina and even ulceration in severe cases
- Decreased libido (desire to have sex)
- Difficulty achieving orgasm and reduced satisfaction from sex
- Pain during sex and bleeding afterwards.
- An irregular or absence of your menstrual cycle and other symptoms of early menopause, such as hot flushes and vaginal dryness
- Difficulty in achieving and sustaining a full erection, known as erectile dysfunction
- Decreased libido (desire to have sex)
- Inflammation or a rash on the penis and/or scrotum caused by GvHD. This often leads to pain or discomfort during sex
- Narrowing of the urethra, the tube in the penis that carries urine and sperm, which can cause discomfort
- Inability to ejaculate
‘In my experience, one of the things that helps patients and loved ones is accepting that the illness and the transplant have changed the person who’s had it. These can be both positive and negative changes, but there is a difference.’
Philip Alexander, counsellor and cognitive behavioural psychotherapist
Your transplant team will provide you with the best possible treatment based on your medical situation. If you are unsure about anything, feel free to ask your transplant team for more information, they will be happy to help. It is likely that your treatment plan will include a combination of the following medications:
Men and women
All patients can be given a range of treatments to target the localised immune responses leading to painful inflammation, including:
- Immuno-suppressants that can be applied to areas of the skin showing signs of inflammation.
- Steroids are often given in response to inflammation and then reduced over a few weeks.
- Calcineurin inhibitors can also be given to replace long term steroid use.
- Oestrogen, the female sex hormone, causes the lining of your vagina/vulva to thicken and become more resilient. It can be given in the form of creams, capsules or release rings.
- Conditioning therapy prior to your transplant can cause women to go through the menopause much earlier than expected. You can discuss treatment options with your doctor and will probably be offered HRT
- (Hormone Replacement Therapy) to alleviate hot flushes and other symptoms. HRT may also make sex less painful and can increase your sex drive.
- You may be referred to a gynaecology specialist who will examine and treat you.
- You may be offered a course of testosterone, the male sex hormone, to increase your libido.
- PDE-5 inhbitors are a class of drugs you may not have heard of before although you probably know one of their commercial names: Viagra. These oral tablets are used to increase blood flow to the penis, which helps to sustain an erection when required.
- Other possibilities (although much less common) include the use of vacuum erection devices, an Alprostadil injection or in some cases penile implants.
- These options can be discussed in more detail at an erectile dysfunction clinic which you can be referred to via your transplant team. Our men's health blog also has more info on how these problems are treated.
While some treatments need to be prescribed by your transplant team, there are also a few things you can try to help ease any discomfort you might be experiencing:
- Bath in warm water to avoid chemical or physical irritation, and try not to use perfumed lotions and soaps.
- Wear loose fitting clothes and cotton underwear. If your skin is particularly sensitive, consider washing your clothes in a mild detergent.
- When symptoms arise they can sometimes be relieved by sitting in a sitz bath (warm water that covers up to the hips) for five to 10 minutes.
- Moisturisers or emollients should be applied to the skin to prevent dryness.
- Barrier creams – such as bacteriostatic gels, petroleum jelly or lanolin cream – can be applied to lock in moisture after a bath or wash.
- Vaginal moisturisers and lubricants can make intercourse more comfortable. If you are using condoms, make sure the lubricant is water-based rather than oil-based because oil-based lubricants can tear condoms.
- If women experience narrowing of the vagina, it can be eased by regularly inserting dilators of varying sizes. Having regular intercourse with your partner can also help, but only try it if you both feel comfortable.
The way you feel and your general outlook on life can be lifted by following a healthy lifestyle. This is true for your sexual well being too. We have lots of advice to help you eat, sleep and exercise well.
Information published: 24/10/2017
Next review due: 24/10/2020 - review in progress