Relationships and sexual health

Some sexual problems after transplant may be temporary side effects from treatment. Other sexual problems may be long-lasting or signs of a more serious complication. Tell your doctor or nurse about any new sexual problems you experience and how you are feeling. These are some of the more common sexual problems people experience after transplant.

Loss of interest in sexual activity

When you don’t feel well or have changes in your hormone levels, you might not feel like being intimate with your partner. As your strength starts to come back, your sexual desire may go back to normal. If you have lost interest in sexual activity, talk to your doctor or nurse. Estrogen replacement might be an option for some women. Medicines for erectile problems or testosterone replacement might be appropriate for some men. You might also find it helpful to see a professional sex therapist or counselor.

Vaginal changes

Many women have vaginal dryness, which can cause discomfort or pain during intercourse. Over-the-counter water-based lubricants or vaginal moisturizers can help reduce pain. Prescription medicines, like vaginal estrogen, may help some women. Ask your doctor or nurse what is best for you.

After transplant, some women may have vaginal infections. Symptoms include a creamy-white discharge, or itchiness that gets worse if you scratch. This may be treated with anti-infection medicines. If you have had sexual contact, your partner may also need treatment.

Be sure to tell your doctor right away if you have any pain with sex, unusual bleeding after sex, vaginal dryness or itching, or burning with urination. These can all be signs of GVHD.

Erectile issues

Many men have difficulty having or keeping an erection during their recovery. Talk to your doctor about options for dealing with erectile dysfunction. You might also try other sexual activities for pleasure, including oral sex or masturbation.

Pain during sex

If sex is painful, tell your doctor or nurse. They can help find out what is causing the pain and recommend the best treatment. But even with treatment, some people still have pain with sex. Talk to your partner about what hurts. Explore other positions or ways of sharing intimacy. You might
experiment with less strenuous activities, such as mutual masturbation, side-by-side positions or quicker rather than longer sexual encounters.

Plan times for intimacy after you have taken pain medicines. Use pillows and cushions to get more comfortable. Allow the person who has the pain to control the depth, speed and duration of penetration.

When you are intimate with your partner again, remember to practice safe sex even if you have been in a long-term, committed relationship. Your immune system is weaker than normal right now so your risk for infection is higher. Ask your doctor if there are any sexual practices that you should avoid.

You should always use a latex condom during sex, especially if you’re not in a committed relationship. Condoms help lower your risk of getting a sexually transmitted disease (STD). Condoms help lower your risk of exposing yourself to a sexually transmitted disease (STD).

Be sure to use condoms and other forms of birth control to prevent pregnancy. While pregnancy is unlikely without fertility preservation before transplant (for example sperm banking or egg freezing), it may still be still be possible for you or your partner to become pregnant without birth control. Preventing a pregnancy is important because the medicines you are taking might hurt a developing fetus (unborn baby).

It may not be easy, but it’s important to talk with your partner about any sexual problems you may be experiencing. Talk openly and encourage your partner to do the same. If you understand each other’s feelings and experiences, you can help each other cope with any changes.

Start the conversation

Sometimes it’s hard to find the ‘right’ words to share your feelings with your partner. Still, sharing your feelings honestly and with compassion can help strengthen your relationship. You might talk about:

• The good and the bad with a focus on solutions
• How you’d like things to be
• Your own feelings and actions you can take

Be mindful to:

• Not interrupt your partner. Let them know you’re listening by saying, “I hear you.”
• Use “I” statements instead of “you.” Statements that start with “you” can put people on the defensive. Instead of “You make me feel …” say “I feel (name the emotion) when (name the behavior) and (state what you need to happen).” For example, “I feel hurt when I’m shouted at. It would be helpful if we could talk about our feelings calmly.”

Some questions that can help you and your partner talk about your relationship are:

• How is your communication? Has it changed?
• Do you feel emotionally close, or distant?
• Do you share the same expectations about recovery?
• Do you share the same goals for the future?
• Have your roles changed? How do you feel about that?How do you feel about your sexual intimacy? How might you want it to change?

Rekindle intimacy

Intimacy starts with communication. Intimacy doesn’t just mean having sex. Explore other ways to be intimate, such as cuddling, giving each other a massage or having a romantic dinner. 

If you’re in a relationship, talking about your feelings can help build physical intimacy. Explore ways to be intimate with your partner without having sex:

• Cuddle
• Give each other a massage
• Tell each other what you love about the other

If you’re single, you may have worries about dating again. Remember, someone who truly cares about you will accept you for who you are and what you’ve been through. When the time feels right, tell your partner about your transplant experience. Some people are ready to share this right way. Others feel more comfortable waiting until they know someone a little better. There’s no right or wrong way to share your experience.