Sex and
Leukaemia
A Guide for
Patients
www.leukaemiacare.org.uk2
As long as you are fit and well to do so, you can still have
sex. You cannot catch leukaemia through sex.
Introduction
There may be times when you don’t
want sex. You may feel differently
about sex after treatment. For some
people, achieving a fulfilling sex life
after you’ve had treatment (or if you
are living with leukaemia) means
finding new ways of giving and
receiving pleasure.
The aim of this booklet is to be
honest and open with patients
and your loved ones. We have tried
to answer many of the common
questions online. The following
material is very sexually explicit.
It is extremely frank and uses a
fair amount of direct phrasing and
descriptions of specific sexual acts
and practices.
This booklet has been written by
Nurse Fiona Heath, Nicole Scully and
Fergus Metcalf. We’re very grateful
for the valuable patient reviews by
Julie Quigley and Nick York.
If you would like any information on the sources
used for this booklet, please email
for a list of references.
Version 1
Printed: 09/2019
Review date: 08/2021
Helpline freephone 08088 010 444 3
In this booklet
Introduction 2
About Leukaemia Care 4
Introduction to sex and leukaemia 6
Sex and chronic leukaemias 16
Orgasms 18
Loss of libido 20
Ways to increase libido 24
Treatment related side effects 28
Sex positions for when you are fatigued 32
Sex toys 46
Lubricants 48
Advice for men 50
Advice for women 62
Your relationship with yourself and others 70
Useful contacts and further support 76
Notes 78
www.leukaemiacare.org.uk4
Leukaemia Care is a national charity dedicated to ensuring
that people affected by blood cancer have access to the
right information, advice and support.
About Leukaemia Care
Our services
Helpline
Our helpline is available Monday -
Friday 9am until 5pm. If you need
somebody to talk to, ring 08088
010 444.
Nurse service
We have two trained nurses on
hand to answer your questions
and offer advice and support,
whether it be through emailing
over the phone on 08088 010 444
or via LiveChat.
Patient Information Booklets
We have a number of patient
information booklets like
this available to anyone who
has been affected by a blood
cancer. A full list of titles – both
disease specific and general
information titles – can be
found on our website at www.
leukaemiacare.org.uk/support-
and-information/help-and-
resources/information-booklets/
Support Groups
Our nationwide support groups
are a chance to meet and talk
to other people who are going
through a similar experience.
For more information about a
support group local to your area,
go to www.leukaemiacare.org.
uk/support-and-information/
support-for-you/find-a-support-
group/
Buddy Support
We offer one-to-one phone
support with volunteers who have
had blood cancer themselves
or been affected by it in some
way. You can speak to someone
who knows what you are going
through. For more information
on how to get a buddy call
Helpline freephone 08088 010 444 5
08088 010 444 or email
Online Forum
Our online forum,
www.healthunlocked.com/
leukaemia-care, is a place
for people to ask questions
anonymously or to join in the
discussion with other people in a
similar situation.
Patient and carer conferences
Our nationwide conferences
provide an opportunity to
ask questions and listen to
patient speakers and medical
professionals who can provide
valuable information and support.
Website
You can access up-to-date
information on our website,
www.leukaemiacare.org.uk,
as well as speak to one of our
advisers on our online support
service, LiveChat (9am-5pm
weekdays).
Campaigning and Advocacy
Leukaemia Care is involved in
campaigning for patient well-
being, NHS funding and drug
and treatment availability. If you
would like an update on any of
the work we are currently doing or
want to know how to get involved,
email advocacy@leukaemiacare.
org.uk
Patient magazine
Our quarterly magazine includes
inspirational patient and carer
stories as well as informative
articles by medical professionals:
www.leukaemiacare.org.uk/
communication-preferences/
www.leukaemiacare.org.uk6
Introduction to sex and
leukaemia
Issues with sexuality are one
of the most important quality
of life concerns for people
undergoing treatment for blood
cancer. Sexuality is complex, as
it includes intimacy, body image,
sexual desire and the ability to
have sex, and is linked to our need
for caring, intimacy, closeness
and touch.
Sexuality is a very personal matter
and means different things to
different people. Physical changes
caused by chemotherapy such
as weight loss or gain, changes
in skin colouring, hair loss,
hormonal changes, energy levels,
fatigue and the functioning
of sexual organs all influence
feelings about sexuality and
sexual appeal.
Helpline freephone 08088 010 444 7
www.leukaemiacare.org.uk8
Can I have sex whilst
being treated with
chemotherapy?
You may still be able to have sex
during chemotherapy if you are
feeling up to it. If you are being
treated with chemotherapy, your
medical team will advise you
to avoid unprotected sex. Using
protection is not only advised for
the avoidance of pregnancy, but to
avoid any traces of chemotherapy
being transferred in bodily fluids.
Typically, chemotherapy is
excreted in the bodily fluids for
48-72 hours. Some chemotherapy
drugs can be found in bodily
fluids for up to seven days
after treatment. Some doctors
may recommend using barrier
protection for 72 hours post
chemotherapy treatment, while
some may advise it for longer.
Chemotherapy can be transmitted
through bodily fluids and is
known to irritate the skin.
Types of barrier
protection
Many guides will talk about using
barrier methods or protection
or barrier contraception. Barrier
methods of contraception can
also prevent the transfer of
infections
The main types are:
The male condom
Worn on the penis, the condom
can be worn for penetrative sex
(anal, vaginal) or for receiving oral
sex.
The female condom, or femidom
The femidom is an internal device
much like the male condom
equivalent. It is inserted before
sex and can be put in place up
to six hours before sex happens.
Female condoms are not a reliable
method of contraception if you
are preventing pregnancy.
Do not use female and male
condoms together. Using both
types of condom together can
cause friction, which leads to
Treatment and sex
Helpline freephone 08088 010 444 9
splitting of the latex. Using both
methods can also make one slip
out of place.
Dental dam
A dental dam is a thin piece of
latex or silicone. Typically, they are
rectangular in shape. They can be
used during various forms of oral
sex including:
• Used to cover female genitalia
during oral sex
• Used to cover the anus for a
partner receiving anilingus/
analingus. This is a sex act
where one partner stimulates
the other’s anus using their
tongue.
How to make a dental dam
You can make your own dental
dam using a condom. Cut off each
end of the condom and cut down
the side of the tube that remains.
This piece of material can then
be used as a dental dam. For this
purpose, you may want to avoid
condoms that have lubrication or
even flavoured lubricants because
they may taste unpleasant.
Effective birth control methods
Some forms of treatment may
affect a developing baby should
you become pregnant. Therefore,
it may be recommended that you
seek birth control. These methods
may include:
• combined pill
• contraceptive implant
• contraceptive injection
• contraceptive patch
• intrauterine device (IUD)
• Mirena (intrauterine system
or IUS)
• progestogen-only pill (mini-
pill)
Birth control is something you
can talk about with your medical
team to discuss what is right for
you. However, birth control is free
on the NHS should you seek to
use it.
www.leukaemiacare.org.uk10
Hand jobs and
chemotherapy
A hand job is a sexual act
involving a partner stimulating
the male’s penis with their hand.
If the male patient has been
receiving chemotherapy, you may
have concerns about whether you
need to use condoms for hand
jobs.
If you are within 2-3 days of
receiving chemotherapy, there
may still be some of the drugs
present in the ejaculate. These
drugs may cause irritation to
the skin, so you may want to
be cautious and use a condom
during those times.
Oral sex and
chemotherapy
Many doctors will advise that
patients use barrier methods of
contraception following treatment
with chemotherapy drugs. Some
may recommend avoiding
unprotected sexual acts for 72
hours post treatment, some may
recommend longer.
This would also include oral sex.
Therefore, men receiving oral
sex would need to use a condom
and women receiving oral sex
would be advised to use a barrier
method such as a dental dam.
Chemotherapy and
infections
A common cause of infections for
patients receiving chemotherapy
is due to yeast or fungus. You are
more likely to be susceptible to
an infection of this type if you
have low white blood cell counts
(neutropenia).
Herpes simplex virus (HSV)
If you have ever had herpes
simplex virus in the past, you
may experience a flare up due
to a weakened immune system
caused by chemotherapy
treatment.
It is a virus that can be passed
onto a partner and is diagnosed
with a blood test which can see if
you have ever been exposed to the
virus. Alternatively, they can also
take a swab from the areas to look
Treatment and sex (cont.)
Helpline freephone 08088 010 444 11
at under a microscope.
If you are undergoing active
treatment and have a flare up of
herpes, speak to your healthcare
team who will be able to give you
treatment to make the lesions
heal.
Yeast infections
A yeast infection can make you
feel very uncomfortable. Yeast
infections are very common.
There are many types of candida
(yeast) that live in various areas
across your body. They do not
pose a problem as the growth is
managed by bacteria. However,
when something happens to
kill off bacteria (in this case
chemotherapy), it can multiply
and cause mild to serious
infections in the body. One place
where these yeast infections can
manifest is in the genitals.
In the vagina, symptoms may
include:
• Itching and burning of the
vagina. The area may appear
red and inflamed.
• You may have abnormal
discharge. Some people
describe it as looking a little
like cottage cheese (white and
thick). Some women may not
have this discharge.
• A yeast infection can cause
pain or discomfort during sex.
Men can also get yeast infections.
Symptoms may include:
• A red rash on the penis.
• Sometimes, you may see
patches of white, shiny skin
on the penis.
• The skin of the penis may be
moist.
• A thick white substance may
be found under the foreskin or
other folds of skin.
• Itching or burning feeling of
the penis.
www.leukaemiacare.org.uk12
Managing a yeast
infection:
• Ensure your genitals are
dried properly after a bath or
shower.
• Avoid wearing tight clothes or
underwear.
• Wear underwear that has a
high percentage of cotton.
• Avoid scented lotions or
potions in this area.
• Don’t use Vaseline as a
lubricant as it can increase
the chances of a yeast
infection.
• If you or your partner has a
yeast infection, use a condom
during sexual activity.
Sexually transmitted
infections (STI’s) and
treatment
With a lowered immune system,
you may be more susceptible to
catching an infection or being
exposed to a sexually transmitted
disease. The usual advice would
apply: use protection and ask any
new partners whether they have
been tested for an STI.
If you are a little older and have
met a new partner, do not be
shy about asking the question.
In 2016, the topic made the
national news as England’s Chief
Medical Officer revealed that STI
diagnoses in people aged 50 to 70
had risen by a third over the last
decade. Some people may think
that contraception is there just
to prevent pregnancy. However,
contraception and sexual health
checks will keep the spread of
diseases such as chlamydia and
gonorrhoea at bay.
Treatment and sex (cont.)
Helpline freephone 08088 010 444 13
Other types of infection
Urinary tract infections can be
avoided by urinating soon after
sex has finished, as this can
wash away much of the bacteria.
To make it easier to have a
wee after sex, you may want to
consider drinking a glass of water
beforehand.
With low white cell counts, you are
susceptible to infection. Before
any sexual contact, ensure that
you and your partner’s hands
and genitals are clean before
engaging in any types of sex and
are thoroughly washed after.
www.leukaemiacare.org.uk14
Love bites
A love bite is essentially a bruise
caused by sucking on a partner
in a sexual way. Blood cancer
patients are susceptible to
bruising because of low platelet
counts. Therefore, it would be
generally recommended for
patients affected by a leukaemia
to not allow this to happen to
themselves.
BDSM
BDSM is an abbreviation
for Bondage, Discipline (or
domination), Sadism, and
Masochism. It is a sexual
practice that some people choose
to engage in. A masochist is
somebody that enjoys physical or
mental pain during sex.
Some people may not realise they
are partaking in BDSM; however,
many people would consider the
following activities to be BDSM:
domination, submission, pain play,
dressing up and role playing.
BDSM and radiotherapy
If you enjoy taking part in BDSM,
and are being treated with
radiotherapy, you should be aware
of the changes that radiotherapy
can do to your skin. These can
include:
• A skin reaction which may be
sore like a sunburn
• A darkening of the skin
While being treated with
radiotherapy, you should be
gentle with any sore areas of skin.
You may want to avoid perfumed
products on the area. In terms of
sexual practice, you may want
to avoid scented lubricants
which could further irritate these
delicate areas. Although you
may enjoy receiving pain, due to
your reduced platelet levels and
heightened risk of infection, you
should try to avoid this during
active treatment.
You may enjoy dressing up or
sexual role play as part of your
BDSM play. However, during
radiotherapy treatment you may
want to avoid this altogether
to prevent further irritation to
delicate skin.
Treatment and sex (cont.)
Helpline freephone 08088 010 444 15
www.leukaemiacare.org.uk16
CML
Patients with a chronic leukaemia,
such as chronic myeloid
leukaemia, may be treated with
a tyrosine kinase inhibitor, also
known as a TKI.
While many people may refer to
a TKI as a form of chemotherapy,
a TKI is a targeted therapy which
will be taken for many years.
You may find mixed information
online as to whether you should
use a condom if you or your
partner is being treated with a TKI
and this information can be very
confusing.
Many of the key CML experts both
in the UK and worldwide say that
a condom isn’t necessary as the
levels of treatment in secretions
such as semen or vaginal fluids
would be very low and would not
interfere with a partner.
Although this booklet is not
necessarily about fertility, it is
important to raise the issue of
contraception with female CML
patients of a child bearing age.
Studies show no suggestion
of any problems in pregnancy,
delivery or any increase in
congenital abnormalities when
the father is being treated for
CML. For male patients, fathering
children could be achieved
without interruption of treatment.
For a female patient being
treated with TKIs, this is not the
case. TKI’s are teratogenic drugs
which means they can disturb
the development of the embryo
or foetus. Therefore, pregnancy
in women with CML is closely
monitored by a consultant.
Women with CML who aren’t
actively trying for a baby should
use a form of contraception to
prevent pregnancy. Having CML
does not mean you shouldn’t get
pregnant, however, it should be
discussed with your consultant.
There are a number of resources
online that discuss pregnancy
and CML. Leukaemia Care have a
video on their YouTube channel
from a world-renowned expert
on the subject, Professor Jane
Apperley. The charity has been
allowed to share the footage by
the CML advocates network and
can be found on their YouTube
channel at http://www.youtube.
com/c/leukaemiacare
Sex and chronic leukaemias
Helpline freephone 08088 010 444 17
CLL
85% of patients with chronic
lymphocytic leukaemia (CLL) have
issues making antibodies. This
difficulty in producing antibodies
can lead to a rise in infections.
To combat any infection risk,
increase hygiene strategies that
you may already have in place
such as handwashing or using
barrier contraception if you are
susceptible to thrush. You may
find some of the information from
pages 11-13 which cover different
types of infection useful.
Fatigue can also impact on your
sex life. Fatigue can impact on
your libido (as detailed on page
21) or your ability to have sex
in certain positions. We have
suggested some sex positions
or sexual acts which may be
appropriate for when you feel
fatigued from pages 32 to 44.
The CLLSA (Chronic
Lymphocytic Leukaemia
Support Association) run
an online forum which is
frequented by over 13,000
CLL patients. Sex is a topic
which is discussed fairly
regularly.
Their forum has the ability
to sign up anonymously if
you wish to discuss the topic
of sex and CLL and to share
patient experience on the
topic.
The CLLSA healthunlocked
forum can be found at:
healthunlocked.com/
CLLSupport
www.leukaemiacare.org.uk18
Orgasms
Some chemotherapy treatments
may cause toxicity to the pelvic
blood supply or nerves. In men,
this could change the feeling of
your orgasms and they may not
feel the same as they did before
treatment.
According to research conducted
on the general public in 2017, up
to 80% of women cannot orgasm
through penetrative sex alone.
One in seven women experienced
pain when climaxing and 3% of
those surveyed had never had an
orgasm.
The causes of sexual dysfunction
in women that have undergone
cancer treatment are both
physical and psychological.
For any patient, you may find that:
• You may have difficulties in
reaching orgasm.
• You have decreased pleasure
at orgasm.
• You have no changes at all.
•
As well as being cancer related
side effects, these issues can also
be attributed to ageing.
Decreased sexual
sensation
If you feel that your sexual
sensation has diminished, you
could use a vibrator to help
increase the sensation in these
areas. This works by stimulating
nerve endings.
It may be that you need a stronger
vibration if your sensation has
decreased. Instead of using a
vibrator, you may wish to try a
body massager instead which
has stronger vibrations. A body
massager can be used on all
areas of the body and could be
used to ease any aches you have
across your body.
Vibrating toys can be used by men
too where achieving an erection
is difficult. Vibrating toys can be
placed around the head of the
penis and they will produce sexual
stimulation.
Helpline freephone 08088 010 444 19
Difficulties in reaching
climax
You may find that you are not able
to achieve orgasm in the way you
were used to.
As we age, it can be harder to
achieve orgasm or it may take
longer. This is also true for
patients that have been treated
for a cancer.
You may need to spend more time
in foreplay or try touching new
areas on your body to see what
you respond to.
In some cases, it may
be beneficial to talk to a
psychosexual counsellor to look
at strategies for achieving or
improving orgasms.
www.leukaemiacare.org.uk20
Loss of libido
Before you were told you had
leukaemia, you had a libido. Some
people have a high libido, some
have a lower libido. Only you will
know what your libido was like
before treatment.
A key question following
diagnosis will be, "Do you have
desire, to have desire?". If the
answer is yes, the likelihood is
that you do have libido, it is just
that your body is not doing what it
used to do.
Hormones and libido
Some cancers or treatments
alter the hormones that the body
produces. Some cancer cells
cause hormones that will create
symptoms.
Some treatments can stop the
body making certain types of
hormone altogether. In terms
of sex and cancer, the main
hormones that may be affected
are oestrogen, progesterone and
testosterone.
These alterations in hormone
levels can lead to a loss of libido.
Doctors may want to measure
your hormone levels to see if your
levels have dropped and then
treat this.
Mental health and
libido
The Leukaemia Care patient
survey revealed that some
leukaemia patients felt constantly
depressed or anxious since their
diagnosis. Depression and anxiety
are both common responses to
being diagnosed with a leukaemia
as well as the treatment you have
faced. For some CLL patients,
living on "watch and wait" can
cause depression or anxiety too.
Signs of depression can include:
• Signs of extreme sadness
that don’t go away.
• Feeling low or hopeless.
• Losing interest or pleasure
in doing things you used to
enjoy.
You should speak to your GP if
you think you may be depressed.
They may be able to prescribe
you antidepressants or refer you
for counselling. This may help to
alleviate symptoms of depression
Helpline freephone 08088 010 444 21
and help to resolve your libido
issues.
However, if you are taking
antidepressants, a lowered
libido can be a side effect of
this treatment. Most prescribed
antidepressants are SSRI’s, this
stands for selective serotonin
reuptake inhibitors. The drugs
work by raising levels of serotonin
in the body. Serotonin plays an
important role in regulating your
mood and low levels of serotonin
have been linked with depression.
Some people are more sensitive
to the effects of these treatments
than others. Therefore, some
people taking antidepressants
may have a lowered libido
because of the treatment but
some may not.
Pain, nausea and libido
You may feel nauseous as a result
of chemotherapy treatment and
the result of this is that you do
not feel like you want sex. For
some leukaemia patients, such
as those diagnosed with chronic
myeloid leukaemia, the side effect
of the tyrosine kinase inhibitor
treatment may also include
nausea.
Over time, you may learn when
you’re likely to experience nausea
and you could plan your sex to
avoid these times.
You may be prescribed an anti-
nausea medicine to deal with
nausea as a side effect; however,
these could also lead to a loss of
libido. If this is something you are
worried about, you should talk to
the medical professional that is
recommending the medication to
discuss your worries and to work
towards a solution.
Fatigue and libido
Fatigue is one of the most
common consequences of
cancer and related treatments.
Its cause, however, is not yet
fully understood. Cancer related
fatigue is thought to affect the
majority of people who have had
a cancer episode and may be
defined as:
"A distressing, persistent, subjective
sense of tiredness or exhaustion
related to cancer or cancer treatment
that is not proportional to recent
www.leukaemiacare.org.uk22
activity and interferes with usual
functioning."
Given the subjective nature of
fatigue, it may feel different from
one person to the next. Most
people however, will experience
a degree of fatigue which feels
invasive in that, it affects them
both physically and cognitively.
This means that it is different
to the tiredness you might
usually have experienced prior to
becoming ill or as a consequence
of doing something pleasurable.
It is common for patients to
sometimes find it difficult to
adequately explain how cancer
related fatigue actually feels due
to its invasive, fluctuating and
troublesome nature.
Your cancer episode and
associated fatigue can negatively
impact on all aspects of your
day to day life. This may include
disruption to your usual and
taken for granted activities
such as personal care, including
showering and dressing; leisure
and social activities, such as
keeping fit or going out with
family and friends; and others
may experience disruption to
work and educational attendance
and performance. Relationships
of an intimate nature may also be
affected by the presence of cancer
related fatigue and you may feel
too tired to participate in sexual
intercourse. Additionally, your
partner may be cautious to do so
and worry that they may make
your fatigue symptoms worse.
The first step in self-managing
your fatigue symptoms is
acknowledging that you have
cancer related fatigue. Secondly,
being self-compassionate and not
expecting yourself to perform all
the activities you did before you
became ill will help if fatigue is an
issue.
Congratulate yourself on what
you do achieve rather than what
you don’t, regardless of how little
it seems, and do not compare
yourself with others or past
performance.
If you accept that your available
energy is not currently what it
used to be, you can then begin to
think about how much energy you
have in ‘your battery’, how you are
Loss of libido (cont.)
Helpline freephone 08088 010 444 23
using this and whether you would
like to use it differently. This
self-management approach will
hopefully help you to regain some
control over your daily activities,
roles and responsibilities.
If you are looking to have sex, we
have included a section in this
booklet which looks at sexual
positions which may be of use
when you are fatigued. They can
be found on pages 32 onwards.
Remember the fatigue you
are currently experiencing
may well go away over time. In
the meantime, however, self-
managing your fatigue will help
you feel more in control and add
to your sense of wellbeing.
www.leukaemiacare.org.uk24
Ways to increase libido
Watching pornography
together
Before being treated for a
leukaemia, you may or may not
have watched pornography by
yourself or with your partner.
Some people do not feel
comfortable watching
pornography. Some people
feel uncomfortable with the
idea of their partner watching
pornography. Only you know what
your personal feelings are on the
subject.
Communication is key on issues
such as pornography. Talk to
your partner about what they are
comfortable with and make sure
you both know what one another’s
feelings on porn are.
Relate, the relationship charity,
commissioned a survey in 2012
that revealed that 41% of women
watched pornography once a
month or more, while 76% of
men admitted watching it. 19%
of women watched once a week,
with 58% of men saying they also
watched it once a week. These
figures may indeed be higher,
as some respondents said they
would prefer not to say whether
they used porn.
A study published in the journal
Sexual Medicine revealed that
men that watched porn had a
marked increase in sexual desire
compared to those who did not.
However, the men in the study
were all in their 20s so the report
did not offer insight on older
males.
Being diagnosed with a
leukaemia does not mean you
have to change your opinion on
pornography. However, if you
are comfortable in watching
pornography either on your own,
or with your partner, it may help
to improve your libido.
Reading erotic novels/
listening to erotica
Some people would argue that the
brain is the biggest sexual organ,
as desire begins in the mind.
Over the past five years, reading
erotic fiction has become
increasingly popular. Some would
call it the "Fifty shades" effect!
Helpline freephone 08088 010 444 25
In 2015, a study was conducted
which looked at women with low
sexual desire. Half of the women
in the study were given self-help
books to read, whilst the other
half were given erotic fiction. The
study revealed that both groups
made equal gains in the following:
sexual desire, sexual arousal,
lubrication, satisfaction, orgasms,
pain reduction and overall sexual
functioning.
The term erotica is used for
written words that arouse and
excite the reader and could
be consumed in the following
formats:
• Fiction, from short stories to
novels
• Nonfiction essays and
retellings of true experiences
• Romance novels
• Fan fiction
• Web content and e-books
There is a stereotype that men
need visual stimulus, whilst
women prefer reading about
sex. Most studies suggest that
men are just as turned on by the
written word as women, and many
women enjoy porn as much as
men.
There are thousands of books
available that would be
classified as erotica with many
subcategories from erotic
romance to erotic BDSM. Many
are available on popular book
websites such as Amazon,
Waterstones or your local
independent book shop. Your local
library is likely to have its own
section of books that you could
borrow or even e-books that you
could download to your e-reader.
www.leukaemiacare.org.uk26
Ways to boost libido (cont.)
Podcasts
Podcasts are increasingly popular
too. There are over half a million
podcasts that exist and the
number rises daily.
To find an erotic podcast, simply
search erotica in the podcast
device that you use such as
Castbox, Spotify or iTunes. These
shows are typically free so you
could try a few shows to see what
you like. The advantage with
Podcasts is that it is private; you
simply pop in your headphones
and nobody would know what you
are listening to!
Both books and podcasts are
something that you could try as
an individual or you could involve
your partner. This could involve
listening or reading the same
piece at the same time. If you are
reading, you could choose to read
passages to one another.
Helpline freephone 08088 010 444 27
www.leukaemiacare.org.uk28
Treatment related side effects
that may affect your sex life
Graft Versus Host
Disease (GVHD) and
Sex
Patients may develop GVHD after
their transplant; this can affect
women and men in different ways.
High dose steroids are often used
to treat GVHD and these can also
suppress the production of sex
hormones, which may decrease a
person’s sex drive.
For information specific for
men and women, please see the
relevant sections of this booklet.
Transplants and sex
Sexual dysfunction is one of the
most frequently described issues
experienced by bone marrow
transplant patients. Impairment
of sexual functioning, interest
in sexual thoughts or feelings
and satisfaction with personal
sexual appeal are common
issues. Approximately half of all
patients experience issues with
their sexual health after their
transplant.
Sexuality and sexual
function
Organic sexual dysfunction in
bone marrow transplant patients
is thought to be caused by
systemic therapies, particularly
the alkylating agents and total
body irradiation, which are known
to damage the endocrine and sex
organ pathway responsible for
sexual maturation and function,
resulting in very low sex hormone
levels and low or absent function
of sex organs.
Sexuality
Changes in sexuality after a
transplant are common. Issues
with sexuality and sexual
dysfunction are one of the most
important quality of life concerns
for people after a transplant.
Sexuality is complex and involves
more than just having sex.
Sexuality includes intimacy, body
image, sexual desire and the
ability to have sex and it is linked
to our need for caring, intimacy,
closeness and touch. Physical
changes caused by transplant
such as weight loss or gain,
Written by Nurse Advisor Fiona Heath
Helpline freephone 08088 010 444 29
changes in skin colouring, hair
loss, hormonal changes, energy
levels, fatigue and the functioning
of sexual organs all influence
feelings about sexuality and
sexual appeal.
Relationships
A transplant can also place a
huge strain on the intimate
relationship you have with your
partner. It is sometimes hard
to make the switch from being
the patient or caregiver back to
seeing your partner as a sexual
being. The most important thing
is to maintain honest, open
communication with your partner
about what both of you need and
can achieve. You may need to
get to know each other again in
a sexual sense. Going on dates,
massage, cuddling, showering or
bathing together may be helpful
with this. Activities such as
touching, hugging, and kissing
provide feelings of warmth and
closeness even if intercourse
is not involved. Professional
sex therapists can recommend
alternative methods. Emotions
can also affect sexual functioning,
including stress, marriage
problems, or depression.
If you are having sexual
problems, talk to your healthcare
professional. Don’t be afraid to
ask questions and seek answers.
Many of these problems can be
treated.
Guidelines for
resuming sex
Your transplant team will be able
to give you personalised advice
about when it’s safe to have sex
after your stem cell transplant.
• You should have a single
partner rather than multiple
partners in order to minimise
the risk of getting an
infection.
• Your partner should be well,
that is, they should not have
cold sores, influenza, a cold
or a sexually transmitted
disease.
• Your platelet count should be
more than 50 x 10/9/L.
• Use condoms for three
months after your transplant
www.leukaemiacare.org.uk30
Treatment related side effects
that may affect your sex life
(cont.)
because they lesson the risk
of getting an infection
• You may receive oral sex
but shouldn’t give it for
three months after your
transplant or while you are on
immunosuppressive drugs
• Anal sex should be avoided
while on immunosuppressive
drugs or if skin breakdown is
present
• Use birth control until your
fertility status has been
assessed and confirmed.
If your desire to become more
sexually active does not increase
as your recovery proceeds, bring
this up with your doctors on your
follow-up visits. It is important to
remember that as with everything
else after a bone marrow
transplant, getting back to normal
in terms of sex will take time. Try
to be patient with yourself.
Helpline freephone 08088 010 444 31
www.leukaemiacare.org.uk32
Sex positions when you are
fatigued
As a leukaemia patient, you may
well want sex but find a barrier
to becoming intimate is your
ongoing levels of fatigue. This
fatigue may affect before, during
or after treatment. You may also
feel fatigued if you are on ‘watch
and wait’.
One solution is to find positions
with your partner where your
partner is willing to do the more
strenuous activity during sex.
Alternatively, you can choose
positions where the sex is more
gentle but both partners are
active in the act. You could also
consider having sex at the times
in the day where you feel the least
fatigued, for example, this may be
in the morning rather than in the
evening.
We have listed a number of
positions below with a brief
description and we’ve tried to
include diagrams where possible.
We have listed positions which
may be suitable for those in a
heterosexual relationship (male
and female) or gay relationships
(male and male, female and
female).
Points to keep in mind for all of
these activities:
Penetrative sex (anal or vaginal)
may need to be avoided if you
have a low cell count or a low
platelet count. This is because
you might be at risk of bleeding
or infection. If in doubt, ask your
consultant or CNS or ring the
Ward or department that looks
after you (don’t be embarrassed,
they are here to answer your very
normal question about sex!).
If it hurts at any time, stop. If
you are worried about mild pain
during sex, take painkillers about
30 minutes beforehand.
Chemotherapy can be excreted in
semen for a period of time after
treatment; therefore, you will need
to use condoms. Women may
need to use dental dams.
Your partner should be well,
that is, they should not have
cold sores, influenza, a cold or a
sexually transmitted disease.
Treatment for cancer can cause
problems in climax. Don’t worry
if you don’t manage to climax.
Similarly, being the partner of a
Helpline freephone 08088 010 444 33
person diagnosed with a blood
cancer can cause anxieties
and stress which can manifest
in problems with orgasming.
Achieving orgasm does not
have to be the ‘end goal’ of sex.
Concentrate on enjoying what you
are doing.
www.leukaemiacare.org.uk34
Spooning
In some cases, when people refer
to spooning they are referring
to the act of sleeping with one
partner behind the other. Both
partners are facing the same
way. The name refers to the way
that spoons fit together if placed
facing the same way.
A variation on this position is
for both partners to bring their
knees towards their chest. It is
super comfortable - and there is
something to be said for gentle
sex!
The way this position is performed
depends on the partner that is
fatigued.
Alternatively, the partner that is
behind (also known as in the ‘big
spoon position’) could use their
free hand to masturbate their
partner.
Helpline freephone 08088 010 444 35
www.leukaemiacare.org.uk36
Sex from behind
In this position, one partner is
on the bed typically on all fours.
The other person positions
themselves behind the person on
the bed and penetrates them from
behind. The position is also known
as doggy style and the name is
taken from the way in nature
that dogs have sex. There are
modifications that can be made
to this position to take pressure
off knees for both partners.
If you struggle with kneeling,
the position can be performed
standing up. A modification to
make this position easier for the
partner receiving penetration is
to lie on the stomach and prop up
the bum using a pillow.
Helpline freephone 08088 010 444 37
www.leukaemiacare.org.uk38
Sex in a seated position
In this position, the partner that is
being penetrated straddles their
partner. This allows the partner on
top to control the speed of the sex,
as well as controlling the depth of
penetration.
The position could be performed
by leaning against a wall too to
take pressure off the back.
Helpline freephone 08088 010 444 39
www.leukaemiacare.org.uk40
Missionary
The best known sexual position of
them all.
In this position, the partner that is
penetrated is on the bottom.
You can make modifications to
the missionary position including
placing a pillow underneath your
bum to lift the pelvis and to allow
deeper penetration.
If the partner on top gets an ache
in their arms, they could lean
forward onto their forearms rather
than leaning onto their hands.
Helpline freephone 08088 010 444 41
www.leukaemiacare.org.uk42
Other sexual acts you may want
to consider when fatigued
Outercourse, or non-penetrative
sex, is any sexual activity
which doesn’t involve sexual
penetration. This could include
the following activities:
• Frottage – the act of rubbing
any part of the body against
the sexual organ of another
person either naked or
clothed
• Mutual masturbation
• Kissing
• Cuddling
• Erotic massage
• Masturbation or ejaculation
onto a partner’s body part or
parts
Helpline freephone 08088 010 444 43
www.leukaemiacare.org.uk44
Anal sex is very normal in both
heterosexual and homosexual
relationships.
When white blood cell counts are
low, you are at risk of infection so
you may want to avoid partaking
in anal sex during that time. If
your platelet count is low, you will
need to be gentle during sex.
If you regularly partake in anal
sex, talk to your healthcare team
to ensure you are safe to do so.
Anal sex
Helpline freephone 08088 010 444 45
www.leukaemiacare.org.uk46
You may or may not have used
sex toys before the diagnosis but
after a diagnosis, you may want to
consider using sex toys.
According to a survey conducted
in 2017, almost three million
people in the UK confessed to
owning at least one sex toy.
The most popular form of sex toy
was a vibrator, followed by cock
rings and butt plugs.
If you’ve never used a sex toy, this
doesn’t mean you need to start.
Simply, sex toys are an option for
engaging in various sexual acts.
As always, communication is key
so talk to your partner if you’d like
to explore sex toys for the first
time.
Some gynaecologists are even
looking to sex toys as a way of
increasing natural oestrogen
in the body. A natural way of
increasing moisture in the vagina
is to increase blood flow into
the pelvis, and a sex toy such as
a vibrator can be a natural way
of doing this and an option for
women that do not want to take
synthetic oestrogen.
Cleaning sex toys
If you wish to continue or begin
to use sex toys, it would be
advised to keep them very clean -
especially when you are prone to
infection.
Tips for keeping your sex toys
clean include:
• Use mild soap to clean your
toys. Harsh materials can
actually damage the surface
of the toy. Using a mild,
fragrance free soap should
also avoid causing irritation
to delicate skin.
• Don’t submerge any toy that
is motorised.
• For toys made from a durable
material, such as glass or
silicone, you should submerge
them in boiling hot water.
• Once cleaned or washed, dry
sex toys using a clean dry
towel.
• Wash all toys before and after
use.
You may have never used sex toys
and you may not feel comfortable
visiting a shop to buy these items.
The internet now has a wealth
of websites where you can buy
Sex toys
Helpline freephone 08088 010 444 47
products of this type. The items
will arrive in plain packaging so
nobody will know what you are
buying. There are toys available
for people to use alone or as a
couple.
Many of these online stores will
have the ability to chat with
an employee. If you don’t feel
comfortable sharing your email
to ask questions, simply set
up an email address which is
completely different from your
own to answer those questions.
Remember - your questions are
normal!
www.leukaemiacare.org.uk48
Using lubricants can not only
make sex more comfortable but it
can also make sex more fun. There
are many lubricants that you can
purchase nowadays for different
uses or with different flavours, the
choice is seemingly endless.
Lubricants help to ease friction
during sex. They may be
particularly helpful if you have
vaginal dryness, for example, after
treatment which has sent your
body into a menopausal state.
You could use lubricant as a
part of foreplay. As a woman, you
may want to spread it over the
labia, clitoris and over the vagina
to make penetration easier. It
can also be spread onto your
partners genitals or on sex toys
too. You may need to apply further
lubricant later during sex.
If you don’t like putting on
lubricant with your hands, you
could wear surgical gloves but you
may find that this kills the mood.
Some lubricants also come with
an applicator.
When buying a lubricant, look for
one that is water based rather
than oil based. If you are using
contraception such as condoms,
oil-based lubricants can actually
damage condoms and reduce
their effectiveness.
You should also be aware that
some lubricants include the
ingredient glycerin. Glycerin can
actually promote the growth of
thrush. Another ingredient that
can cause issue is parabens, as
they can cause imbalances in
the vagina and make existing
problems worse.
Many lubricants are advised with
qualities such as "tingle", "heat",
perfumed or flavoured. These can
cause irritation to the genitals
and should be avoided.
Keep your lubricants near places
where you’re likely to have sex, for
example in the bedroom. This will
stop you fumbling around when
you need them!
Lubricants
There is a fantastic website
run by a former nurse which
includes many articles
looking at the wider issues
of sex after cancer, including
fantastic practical tips on
sex. The website can be
found at: JoDivine.com
Helpline freephone 08088 010 444 49
www.leukaemiacare.org.uk50
Advice for men
Men and Genital GVHD
Chronic GVHD may affect your
penis and sexual function. It may
cause:
• A decreased desire to have
sex
• Redness/rash on your penis
• Ulcers on the penis
• Inflammation of the penis
and/or scrotum
• Narrowing of the urethra
• An inability to ejaculate
If you experience any of these
symptoms, it is important to let
your transplant team know. You
may want to ask if they can test
your testosterone levels to see if
there has been a decrease.
Treatments for genital GVHD may
include some of the following
medications:
• Steroids are the most
common treatment given
• Calcineurin inhibitors are
sometimes given as an
alternative to avoid long term
steroid use
• Topical immuno-
suppressants
• Testosterone may be
prescribed – this may help to
increase your libido
• PDE-5 inhibitors – e.g. Viagra
If you experience any of these
symptoms of GVHD it is important
to inform your medical team so
that the appropriate treatments
can be given.
Genital GVHD can be a difficult
and uncomfortable subject to talk
about; however, it is important
to discuss any issues with your
transplant team as genital GVHD
can become severe if not treated
and can have a devastating effect
on quality of life.
Helpline freephone 08088 010 444 51
Priapism
Priapism is defined as a long-
standing and painful erection
that lasts longer than four hours
without sexual stimulation and is
unrelieved by ejaculation.
The word "Priapism" has its roots
in Greek mythology. The term
is named after a Greek god of
fertility called Priapus, who is
said to be a son of Zeus. A jealous
female cast a spell over Priapus’
mother whilst she was pregnant,
causing her son Priapus to be
born with this affliction for which
he was disowned by his mother.
Priapus is often represented in
ancient statues and paintings
with a disproportionately large
and permanent erection.
In reality, priapism is a very
serious condition and is
considered to be a medical
emergency that requires
immediate treatment. An erection
that lasts too long can cause
permanent damage to the penis,
with the risk of impotence being
as high as 50% in males affected
by priapism.
Priapism and leukaemia
Priapism in its own right is a very
rare disease, and so for priapism
to be caused by leukaemia is
extremely uncommon. About two
thirds of adult cases of priapism
are caused by the use of agents
to treat erectile dysfunction and,
in children, the major cause
of priapism (67%) is sickle cell
anaemia. Generally speaking,
leukaemia is only responsible
for around 20% of all the cases
of priapism, and the incidence
in adult leukaemic patients is as
little as 1-5%. Approximately half
of these have chronic myeloid
leukaemia (CML) as it is far more
common to have priapism with
chronic leukaemia than acute
leukaemia.
There are three different types of
priapism, all of which vary in the
underlying biological cause:
Low-flow priapism (ischemic)
Low-flow priapism occurs when
blood becomes trapped in the
erection chambers, meaning
it is not able to leave the penis
after an erection. This is the most
www.leukaemiacare.org.uk52
common and represents over 95%
of cases.
Symptoms of low-flow priapism
include:
• Erection lasting over
four hours or at times
unconnected to sexual
interest or stimulation.
• Pain in penis that gets
progressively worse.
• Rigid penile shaft, but the tip
of the penis (glans) remains
soft.
It is low-flow priapism that
can present in men affected by
leukaemia (as well as sickle-cell
disease and malaria).
How does leukaemia cause low-
flow priapism?
Priapism in leukaemia is caused
by an abnormally high number
of white blood cells in the blood,
which can occasionally cause
the blood to thicken and clog
up the small veins, leading to
decreased blood flow out of the
penis and stagnation of the blood.
When blood becomes stagnant, it
cannot replenish oxygen, which
means that the penile tissue
becomes deprived of oxygen, often
leading to long term damage.
Another contributing factor to the
congestion of blood flow out of
the penis is the result of physical
pressure upon the abdominal
veins by an enlarged spleen
(splenomegaly), a comparatively
common symptom of leukaemia.
Stuttering priapism
Stuttering priapism is a more
uncommon type of low-flow
(ischemic) priapism. It is a
recurring form of low-flow
priapism which is identified by
episodes of unwanted and/or
painful erections that last for
three hours or more. It occurs
repeatedly with intervening
periods where the penis relaxes
and subsides from its swollen
state. This type of priapism is
more likely in males who have
inherited a genetic disorder
which changes the shape of their
red blood cells (e.g. sickle cell
anaemia) as these abnormally
shaped cells can temporarily
block the blood vessels.
Advice for men (cont.)
Helpline freephone 08088 010 444 53
High-flow priapism (non-
ischemic)
This type of priapism is rarer than
low-flow and is usually not as
painful. The cause of this type of
priapism is usually from an injury
to the penis or the perineum
(the area between the scrotum
and anus). This then prevents
the blood in the penis from
circulating normally.
Symptoms of high-flow priapism:
• Erection lasting over
four hours or at times
unconnected to sexual
interest or stimulation.
• Erect but not fully rigid penile
shaft
• Often painless
How is priapism treated?
Treatment of priapism depends
on the type and the cause.
Your doctor will evaluate your
symptoms and run tests to decide
whether it is ischemic or non-
ischemic, as well as the possible
cause.
If the erection has lasted for
four to six hours, decongestive
medication in tablet form is
usually effective as an immediate
relief method.
However, if this doesn’t work,
other treatments to help reduce
your erection might be:
• Decongestive medications
injected directly into your
penis.
• Aspiration – where the
penis is numbed with local
anaesthetic, using a needle to
drain the excess blood.
• Surgery whilst you are asleep
under general anaesthetic to
draw out the blood through a
small incision.
Due to the relative rarity of
priapism occurring as a symptom
of leukaemia, there are currently
no standard protocols for its
treatment or management in
leukaemia patients, and there
is still debate over what method
is most effective. However, all
methods look to reduce the
excess burden of white blood cells
in the blood causing the blockage
(hyperleukocytosis).
A rather out-dated technique
www.leukaemiacare.org.uk54
used in the past included local
radiotherapy, with or without open
surgical shunting (using a long
needle to create a bypass around
the obstructed portion of the vein
in the penis).
More recent therapies include:
• Chemotherapy to kill the
excess white blood cells
clogging the veins of the
penis.
• Leukapheresis to temporarily
reduce the number of
leukaemia cells in the blood.
• In the case of CML, initiation
of TKI therapy with agents
such as imatinib to
selectively kill the cancer
cells.
Changes to your sperm
Due to treatment such as
radiotherapy or chemotherapy,
men may find that their semen
is a different colour; typically,
orange or brown. Some men may
also feel pain in the testicles
upon orgasm. The colour of the
ejaculate will be temporary, as will
the pain.
If you have been treated with any
form of radiotherapy, for example,
in preparation for a stem cell
transplant, you may find that
the volume of semen when you
ejaculate (come) has decreased.
Towards the end of the radiation
treatment, some men may feel
pain as they ejaculate. This is
caused by irritation in the tube
that carries urine and semen (the
urethra). This should dissipate
as treatment ends. However, if
the pain continues and you are
worried about it, speak to your
nurse.
Advice for men (cont.)
Helpline freephone 08088 010 444 55
Managing infection
Men who have had a stem
cell transplant can be more
susceptible to thrush and cystitis
(infection of the urinary tract). It
is important to wash and go to the
toilet after sex to try and prevent
these infections. For cystitis,
drinking plenty of water can help
flush the infection from your
system and cranberry juice may
ease your symptoms too.
www.leukaemiacare.org.uk56
Treatments for men
Erectile dysfunction
Being diagnosed with a cancer
like leukaemia can cause issues
to your sex life, either directly or
indirectly. Erectile dysfunction
can be the result of cancer
treatment such as chemotherapy.
A study published in 2016 revealed
that 60% of male cancer patients
in the United States had sexual
problems following treatment.
Just 20% of male patients in this
study had sought advice for their
cancer-related sexual problem.
Erectile dysfunction is the
inability to obtain an erection
which can be maintained (kept
firm enough) for sex.
Although physical side effects can
affect the ability to maintain an
erection, psychological effects of
having cancer can also impact on
this.
Treatments for erectile
dysfunction include:
• Tablets taken before sex, such
as ‘viagra’: We have covered
this in greater depth in this
booklet and why this may
not always be suitable for
leukaemia patients.
• Injections into the penis: This
is generally for men that have
erectile dysfunction due to
nerve damage in the penis.
• A pellet or cream that you put
into the opening of the penis.
• Vacuum pumps: This involves
putting your penis into a tube
and the vacuum effect of the
pump creates an erection.
To maintain the erection,
you place a constriction ring
around the base of the penis
which means the erection can
be maintained for up to 30
minutes.
• Sex therapy.
For some men, it may be a
combination of treatments that
work rather than one in isolation.
Men who are older, or who have
experienced erectile dysfunction
before a diagnosis are more likely
to experience erectile dysfunction
after treatment.
Helpline freephone 08088 010 444 57
Viagra
Since April 2018, Viagra has been
available "over the counter" in
pharmacies and even in some
supermarkets. Here we look at
what Viagra is and its availability
for leukaemia patients.
Before the "little blue pill"
was made available without
a prescription, men had to
visit their GP and have a full
examination before being able to
access the drug on prescription.
For men who didn’t want to speak
to their GP, many were accessing
the treatment online which came
with its own problems including
counterfeit tablets.
Now, men can speak to a
pharmacist and buy tablets
over the counter (without
a prescription) costing
approximately £20 for four.
What is Viagra?
Viagra is a treatment for men,
over the age of 18, that are
experiencing erectile dysfunction
(ED). This dysfunction could
include difficulties in getting
an erection during sex, trouble
maintaining an erection. Some
men also take this drug because
they have a reduced libido.
‘Viagra’ is common name for
referring to a tablet that helps
to treat erectile dysfunction. The
medication’s actual name is
Sildenafil. It was launched in 1998
by drugs company Pfizer and was
originally formulated to treat high
blood pressure. Since its launch in
1998, it is claimed that 62 million
men have tried the drug.
How does Viagra work to treat ED?
Sildenafil increases blood flow
to the penis to help men get or
maintain an erection. According
to the NHS website, 2/3 men have
an improvement when using this
treatment.
Men who are taking Sildenafil
must take the treatment up to
four hours before sex, ideally
around an hour before. The
medication alone will not cause
an erection and a man must be
aroused for it to work.
How do you take it?
Although the common image for
this treatment is a little blue pill,
Sildenafil can also be supplied in
a liquid format.
www.leukaemiacare.org.uk58
Treatments for men (cont.)
Can men treated for a blood
cancer buy Sildenafil over the
counter?
If you are a man seeking
treatment for erectile dysfunction
after the diagnosis of a blood
cancer, such as a leukaemia or
myeloma, then you should speak
to your GP or consultant first.
For some men that are diagnosed
with a leukaemia, they may be
more susceptible to a condition
called priapism. Priapism is
defined as a long-standing and
painful erection that lasts longer
than four hours without sexual
stimulation and is unrelieved by
ejaculation.
Priapism in its own right is a very
rare disease, and so for priapism
to be caused by leukaemia is
extremely uncommon. About two
thirds of adult cases of priapism
are caused by the use of agents
to treat erectile dysfunction and,
in children, the major cause
of priapism (67%) is sickle cell
anaemia. Generally speaking,
leukaemia is only responsible
for around 20% of all the cases
of priapism, and the incidence
in adult leukaemic patients is as
little as 1-5%. Approximately half
of these have chronic myeloid
leukaemia (CML) as it is far more
common to have priapism with
chronic leukaemia than acute
leukaemia.
Talking to your doctor about
erectile dysfunction
While sex may not be the
first thing on your mind upon
diagnosis, it is a key part of
many people’s lives and therefore
it is important that you feel
comfortable in asking for support
in this area of your life.
To ensure you get the most of this
important conversation, there are
a number of steps you could take:
• Prepare for your visit.
Preparation would include
making lists of all the
medications you take. If you
take supplements such as
vitamins or herbal remedies,
ensure that you list these too.
• Keep a diary about your
symptoms. Key information
will include when the
symptom started (or a rough
approximation of time). Does
it happen every time you want
sex or is this intermittent?
• Make a note of any personal
information. Other than your
Helpline freephone 08088 010 444 59
diagnosis, is there anything
else affecting your life right
now?
• You’ll probably be asked
questions on the following
subjects so it’s important to
be honest about whether you
drink heavily, use cocaine,
smoke cigarettes or use
opiods for recreational use.
You may find it useful to take a
partner; however, some people
may be more comfortable
discussing these subjects alone.
There are a number of questions
you may want to ask your doctor
which include:
• What is the cause of my
erectile dysfunction?
• Can it be treated? Is it
temporary?
• What treatment options are
available to me?
• What happens if that doesn’t
work?
• Will I be referred to a
specialist?
• What lifestyle changes may
help my erectile dysfunction?
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Other factors that affect sexual
function
There may be other reasons why
your ability to function sexually
has decreased.
These can include:
• Being overweight
• Smoking, alcohol or drug
consumption
• Stress and anxiety
• Age related causes
• High blood pressure
• High cholesterol
• Diabetes
The wide range of reasons for
issues with sexual function
means its important to talk to
your GP or consultant about the
issues in case they are something
else other than your blood cancer.
Other factors that affect
sexual function
Helpline freephone 08088 010 444 61
www.leukaemiacare.org.uk62
Women and Genital
GVHD
Chronic GVHD may affect your
vaginal and genital area. It may
cause:
• Vaginal burning
• Vaginal tightness
• Discomfort or pain with
sexual intercourse
• Abnormal vaginal discharge
• Narrowing of the vagina
• In severe cases the vagina
may become ulcerated.
Women who have genital GVHD
may have a decreased desire
to have sex. They may find it
difficult to achieve an orgasm
and experience pain or bleeding
during or after sex.
There are a few things that can be
done to help prevent vaginal GVHD
and its symptoms.
• Avoid using chemical irritants
when washing and try not
to use perfumed lotions and
soaps
• Wear cotton underwear
• If you have very sensitive skin
use a very mild detergent
• Apply moisturisers to avoid
dry skin
• Vaginal lubricants can make
sexual intercourse more
comfortable. However, make
sure they are water-based
lubricants as oil-based
lubricants can tear condoms
If you get any symptoms of
vaginal GVHD such as vaginal
burning, vaginal tightness,
discomfort or pain with sexual
intercourse and abnormal vaginal
discharge, let your transplant
team know immediately.
Treatments for women
experiencing vaginal GVHD:
• Oestrogen cream, capsules
or release rings may be
prescribed. This should be
inserted into the vagina 2-3
times a week as prescribed.
Oestrogen cream will help to
increase the moisture and
elasticity of the vagina.
• The transplant team may
encourage you to use vaginal
dilators or sexual intercourse
two to three times a week to
help keep your vagina healthy.
If you don’t currently
Advice for women
Helpline freephone 08088 010 444 63
• feel ready for sexual
intercourse then vaginal
dilators should be inserted
two to three times a week.
• Hormone replacement
therapy: Chemotherapy given
as part of the transplant
conditioning regimen can
cause women to go through
the menopause much
earlier than usual. Hormone
replacement therapy
may help to alleviate the
symptoms of menopause
such as hot flushes and it can
help to increase sex drive.
If you experience any of these
symptoms of GVHD it is important
to inform your medical team so
that the appropriate treatments
can be given.
Genital GVHD can be a difficult
and uncomfortable subject to talk
about; however, it is important
to discuss any issues with your
transplant team as genital GVHD
can become severe if not treated
and can have a devastating effect
on quality of life.
www.leukaemiacare.org.uk64
Why do people get hot flushes
after treatment?
Some women will get hot flushes
after treatment because the
cancer treatment has placed
them into the menopause.
The menopause is when a woman
stops having periods. Usually,
the menopause will happen
over the age of 45 but cancer
treatment may put some women
into the early menopause. Some
patients mistake their leukaemia
symptoms for the menopause as
the hot flushes and night sweats
could be attributed to either
condition.
Hot flushes can interfere with
quality of life. One of the most
basic ways that hot flushes can
interfere with your life is when
you share your bed with another
human being.
Medications can be prescribed
to help with the hot flushes, and
these would need to be discussed
with your healthcare team.
There may be some homeopathic
approaches that you might like
to try such as acupuncture, and
there has been some evidence
to show that this can help to
reduce hot flushes. If you plan to
try acupuncture, you should talk
to your consultant to ensure that
this is the right thing to do.
Other tips for managing hot
flushes at night include avoiding
hot drinks before bed, avoiding
exercise before intimacy or even
taking a cool shower before you
become intimate. You could also
try having a fan on your side of
the bed to help you to cool down.
Physical arousal can also trigger
hot flushes. If this happens, take
a moment to explain to your
partner what is happening and
that you need to cool down before
continuing.
Hot flushes
Helpline freephone 08088 010 444 65
www.leukaemiacare.org.uk66
Symptoms of vaginal dryness
include:
• Feeling sore or itchy in or
around your vagina
• Pain, soreness or discomfort
during sex
Vaginal dryness is very common
for women and will be something
that your GP will discuss regularly,
so try not to feel embarrassed
about discussing it. There are
options available that you can try
to alleviate the dryness, including:
Avoid scented products in your
intimate areas
Many products will advertise
using phrases such as "balancing"
the natural PH in this area or
phrases of this type. While some
people may want to use washes
like this, they aren’t necessary
at all, and in some cases can
cause imbalances in the delicate
system down there. Avoid scented
products too, as this could cause
infections. If there was a need for
you to use a dedicated wash in
this area, it would be something
that was prescribed by your GP.
•
Vaginal moisturisers
There are many vaginal
moisturisers available to patients
and your GP or healthcare team
will be able to recommend a
suitable product. A vaginal
moisturiser is used inside the
vagina to keep the area moist.
They differ to lubricants as you
use them outside of times where
you have sex. Typically, you would
apply a vaginal moisturiser once
every couple of days.
Vaginal lubricants
Typically, you would apply a
vaginal lubricant to your vulva,
vagina and any part of your
partner during sexual acts. The
relief for the dryness is short term
and typically only lasts during
sex. If you are looking for longer
term relief, it’s worth discussing a
moisturiser with your healthcare
team.
Vaginal oestrogen
If you have entered the
menopause, your oestrogen levels
will drop which can cause the
dryness.
Vaginal oestrogen is prescribed
as pills that you place inside
your vagina (pessaries), creams
Vaginal dryness
Helpline freephone 08088 010 444 67
or vaginal rings. You may prefer
one type over the other and you
may have to try all three to find
out what you’re most comfortable
with.
Compared to moisturisers or
lubricants, it is not a fast-acting
option and you may need to use it
in conjuction with another option
until the oestrogen takes effect.
This is a long-term option as the
symptom typically returns if the
treatment stops.
HRT
HRT stands for hormone
replacement therapy. After
entering the menopause, the
ovaries stop producing oestrogen
which causes symptoms such
as hot flushes, mood swings and
vaginal dryness.
There are two types of HRT:
Combined HRT which is oestrogen
and progesterone together, as well
as oestrogen only HRT.
There are other forms of HRT that
are less commonly used too and
these may be discussed with your
GP.
HRT can prove beneficial for some
women experiencing side effects;
however, there are other risks to
consider.
Vibrator therapy
There are some US based
gynaecologists who have begun
to prescribe vibrator therapy
to those experiencing vaginal
dryness. The theory behind
this is that to increase vaginal
moisture, you need to increase
blood flow to the area and using
a vibrator can do just this. In this
setting, it doesn’t necessarily
matter whether you orgasm or
not through using the vibrator
but orgasms will help with the
production of natural oestrogen.
They can also help a person to
feel better about themselves and
a partner. They can also reduce
stress and help you to relax.
Pain during vaginal penetration
Research published in 2016
revealed that nearly one in 10
women experience painful sex,
also known as dyspareunia.
Despite there being treatments
to help combat painful sex, the
research also revealed that many
women find the topic too difficult
to talk about and therefore are
suffering in silence.
www.leukaemiacare.org.uk68
There are ways that pain can be
managed including:
• Taking pain medication 30
minutes – 1 hour before sex.
Although this might take
some of the spontaneity
out of sex, you will feel more
comfortable knowing that you
have taken pain medication.
• Lubrication: Some pain
can be caused from a lack
of lubrication. This lack of
lubrication can make having
sex difficult. See our sections
on lubrication and vaginal
dryness on more information
about how this can be
managed.
• You may find certain
positions painful. This may
mean you need to experiment
with different positions
thinking about positions
where penetration isn’t so
deep. You could also control
the depth of penetration by
having sex in a position where
you are in control, such as the
woman going on top of the
partner.
• You may find sex painful if
you are not fully aroused. Take
time to engage in foreplay
before attempting penetrative
sex.
Vaginal dryness (cont.)
Helpline freephone 08088 010 444 69
www.leukaemiacare.org.uk70
Body image and self-
esteem
How can low self-esteem affect
my sex life?
Low self-esteem can manifest
itself in a number of ways,
including:
• Not wanting to be seen naked
or semi-naked
• Only willing to have sex in the
dark or under covers
• Inability to become aroused
• Lack of desire to have sex
Improving your body
image and self-esteem
Body image is how you feel about
your body. Self-esteem is how you
feel about yourself. These terms
are very closely linked. Negative
body image or self-esteem can
have an effect on your sex life or
how you feel about sex after you
are diagnosed.
Some people worry that the
appearance-related side effects
of treatment will draw attention
to the fact that they have cancer,
which can affect their self-esteem.
The psychological distress of
being diagnosed with a blood
cancer can also have an effect
on an individual’s self-esteem.
You have been through a life
changing event. In the case of
acute leukaemia, you’ve been
given news about an illness that
needs treating very quickly. In the
case of chronic leukaemia, you
have been given a diagnosis that
will be a part of you for the rest of
your life. Studies have shown that
many cancer patients display the
signs of post-traumatic stress
disorder (PTSD).
If you are a patient that has
undergone chemotherapy, you
will know the effects that this can
have on the body including hair
loss, changes to your nails or skin.
Some of these effects will be
temporary. Some will become the
new-normal. You may feel that you
are grieving your ‘old’ life, or ‘old’
body or even just the ‘old’ you.
You may want to adopt one of
the following coping strategies
to help you work through these
issues:
Your relationship with yourself
and others
Helpline freephone 08088 010 444 71
Improving your own
self-esteem
There are a few strategies that you
could employ to try and improve
how you feel about yourself and
how you feel about your body.
Mind, the mental health charity,
have some fantastic guides on
their website for improving self-
esteem. These tips include:
Being kind to yourself
Instead of focusing on the
negative about yourself, find
something that you like. For
example, you may dislike a
certain part of your body after
treatment. Instead, try and focus
on one thing that you like about
your physical body. When thinking
about yourself, try not to compare
yourself to others.
You may want to keep a diary
where you write one nice thing
about yourself each day. When
you are having a day where you
are struggling with how you feel
about yourself, you could then
look through your diary and
remember those things that you
do like about yourself.
Remember, there are many
qualities about you that your
friends, family and loved ones
really like about you, even if you
struggle to see it.
There is a full guide on the Mind
website https://www.mind.org.uk.
Talking to others
You may find it useful to be open
with your loved ones with how you
are feeling.
You may want to talk to a partner,
loved one or trusted friend about
the feelings you have been or are
experiencing.
It may help you to write down
these feelings too so you can
talk about them during the
conversation.
The person you are speaking to
might not be able to give you all
the answers you need but saying
these feelings out loud may help
you move towards rebuilding your
self-esteem and body issues.
You may also consider joining
a support group for those with
or who have had a blood cancer
diagnosis. In a support group, you
can talk with others in a similar
situation knowing they are facing
situations like you are. There
www.leukaemiacare.org.uk72
are a number of blood cancer
support groups across the UK.
Alternatively, there are a number
of online forums or private
groups where you can discuss
your feelings with people that
understand.
We will list all the relevant groups
at the end of this section.
Talking to a
professional
You may want to seek
professional support to help
you psychologically. This may
include talking therapies, such
as counselling, where you may
or may not want your partner to
attend with you.
You may be able to get a referral to
a counsellor through the NHS.
Although you may want to talk to
your GP, a GP referral is not always
needed to access counselling
services. The NHS has launched
a new service which will help to
self-refer to services that are
available in your area. To start this
process, you need to go to https://
beta.nhs.uk/find-a-psychological-
therapies-service/ and type in
some details about where you live
so they can find the support most
relevant to you.
Counselling services are in high
demand and there can be very
long wait times to access the
support you need. If you feel like
you would benefit from speaking
to a trained professional a little
sooner, you may want to consider
paying for a counselling service.
Relate is a charity that offers
low-cost, or in some cases,
free counselling. They can offer
support on relationships, sex
or even talking about sex with
others. Each Relate centre has
their own rate for charging.
They do offer a live chat service
through their website where you
can message a trained counsellor
and this is a free service. You can
find out more about Relate on
their website https://www.relate.
org.uk
You may be able to get support
in funding for relationship
counselling. A member of
the team at Leukaemia Care
is available to talk and help
with signposting for relevant
counselling services.
Your relationship with yourself
and others (cont.)
Helpline freephone 08088 010 444 73
Support groups
Leukaemia Care online forum
https://healthunlocked.com/
leukaemia-care
The Leukaemia Care online forum
is open to anybody affected by
a blood cancer diagnosis. You
can sign up with an anonymous
username if you so wish.
The forum is moderated by the
team at Leukaemia Care.
Leukaemia Care Facebook groups
The Leukaemia Care facebook
groups are open to anybody
affected by a blood cancer
diagnosis. There are a number
of sub-groups according to
diagnosis type.
Facebook groups will show off
your real name, so these are
not suitable for those people
who wish to ask anonymous
questions.
Leukaemia Care Facebook groups
can be found by going to the
Leukaemia Care facebook page,
https://www.facebook.com/
LeukaemiaCare/ and click on the
groups tab.
Lymphoma Action
Lymphoma Action are the UK’s
only dedicated lymphoma charity.
They run a number of support
services which include in-person
support groups. To find out about
the full range of support available,
go to their website at
www.lymphoma-action.org.uk
CML-UK
CML-UK is a dedicated charity for
anybody affected by a chronic
myeloid leukaemia diagnosis.
They run a forum which can
be found on their website at
cmlsupport.org.uk. There is also a
very active Facebook group which
can be found by searching "CML
Support – UK" on Facebook.
CLLSA Forum
The CLLSA forum is hosted on the
HealthUnlocked platform and
has over 10,000 members and
rising. This is an international
platform with members from
across the globe. It is a fantastic
way to share experiences and you
have the ability to be completely
anonymous. There is also the
ability to "lock" your posts so
that they cannot be indexed by a
Google search.
www.leukaemiacare.org.uk74
You can access the CLLSA forum
at: https://healthunlocked.com/
cllsupport
Macmillan forums
Macmillan host their own online
community for cancer patients
of any type. Although it is not
necessarily leukaemia specific,
the forums offer a chance to
ask questions that are common
across all cancer diagnoses and
you will find many members on
that site that have been affected
by a leukaemia diagnosis. To
access the Macmillan online
community, go to https://
community.macmillan.org.uk
Your relationship with yourself
and others (cont.)
Helpline freephone 08088 010 444 75
www.leukaemiacare.org.uk76
Useful contacts
and further support
There are a number of helpful
sources to support you during
your diagnosis, treatment and
beyond, including:
•
Your haematologist and
healthcare team
•
Your family and friends
•
Your psychologist (ask your
haematologist or CNS for a
referral)
•
Reliable online sources,
such as Leukaemia Care
•
Charitable organisations
There are a number of
organisations, including
ourselves, who provide expert
advice and information.
Leukaemia Care
We are a charity dedicated to
supporting anyone affected by
the diagnosis of any blood cancer.
We provide emotional support
through a range of support
services including a helpline,
patient and carer conferences,
support group, informative
website, one-to-one buddy
service and high-quality patient
information. We also have a nurse
on our helpline for any medical
queries relating to your diagnosis.
Helpline: 08088 010 444
www.leukaemiacare.org.uk
Bloodwise
Bloodwise is the leading charity
into the research of blood cancers.
They offer support to patients,
their family and friends through
patient services.
020 7504 2200
www.bloodwise.org.uk
Cancer Research UK
Cancer Research UK is a leading
charity dedicated to cancer
research.
0808 800 4040
www.cancerresearchuk.org
Macmillan
Macmillan provides free practical,
medical and financial support for
people facing cancer.
0808 808 0000
www.macmillan.org.uk
Maggie’s Centres
Maggie’s offers free practical,
emotional and social support
to people with cancer and their
families and friends.
0300 123 1801
www.maggiescentres.org
Citizens Advice Bureau (CAB)
Offers advice on benefits and
financial assistance.
08444 111 444
www.adviceguide.org.uk
Helpline freephone 08088 010 444 77
Turn2Us
Help with finding financial
assistance. Website with a
benefits calculator and a search
tool for local benefits advisors
and grant-awarding charities by
location or occupation.
https://www.turn2us.org.uk/
Look good, feel better
Organisation that runs skin care
and make up workshops for
people with cancer.
01372 747 500
www.lookgoodfeelbetter.co.uk
British Association for
Counselling and Psychotherapy
(BACP)
Professional association for
counsellors and psychotherapists
that provides information about
talking therapies and a find a
therapist finding service.
01455 883300
www.bacp.co.uk/
British Complementary
Medicine Association
Member organisation for
complementary therapists that
offers information and a therapist
finding service.
0845 345 5977
www.bcma.co.uk/
Complementary and Natural
Healthcare Council
Maintains a register of
complementary therapists
and set standards for practice.
Provides a therapist finding
service on their website.
020 3668 0406
www.cnhc.org.uk
Learn mindfulness
On line course run in partnership
with the Mental Health
Foundation and recommended by
the NHS.
https://www.bemindfulonline.
com/
www.leukaemiacare.org.uk78
Notes
Helpline freephone 08088 010 444 79
Leukaemia Care,
One Birch Court,
Blackpole East,
Worcester,
WR3 8SG
Registered charity
259483 and SC039207
Want to talk?
Helpline: 08088 010 444
(free from landlines and all major mobile networks)
Office Line: 01905 755977
www.leukaemiacare.org.uk
Leukaemia Care is a national charity dedicated
to providing information, advice and support to
anyone affected by a blood cancer.
Around 34,000 new cases of blood cancer are
diagnosed in the UK each year. We are here to
support you, whether you’re a patient, carer or
family member.
