Loss of Libido During and After Breast Cancer
Loss of libido after a breast cancer diagnosis can have many causes, including physical and emotional changes from the disease and its treatments. Although it may feel a little awkward to talk about sex with your cancer care team, it’s essential to let them know how you feel. Finding the cause — or causes — of decreased libido may help improve your sexual health and quality of life.
Having a lower sex drive can be a symptom of a medical condition as well as a medical condition called hypoactive sexual desire disorder, which means you have a lowered libido that is bothering you. Some people may find that increasing their libido is critical to their quality of life, and other people may be happy to have a quieter sex life while they manage their treatment and focus on their diagnosis or other life changes. Both approaches — and everything in between — are completely normal.
Side effects that can lower libido
Certain side effects of breast cancer treatments can affect your desire to have sex, including:
Your cancer care team can help you manage any side effects you might be having. For example, your doctor can recommend:
over-the-counter treatments for nausea, constipation, or diarrhea
physical therapy and special sleeves for lymphedema
a referral to a mental health professional for anxiety or symptoms of depression
Depending on the types of side effects you may have — or their severity — your doctor might also recommend:
different doses of the same breast cancer treatments
different breast cancer treatments
Getting the help you need to manage side effects can help improve your overall well-being, which can also lead to improved sexual function.
Tamoxifen and libido
Tamoxifen (brand names: Nolvadex, Soltamox) is a type of hormonal therapy used to treat all stages of hormone receptor-positive breast cancer. Tamoxifen works by blocking the effects of estrogen on hormone receptor-positive breast cancer cells.
Some of tamoxifen’s most common side effects include nausea, constipation, fatigue, depression, and vaginal discharge — all of which can lower sexual desire. Tamoxifen can also cause menopausal symptoms such as hot flashes, mood changes, vaginal dryness, and sleep disturbances, which can also decrease libido.
If you’re having any uncomfortable side effects, your doctor may be able to prescribe a different kind of hormonal therapy.
Pain medicines and libido
Some pain medicines can have a negative effect on your sex drive. For example, certain antidepressants and anti-nausea medicines can decrease the libido. Ask your doctor if any medicines you might be taking could be contributing to lower sexual desire. Your doctor may be able to prescribe a different medicine.
The so-called female Viagra drugs
There are currently two medicines approved by the U.S. Food and Drug Administration (FDA) to treat sexual desire disorders in pre-menopausal women:
flibanserin (brand name: Addyi)
bremelanotide (brand name: Vyleesi)
Early media reports about Addyi and Vyleesi incorrectly referred to the two medicines as the female Viagra. But Addyi and Vyleesi are designed to increase sexual desire, not to enhance sexual performance.
According to the FDA, Addyi targets serotonin receptors and Vyleesi activates melanocortin receptors. Serotonin receptors are involved in many biological and neurological processes, including appetite, mood, sleep, and sexual desire. Melanocortin receptors are involved in a wide variety of physiological functions, including pigmentation, inflammation, temperature control, cardiovascular regulation, and sexual function.
But medical experts point out that we don’t fully understand how either medicine affects sexual desire in pre-menopausal women. 1 The National Women's Health Network (NWHN) highlighted the need for larger studies looking at a wider variety of women. Some doctors and experts, including the NWHN, have also described the medicines’ effects on libido as modest or even as “barely better than a placebo” — with unpleasant side effects, to boot.
Neither Addyi nor Vyleesi improves blood flow, the way Viagra does. By improving blood flow, Viagra makes it possible to get and maintain an erection. Viagra — which is not FDA-approved for women — does not directly address a low libido. A few studies have focused on whether Viagra is effective in women, but it’s not yet clear whether it’s safe in the long term.
None of these medicines is explicitly designed for people with a history of breast cancer. If you’re interested in trying one of them, speak with your cancer care team. It’s important to only take medicines that your doctor has prescribed to you and that you’ve discussed with your entire cancer care team.
Lubricants and vaginal moisturizers
Using personal lubricants that are water-based can be helpful if you’re having pain during sex as a result of vaginal dryness. Still, sexual health experts recommend using a vaginal moisturizer regularly, as well. Vaginal moisturizers are non-hormonal and not only provide long-term relief from itchiness and irritation but also help restore vaginal tissue. It’s best to apply vaginal moisturizers at bedtime for best absorption.
Learn more about vaginal dryness.
Additional solutions for loss of libido
A doctor who specializes in sexual function and health can recommend more ways to increase low libido. Depending on what’s causing a decreased libido, some other recommendations that may help include:
talking with someone you trust about how you’re feeling — be it a friend or, if you’re in a relationship, your partner
trying different sexual positions if sex is painful
exercising to improve cardiovascular health and mood, which can indirectly enhance sexual function
talking to a sex therapist for advice on ways to enhance your sex life
joining a support group so you can talk with others who are in similar situations as you
Sexuality and Breast Cancer: Get Your Mojo Back
Oct 19, 20161. University of Chicago Medicine. “Vyleesi? Addyi? How women can get help for low sexual desire.” Available at: https://www.uchicagomedicine.org/forefront/womens-health-articles/vyleesi-addyi-how-women-can-get-help-for-low-sexual-desire
— Last updated on February 28, 2024 at 6:07 PM