My 72 year-old breast cancer patient prompted this article when she and her husband (also in his 70s) asked me this question recently:
When can we start having sex without a condom again after chemo is over?
Both of them blushed but I could see they were happy they built up the courage to ask the question.
I thought it was awesome that they have a sex life in their 70s and was still interested even after a cancer diagnosis and undergoing chemotherapy. I lose interest in sex after a long day at work!
I also thought it was ironic that no one has asked me this question in a long time, and many of my patients are a lot younger. I’m sure it’s gone through their minds. Why isn’t sex discussed more often? Maybe oncologists need to open up a space for patients to discuss their sexual concerns more often.
Before we dig deeper, I want to acknowledge that the topic of sex and cancer treatment is complex and vast. There are hundreds of issues to address, which I will do over time in other articles. But for today, I want to focus on this ‘simple’ question.
Theoretically chemotherapy takes about 48 to 72 hours to leave the body and it’s recommended that you use a barrier method of protection throughout treatment and for about a week after. I generally recommend waiting 2-3 weeks to resume unprotected sex but it depends on a few factors. If you’re pre-menopausal, continue using some form of contraception for a much longer period of time.  Â
Let’s take a deep dive:
How long does chemotherapy take to get out of the system?
The main reason we recommend using a condom during and for a few weeks after chemotherapy is because small amounts of the drugs are excreted through your saliva, urine, poop, vomit, sweat, and yes, in your vaginal discharge or semen as well.
Generally speaking, it takes about 48 to 72 hours for chemotherapy to be cleared from your body. However, the time it takes for chemo drugs to clear from your body varies depending on the specific drug, the dose, and your individual metabolism. Some chemotherapy drugs may only stay in the system for a few hours, while others can linger for several days or even weeks after treatment.
What does protected sex mean?
Without stating the obvious, protected sex means using barrier contraception like a condom or female condom during sexual penetration.
It also means using an oral dam if you’re giving each other oral sex.
Diaphragms, cervical caps, spermicides, contraceptive sponges, vaginal rings, implants, injections and oral contraceptive pills, while effective at preventing pregnancies, are not at all effective at preventing your partner from being exposed to chemotherapy.
When can I resume unprotected sex after chemotherapy?
Organizations like Cancer Research UK recommend having protected sex throughout treatment and to wait for 1 week before resuming unprotected sex. I err on the side of caution and advise to wait at least 2-3 weeks.
Depending on your type of cancer, chemotherapy regimen and risk of immune suppression, I sometimes recommend using barrier protection during sex for a bit longer.
Let’s dig into some of the factors to take into account when deciding to resume unprotected sex.
Type of cancer
If you have a pelvic cancer, for example, cervical cancer, vaginal cancer, vulval cancer, rectal cancer or bladder cancer, you may have had surgery or radiation prior to chemotherapy and your wounds are still healing.
Chemotherapy can cause vaginal dryness, irritation, or inflammation, which is often worse in patients with pelvic cancers. These issues may make sexual intercourse uncomfortable and increase your risk of infections.
If you have a pelvic cancer and you’re still suffering from vaginal side effects, I recommend continuing to use barrier contraception during sex until you’re physically healed.
In fact, we may recommend abstaining from sex if your sensitive pelvic tissues need more time to heal. There are non-sexual ways to be intimate, like kissing and hugging. (Read more:Â Can I Hug Or Kiss My Loved Ones While On Chemo?)
Risk of infection
Chemotherapy almost always impairs your immune system. Depending on your chemotherapy regimen, you can be at high risk of infections 7-10 days after your chemotherapy dose.
Other factors like your general health, amount of chemotherapy you’ve received in the past, and your bone marrow’s response to chemotherapy, you may be at risk of infections for a much longer period.
Sexual intercourse can introduce bacteria and other germs into your body.
If you’ve had lots of issues with white blood cell count during chemo, your immune system may need a bit longer to recover after chemotherapy. If your white cell counts are low (neutropenia), abstain from sex. Wait a few weeks, recheck your counts, and make sure they are back to normal before resuming unprotected sex.
Talk to your healthcare provider
There are so many factors involved with deciding when to resume unprotected sex that it’s best you discuss this issue with your healthcare providers.
Yes, I acknowledge that it can be embarrassing. However, your doctors and nurses are professionals who deal with cancer, cancer treatment and its side effects on a daily basis. If you don’t feel comfortable discussing these issues with your oncologist, speak to your cancer nurse instead.
Unprotected sex when you’re pre-menopausal
If you were still having your periods before chemotherapy, the same advice applies. Wait at least 2-3 weeks before resuming unprotected sex. If you were partcularly immune-suppressed during treatment, discuss with your oncologist when they expect your immune system to be sufficiently recovered to resume unprotected sex.
However, even if your periods don’t come back immediately after chemo, you need to use some form of contraception for at least 6 to 12 months. Chemo is toxic to the fetus, meaning it can cause birth defects, miscarriage, or stillbirth.
Discuss your contraception options with your oncologist. Read about other topics you need to make sure to discuss with your oncologist.Â
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