Ask the Nurse: Myeloma, sex and intimacy

Experiencing difficulties with sex, intimacy, and feeling a loss of libido is common for myeloma patients and their loved ones. You may find it awkward or difficult to start talking about this with your partner or healthcare team but being honest about how you are feeling is the first step to improving things.

This month’s blog aims to be honest and open about overcoming physical barriers to sex when living with myeloma and contains frank information about sex.

Can I have sex whilst being on treatment?

Yes, you may still be able to have sex during treatment if you are feeling up to it.

Can I have unprotected sex?

If you have sex while on myeloma treatment, it is essential to use barrier protection to keep you, and your partner, safe.

Types of protection and when to use them:

Male condoms

  • Penetrative sex (anal or vaginal)
  • Receiving oral sex

Female condoms/ femidoms

  • Penetrative sex

Dental dams

  • Oral sex (cover the female genitals of a partner receiving oral sex)

Condoms and dental dams protect you from infection and your partner from chemotherapy and prevent pregnancy. Some treatments, including thalidomide and lenalidomide (Revlimid®), require you to follow a Pregnancy Prevention Programme, where you must use barrier protection.

Please be assured that myeloma (or any other cancer) cannot be passed on through exposure to semen or any other bodily fluids.

Am I still able to reach climax?

You may find that you cannot achieve orgasm like you used to. As people age, it can be harder to achieve orgasm or take longer. This can also be true for myeloma patients undergoing treatment.

Achieving orgasm does not have to be the ‘end goal’ of sex. Concentrate on enjoying what you are doing. You may want to spend more time on foreplay or try touching new areas on your body to see what you respond to.

Why am I less interested in sex?

Myeloma and its treatment can affect your desire for sex (libido). Your sex drive might be lower because of:

  • Pain
  • Tiredness (fatigue)
  • Anxiety or depression
  • Treatment side effects

As with all side effects and symptoms, it’s important to let your healthcare team know what you are experiencing. They may be able to help you towards a solution that improves your quality of life.

Many of these problems will disappear once your treatment finishes, and you may find your desire for sex returns.

I want to have sex but find it physically challenging. How can I manage this?

You may want sex but find that physical issues, like fatigue or pain, become barriers. 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 gentler, but both partners are active in the act.

Receiving and giving oral sex is a way for partners to feel intimate with one another, which can be gentler than penetration. You may receive oral sex, but shouldn’t give it, while on immunosuppressive treatments due to infection risk.

Other strategies that can help physical barriers include:

  • Planning to avoid times when you know you will be more fatigued or nauseated
  • Using water-based lubricants and moisturisers (oil-based lubricants can cause condoms and other barrier contraceptives to break)
  • Using erectile dysfunction equipment, e.g., vacuum pumps or constriction rings
  • If you are worried about mild pain during sex, take painkillers 30 minutes beforehand (if it hurts at any time, stop)

Penetrative sex may need to be temporarily avoided if you have a low blood cell count. This is because you might be at risk of bleeding or infection.

If in doubt, ask your healthcare team. Don’t be embarrassed, this is a very normal subject and they are there to answer your questions about safe sexual practices.

I want to be intimate, but I don’t want to have sex. Are there any alternatives?

Exploring different ways to show intimacy can be fun and a good opportunity to try something different to see what you enjoy.

You could try:

  • Bathing together
  • Touching each other
  • Masturbation
  • Using sexual aids such as vibrators
  • Communicating sexually

Even if you don’t feel like being sexually intimate, you can still enjoy kissing, cuddling, and being close to your partner. The important thing is to do what feels comfortable and enjoyable for you and your partner.

Intimacy is an important part of a relationship. It can help you express your feelings and make your partner feel valued. Set aside quality time for each other to do the things you enjoy.

For more information on myeloma and intimacy, you can read the Myeloma UK Infopack for living well with myeloma.

If you have any questions about sex and intimacy, or other symptoms and complications of myeloma, you can get in touch with us through the Myeloma Infoline (0800 980 3332) or the Ask the Nurse email service.

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