Quick Overview

Cancer treatments like chemotherapy, radiation, and surgery can disrupt or permanently alter fertility. Even when fertility is preserved, the process can feel overwhelming, rushed, or emotionally raw. What’s often missed in these conversations is how deeply fertility is tied to identity, sexuality, gender roles, and self-image—whether or not someone was planning to become a parent.

You don’t need to want children to feel the loss of fertility. You don’t need to feel ready for kids to feel grief. This guide exists to help you understand and navigate both the practical and the personal sides of fertility and sexual self-understanding.

Common Sexual & Emotional Impacts of Fertility Loss or Preservation

Physical effects (depending on treatment):

• Early or sudden menopause or androgen suppression
  
• Irregular or absent periods
  
• Pain during sex, vaginal dryness, erectile changes
  
• Hormonal imbalances
  
• Testicular removal or damage
  
• Egg or sperm retrieval-related pain or changes
  

Emotional & identity-related effects:

• Grief or shock over loss of future reproductive options
  
• Feeling “less womanly,” “less manly,” or less whole
  
• Shame, anger, or guilt (especially if preservation wasn’t possible or chosen)
  
• Emotional distance from sex due to sadness or identity confusion
  
• Body image issues related to hormone shifts, weight changes – gains or losses, or scars
  
• Anxiety about dating, long-term partnership, or disclosure of fertility status
  
• Pressure to “stay positive” when you’re still processing a loss
  

What You Can Do to Minimize or Manage These Effects

Here are supportive strategies that many oncologists may not proactively mention, either because they’re not trained in this area or because it’s not part of standard care protocols.

Education & Preparation

• Ask about fertility before treatment begins, if possible. Options include egg/sperm freezing, embryo creation, or ovarian/testicular tissue preservation.
  
• If treatment has already started, ask: Is there still a way to preserve or assess fertility? If there is, take measured steps to make that happen.
  
• Request to speak to a fertility specialist—not all oncologists have up-to-date knowledge.
  
• Understand that fertility preservation is not an emotional replacement for the loss—it’s a practical option, not a cure for grief.
  

Medical & Practical Support

• Request hormone testing and reproductive counseling post-treatment to assess options.
  
• Consider counseling around decisions like egg/sperm retrieval, IVF, surrogacy, adoption, or choosing not to parent.
  
• Use lubricants and vaginal moisturizers for hormone-related dryness or discomfort.
  
• Track emotional or relational changes that may be tied to fertility-related hormone shifts.
  
• Talk with a medical team about contraception or pregnancy safety—don’t assume fertility is gone without confirmation.
  

Emotional & Sexual Self-Image Support

• Create space to grieve the loss of choice, control, or identity, even if parenting wasn’t part of your plan.
  
• Rebuild erotic identity through body-based practices like mirror work, sensual touch, and expressive movement.
  
• Remind yourself that your worth is not tied to reproductive ability or parenthood.
  
• Talk to a partner (or future partner) about fertility when the time is right. Practice saying it in your own words.
  
• Journal or speak with a counselor about what sexuality means beyond reproduction.
  
• Explore fertility grief or gender identity shifts with a therapist trained in reproductive trauma, cancer, or LGBTQ+ care.
  

Questions to Ask Your Oncologist or Fertility Specialist

• Will this treatment affect my fertility? If so, how?
  
• Are there any options for preservation before we begin?
  
• If I didn’t preserve fertility earlier, is there anything I can do now?
  
• Can you refer me to a fertility counselor or reproductive endocrinologist?
  
• What do I need to know about contraception or pregnancy safety during and after treatment?
  
• Will hormone changes affect my sexuality, and how can I address that?