Quick Overview

Radiation therapy uses high-energy rays to destroy cancer cells, but it can also affect surrounding healthy tissue—especially in the pelvic region. When directed near reproductive or sexual organs, it may lead to physical changes that affect comfort, function, and desire. Even when radiation is to other areas of the body, systemic effects like fatigue and skin sensitivity can still impact intimacy.

Common Sexual Side Effects of Radiation Therapy

These may vary depending on the area being treated, dosage, and whether combined with chemotherapy, hormone therapy, or surgery.

Physical effects (especially from pelvic radiation):

• Vaginal dryness, narrowing (stenosis), or scarring
• Pain during penetration (dyspareunia)
• Erectile dysfunction or loss of spontaneous erections
• Decreased lubrication or arousal
• Anal sensitivity, scarring, or discomfort
• Reduced blood flow and sensation in genitals
• Infertility (temporary or permanent)
• Skin sensitivity, burns, or tissue changes in the treatment area
• Long-term changes in pelvic floor strength or coordination

Emotional & psychological effects:

• Anxiety about pain or physical limitations during intimacy
• Grief about changes to sexual function or fertility
• Body image issues (due to scarring, burns, or internal discomfort)
• Shame or avoidance of intimacy due to odor, discharge, or incontinence
• Relationship tension or avoidance of sexual closeness
• Emotional shutdown or disconnection from erotic identity

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

• Learn ahead of time which parts of the body will be affected by radiation. If the treatment field includes the pelvis, be proactive in asking about sexual side effects.
• Ask if vaginal dilators, pelvic therapy, or lubrication will be recommended after treatment—and request support early.
• Understand that healing can take time—your sexuality is not “lost,” but may shift.

Medical Interventions

• Use vaginal dilators during and after pelvic radiation (as recommended) to maintain elasticity and reduce stenosis.
• Apply vaginal moisturizers and lubricants routinely, not just during sex.
• Topical estrogen therapy (if safe) may help prevent tissue thinning and atrophy.
• Consider erectile support options (oral meds, vacuum devices, injections) if erections are affected.
• Skin barrier creams or healing ointments can soothe treated areas after radiation.
• Request a referral to a pelvic health physical therapist for pain, scarring, or mobility issues.

Lifestyle & Support

• Normalize non-penetrative pleasure and redefine sex as touch, connection, and sensation, not performance.
• Use arousal-enhancing tools (like erotic audio, fantasy, or sensual massage) to reconnect with desire.
• Prioritize self-soothing and solo pleasure practices to rebuild erotic self-connection.
• Explore body image support through counseling, mirror work, or trauma-informed coaching.
• Involve partners in care planning—intimacy doesn’t have to be paused, only reimagined.

Questions to Ask Your Oncologist

• Will this radiation treatment affect my sexual organs or function?
• Should I be using a vaginal dilator, and when should I start?
• Are there ways to protect my skin and internal tissue during and after treatment?
• Can I use vaginal estrogen or ED support safely with my type of cancer
• Can you refer me to someone who specializes in sexual health or pelvic rehabilitation?