Sexual Health and Head and Neck Cancer

Cancers in the head and neck include cancers that start in parts of the throat (larynx, hypopharynx or esophagus) and in the mouth and sinuses (tongue, tonsils or nasopharynx). The majority of head and neck cancers are related, at least in part, to lifestyle factors, including smoking, heavy alcohol use, and infection with some subtypes of the human papillomavirus (HPV). 

Should You Change Your Sex Life Because of an HPV-Related Cancer? 

When a person is diagnosed with an HPV-related head and neck cancer, some worry that they could infect a sexual partner. It is important to realize that HPV was probably present for decades before the cancer arose. Most HPV infections clear up on their own. It is a very small percentage of HPV infections that persist and eventually may lead to cancer. If you have been in a relationship for months or years, your partner has undoubtedly already been exposed to HPV. Having a higher number of lifetime sexual partners increases a person's risk of HPV infection, but HPV is so common that it is usually impossible to pinpoint when you got infected or who gave you the virus. 

Using condoms or other barriers (like dental dams or female condoms) to prevent all skin-to-skin or body fluid contact during sex can prevent some HPV infections. Unfortunately, the only sure prevention is not to have sex at all.  Talking to your provider can give you further clarification about how to maintain a sex life that is healthy for yourself as well as your partner. 

Sex after Treatment for Head and Neck Cancers 

Although there are many types of head and neck cancer, treatments are similar for most of them. Some are removed by surgery, usually followed by a combination of radiation therapy and chemotherapy. Some can be treated by a combination of chemotherapy and radiation (chemoradiation), avoiding surgery. Surgery or radiation therapy can damage a person’s ability to speak, swallow, and eat. Exercises that help with speech and swallowing are a very important part of rehabilitation. They begin before radiation and continue during and after cancer treatment.  

People who have total laryngectomy usually wear a covering over the tracheotomy, since it tends to drip mucous. They must learn how to suction mucous out of the tracheotomy with a small catheter, and how to avoid the danger of getting water in the opening. It is helpful to suction your tracheotomy before starting sex so that you will be less likely to have trouble breathing that can interrupt sexual activity. Finding a covering that you are comfortable wearing can help you feel less self-conscious during sex. Having a total laryngectomy also may interfere with verbal communication during sex. You may find it works better to use nonverbal communication (gestures, moving a partner’s hand), rather than trying to talk. The International Association of Laryngectomees offers many suggestions on getting support and improving life after a laryngectomy. Local support groups are available in many cities.  

Radiation Therapy for Head and Neck Cancers 

Radiation is sometimes used as the only treatment for cancers of the throat or other head and neck areas, but also may be used after surgery or combined with chemotherapy. Radiation can damage the salivary glands, causing chronic dry mouth and leading to tooth decay and bad breath. It is very important to use good oral hygiene and prevent the damage as much as possible.  

Radiation for nasopharyngeal cancers often does permanent damage to the pituitary gland, which sits at the base of the brain. This gland makes several different hormones, including ones that control a woman's menstrual cycles or a man’s testosterone levels. If your pituitary hormone levels are low, you may need to see a specialist called an endocrinologist and start on replacement hormones. Hormone treatment could be helpful in restoring sexual desire and may also help with sexual problems like vaginal dryness for women or erection problems for men.  

Chemotherapy for Head and Neck Cancers 

Many types of chemotherapy can cause long term damage to fertility.  Consider speaking with a fertility specialist prior to initiating treatment if loss of fertility is a concern for you or your partner.  

During chemotherapy it is important to avoid sexually transmitted infections when the immune system is weakened, and to use condoms to protect against unintended pregnancy. Chemotherapy and radiation therapy are often given at the same time.  

It is possible to stay sexually active despite these difficult factors, if you have an understanding partner and good sexual communication.  It can be helpful to get additional support to navigate these emotional changes within a relationship.  Consider scheduling with one of our Iris Mental Health Therapists.