Elephants and Tea - March 2020 - 17

INTIMATE ISSUES WITH MARLOE

COULD SEX MAKE ME SICK?
Taking steps to prevent infections that are spread through sexual contact (sexually-transmitted
infections, or STIs) is a part of Safer Sex 101 for everyone, but certain circumstances may put cancer
survivors at an increased risk. Why? Well, just like your immune system helps protect against the flu
and other illnesses, it also plays an important role in fighting STIs. Different cancer therapies can affect
how your immune system works and make you more susceptible to getting sick9.
For example, our bodies depend on healthy, intact skin and mucous membranes to create a
protective barrier against germ invasion. This means that damage to oral, vaginal, or anal mucosal tissue from chemotherapy or radiation can make it easier for all germs, including those that
cause STIs, to get into your system. And if you are going through chemo treatments or a stem
cell or bone marrow transplant, your infection-fighting white blood cell (WBC) counts may be
low, making it harder for your body to fight off any invaders.
Being immunocompromised or taking antibiotics or steroid medications can increase your
risk of genital yeast infections, too8. Although not considered an STI, yeast infections can be
passed to your partner via sexual contact. Women may experience vulvovaginal irritation,
itching, pain, or a cottage-cheese like vaginal discharge. Men may experience genital itching,
irritation, or penile discharge. If you have any of these symptoms, be sure to get checked out by
your provider before engaging in intercourse.
Also, if you have been diagnosed in the past with a chronic viral infection that can be transmitted by sexual contact, such as cold sores (HSV-1), genital herpes (HSV-2), or genital warts
(HPV), be sure that your oncologist is aware. If your treatments impact your immune system,
you may have more outbreaks or flare-ups9. Certain antiviral medicines may be recommended
to prevent this.
WHAT CAN I DO TO PROTECT MYSELF?
You might be asked to avoid sex when your WBC counts are low. But how low is too low?
Good question! Because of the lack of research on the safer sex needs of cancer survivors, we
do not have a definitive answer6. This means that safety precautions pertaining to sexual activity
during treatments can be vague and may even differ depending on your doctor or your treatment
facility. If your immune system is working well enough that you can be out in public, you are
probably well enough to have sex 2. Be sure to clarify with your provider what precautions you
should be taking and when.
Since we don't really know how low is too low, and you can't tell what your WBC counts are
at any given moment anyway (it's not like you can request a quick blood draw when things are
starting to get frisky in the bedroom!), a good rule of thumb is to always use a barrier method,
like a condom or dental dam, when you are participating in partnered activity that could lead
to direct contact with each other's mucous membranes or bodily fluids2,5,6,8. Erring on the side of
caution is always the safest bet, and making a habit of using barrier methods creates consistency
and reduces infection risk.
COULD I EXPOSE MY PARTNER TO CHEMOTHERAPY?
After chemo treatments, your body works to break down and remove the drugs from your system. The
time this takes can vary from person to person and with different types of chemo medications. Traces
of chemotherapy have been estimated to be present in bodily fluids (including vaginal secretions and
semen) for up to two weeks2 after administration.
Just as the risk for infection with sexual contact has not been well studied in the cancer population, research is lacking on whether or not exposure to these trace amounts of chemo during
sexual activity is potentially harmful to the partners of cancer survivors6. Using a barrier method
that prevents direct contact with bodily fluids each day that you are receiving chemotherapy, and
for one6,8 to two2 weeks after reduces this type of exposure risk. But again, refer to your facility's
policy and ask your provider to be sure you are following their recommendations.

Sexuality

YOU CAN REDUCE
YOUR RISK OF
INFECTION BY:
Using an appropriate barrier
method with every sexual
encounter, including vaginal or anal
intercourse, and with oral sex2,5,6,8
Avoiding the use of spermicides,
such as nonoxynol-9 (N-9), which
can irritate genital tissues2
Washing your hands with warm
soapy water before and after sexual
encounters8
Washing sexual aids and toys with
warm soapy water before and after
each use8
Using vaginal moisturizers regularly
to help keep your vaginal tissue
healthy, and using lubricants
with sexual touch to help prevent
irritation and tearing8
Avoiding any penetration (which
includes vaginal or anal intercourse,
and inserting fingers or sex toys into
the vagina or anus) if your mucosal
tissue is irritated, bleeding, and
when your white blood cell (WBC)
counts are low2,6,8
Avoiding activities where oral
exposure to feces could occur6
Urinating before and after sexual
encounters, which may help prevent
urinary tract infections (UTIs)2
Inspecting both your and your
partner's genitals for sores, bumps,
rashes, warts, or unusual discharge,
and not engaging in sexual activity
until a provider has assessed any
symptoms2

COULD I EXPOSE MY PARTNER TO RADIATION?
If you are receiving external beam therapy, being near your partner will not expose him or her to
radiation2. Some cancers, however, are treated with placement of small radioactive implants in or near
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Elephants and Tea - March 2020

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