This fact sheet is for people who have had a blood and marrow transplant (BMT).
BMT patients may experience health complications in the months or years following the transplant. Long-term follow up has an important role in the early detection of any health issues.
This fact sheet has general information about ways to look after your health. If you have specific concerns, speak to your BMT team or your doctor for further information and advice.
What can cause sexual health issues after a BMT?
Sexual health, like every other aspect of health, is important to a person’s emotional and physical wellbeing and quality of life.
Following BMT, a range of physical, emotional and psychological factors can affect your sexual health and wellbeing. These are some of the most common and most difficult challenges facing people who have had a BMT.
A number of things may cause sexual and genital problems following BMT including the adverse effects of chemotherapy, radiotherapy and medications and genital graft versus host disease (GvHD). Changes to your body, such as hair loss, fluctuations in weight and skin changes can cause body image issues. Feeling less attractive or ‘not like yourself’ may lead to depression and decreased libido or urge for sex. Other psychological issues may also affect your sexual health including stress, fatigue and fear of your cancer coming back.
What are the symptoms?
Women who have had a transplant may experience less desire for sex, pain during sex, difficulty achieving orgasm and vaginal dryness, irritation, narrowing or ulceration.
Men who have had a transplant may experience less desire for sex, difficulty getting or maintaining an erection, inability to ejaculate, difficulty achieving orgasm and rash or ulceration on the penis or scrotum.
How are sexual health issues diagnosed?
There are generally no specific tests for diagnosing sexual problems after a BMT, so it is really important to speak to your BMT team or general practitioner (GP) if you are experiencing any of the symptoms described above. In order to better understand sexual problems you may face after transplant and work out what treatment is needed, your doctor may do any or all of the following:
- Do blood tests to check hormone levels, blood sugar, cholesterol, kidney and liver function.
- Perform a physical examination to look for high blood pressure, nervous system or vascular problems and genital problems, including GvHD and infection.
- Review your medications.
- Speak with you about your situation and assess whether stress, anxiety or depression is an issue, your relationship, your feelings about yourself, your life since transplant, your sex life and what is important to you and your partner.
If a sexual health issue is identified, how is it managed or treated?
Your BMT team will always be able to assist you with any sexual health concerns you have. Depending upon what the problem is they may often refer you to other health professionals for expert advice, including endocrinologists, gynaecologists, psychologists, relationship counsellors or experts in men’s health.
There are many different therapies that can be used to manage sexual problems after a BMT.
- Hormonal therapy – For women, low-dose oestrogen can be given to relieve vaginal dryness, burning, or itching; while in men, testosterone may improve libido, mood and erectile dysfunction.
- Medications – A range of oral and topical medicine (creams or ointments) may be used to control genital GvHD. Other medicines may be used to assist with erectile dysfunction.
- Psychological therapy – Talking with a professional about your experiences and feelings may help you to address emotional issues that may be affecting your sexual health.
- Mechanical aids – These include vacuum devices or penile implants for erectile dysfunction or vaginal dilators to prevent vaginal narrowing or scarring as a result of GvHD.
- Lubricants – Vaginal lubrication can reduce symptoms of dryness, friction and pain associated with menopause or GvHD.
- Pelvic floor physiotherapy – These exercises may improve the strength of pelvic floor muscles weakened through menopause.
How can I look after my sexual health?
- Be aware –Many people who have a BMT will experience sexual challenges in the years afterwards. So if this happens to you – you are not alone.
- Talk to your BMT team – It is important that you talk with your BMT team about the possibility of sexual health problems after transplant and that you tell them about any symptoms you have. Help is always available.
- Communication – If you have a partner, talk openly and let them know how you feel. Discuss your feelings about your body and sex, and discuss ways other than sex to create intimacy in your relationship.
- Seek support or counselling– Talking with health professionals, including your BMT team, psychologists or relationship counsellors, can help with some of the problems that may contribute to sexual problems post-transplant and can assist you develop effective coping strategies to deal with how you are feeling.
- Protect yourself – Practice safe sex, have regular Pap smears, be immunised against human papillomavirus (HPV), be aware of sexually transmitted infections and be tested if concerned.
- Exercise regularly and maintain a healthy diet and weight – This will help you feel better about yourself and will also reduce the likelihood and impact of diseases that may contribute to sexual health problems after a BMT, including high blood pressure, high cholesterol, obesity and diabetes.
- Avoid smoking –Long term smoking has been linked to vaginal infection and inflammation and to erectile dysfunction.
- Limit alcohol consumption – Drinking excessive amounts of alcohol can have a negative impact on sexual capabilities, reducing the ability to sustain an erection or reach orgasm. To reduce the risk of harm from alcohol-related disease or injury for healthy men and women, drink no more than 10 standard drinks per week and no more than four standard drinks on any one day. Of course, however, the less you choose to drink, the lower your risk of alcohol-related harm. And for some people, not drinking at all is the safest option.