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Sex and Leukaemia Final Web
Sex and Leukaemia Final Web
Leukaemia
A Guide for
Patients
Introduction
As long as you are fit and well to do so, you can still have
sex. You cannot catch leukaemia through sex.
There may be times when you don’t Nurse Fiona Heath, Nicole Scully and
want sex. You may feel differently Fergus Metcalf. We’re very grateful
about sex after treatment. For some for the valuable patient reviews by
people, achieving a fulfilling sex life Julie Quigley and Nick York.
after you’ve had treatment (or if you
are living with leukaemia) means
finding new ways of giving and
receiving pleasure.
Version 1
Printed: 09/2019
2 www.leukaemiacare.org.uk Review date: 08/2021
In this booklet
Introduction 2
About Leukaemia Care 4
Introduction to sex and leukaemia 6
Sex and chronic leukaemias 16
Orgasms 18
Loss of libido 20
Ways to increase libido 24
Treatment related side effects 28
Sex positions for when you are fatigued 32
Sex toys 46
Lubricants 48
Advice for men 50
Advice for women 62
Your relationship with yourself and others 70
Useful contacts and further support 76
Notes 78
Helpline freephone 08088 010 444 3
About Leukaemia Care
4 www.leukaemiacare.org.uk
08088 010 444 or email service, LiveChat (9am-5pm
support@leukaemiacare.org.uk weekdays).
6 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 7
Treatment and sex
8 www.leukaemiacare.org.uk
splitting of the latex. Using both Effective birth control methods
methods can also make one slip
Some forms of treatment may
out of place.
affect a developing baby should
Dental dam you become pregnant. Therefore,
it may be recommended that you
A dental dam is a thin piece of
seek birth control. These methods
latex or silicone. Typically, they are
may include:
rectangular in shape. They can be
used during various forms of oral • combined pill
sex including:
• contraceptive implant
• Used to cover female genitalia
• contraceptive injection
during oral sex
• contraceptive patch
• Used to cover the anus for a
partner receiving anilingus/ • intrauterine device (IUD)
analingus. This is a sex act
where one partner stimulates • Mirena (intrauterine system
the other’s anus using their or IUS)
tongue. • progestogen-only pill (mini-
How to make a dental dam pill)
You can make your own dental Birth control is something you
dam using a condom. Cut off each can talk about with your medical
end of the condom and cut down team to discuss what is right for
the side of the tube that remains. you. However, birth control is free
This piece of material can then on the NHS should you seek to
be used as a dental dam. For this use it.
purpose, you may want to avoid
condoms that have lubrication or
even flavoured lubricants because
they may taste unpleasant.
10 www.leukaemiacare.org.uk
at under a microscope. In the vagina, symptoms may
include:
If you are undergoing active
treatment and have a flare up of • Itching and burning of the
herpes, speak to your healthcare vagina. The area may appear
team who will be able to give you red and inflamed.
treatment to make the lesions
• You may have abnormal
heal.
discharge. Some people
Yeast infections describe it as looking a little
like cottage cheese (white and
A yeast infection can make you
thick). Some women may not
feel very uncomfortable. Yeast
have this discharge.
infections are very common.
There are many types of candida • A yeast infection can cause
(yeast) that live in various areas pain or discomfort during sex.
across your body. They do not
Men can also get yeast infections.
pose a problem as the growth is
Symptoms may include:
managed by bacteria. However,
when something happens to • A red rash on the penis.
kill off bacteria (in this case
chemotherapy), it can multiply • Sometimes, you may see
and cause mild to serious patches of white, shiny skin
infections in the body. One place on the penis.
where these yeast infections can • The skin of the penis may be
manifest is in the genitals. moist.
12 www.leukaemiacare.org.uk
Other types of infection
Urinary tract infections can be
avoided by urinating soon after
sex has finished, as this can
wash away much of the bacteria.
To make it easier to have a
wee after sex, you may want to
consider drinking a glass of water
beforehand.
Some people may not realise they You may enjoy dressing up or
are partaking in BDSM; however, sexual role play as part of your
many people would consider the BDSM play. However, during
following activities to be BDSM: radiotherapy treatment you may
domination, submission, pain play, want to avoid this altogether
dressing up and role playing. to prevent further irritation to
delicate skin.
BDSM and radiotherapy
If you enjoy taking part in BDSM,
and are being treated with
radiotherapy, you should be aware
14 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 15
Sex and chronic leukaemias
16 www.leukaemiacare.org.uk
CLL The CLLSA (Chronic
85% of patients with chronic Lymphocytic Leukaemia
lymphocytic leukaemia (CLL) have Support Association) run
issues making antibodies. This an online forum which is
difficulty in producing antibodies frequented by over 13,000
can lead to a rise in infections. CLL patients. Sex is a topic
To combat any infection risk, which is discussed fairly
increase hygiene strategies that regularly.
you may already have in place Their forum has the ability
such as handwashing or using to sign up anonymously if
barrier contraception if you are you wish to discuss the topic
susceptible to thrush. You may of sex and CLL and to share
find some of the information from patient experience on the
pages 11-13 which cover different topic.
types of infection useful.
The CLLSA healthunlocked
Fatigue can also impact on your forum can be found at:
sex life. Fatigue can impact on
your libido (as detailed on page healthunlocked.com/
21) or your ability to have sex CLLSupport
in certain positions. We have
suggested some sex positions
or sexual acts which may be
appropriate for when you feel
fatigued from pages 32 to 44.
18 www.leukaemiacare.org.uk
Difficulties in reaching
climax
You may find that you are not able
to achieve orgasm in the way you
were used to.
Before you were told you had levels have dropped and then
leukaemia, you had a libido. Some treat this.
people have a high libido, some
have a lower libido. Only you will Mental health and
know what your libido was like libido
before treatment.
The Leukaemia Care patient
A key question following survey revealed that some
diagnosis will be, "Do you have leukaemia patients felt constantly
desire, to have desire?". If the depressed or anxious since their
answer is yes, the likelihood is diagnosis. Depression and anxiety
that you do have libido, it is just are both common responses to
that your body is not doing what it being diagnosed with a leukaemia
used to do. as well as the treatment you have
faced. For some CLL patients,
Hormones and libido living on "watch and wait" can
Some cancers or treatments cause depression or anxiety too.
alter the hormones that the body Signs of depression can include:
produces. Some cancer cells
cause hormones that will create • Signs of extreme sadness
symptoms. that don’t go away.
20 www.leukaemiacare.org.uk
and help to resolve your libido treatment may also include
issues. nausea.
However, if you are taking Over time, you may learn when
antidepressants, a lowered you’re likely to experience nausea
libido can be a side effect of and you could plan your sex to
this treatment. Most prescribed avoid these times.
antidepressants are SSRI’s, this
You may be prescribed an anti-
stands for selective serotonin
nausea medicine to deal with
reuptake inhibitors. The drugs
nausea as a side effect; however,
work by raising levels of serotonin
these could also lead to a loss of
in the body. Serotonin plays an
libido. If this is something you are
important role in regulating your
worried about, you should talk to
mood and low levels of serotonin
the medical professional that is
have been linked with depression.
recommending the medication to
Some people are more sensitive discuss your worries and to work
to the effects of these treatments towards a solution.
than others. Therefore, some
people taking antidepressants Fatigue and libido
may have a lowered libido Fatigue is one of the most
because of the treatment but common consequences of
some may not. cancer and related treatments.
Its cause, however, is not yet
Pain, nausea and libido fully understood. Cancer related
You may feel nauseous as a result fatigue is thought to affect the
of chemotherapy treatment and majority of people who have had
the result of this is that you do a cancer episode and may be
not feel like you want sex. For defined as:
some leukaemia patients, such
"A distressing, persistent, subjective
as those diagnosed with chronic
sense of tiredness or exhaustion
myeloid leukaemia, the side effect
related to cancer or cancer treatment
of the tyrosine kinase inhibitor
that is not proportional to recent
22 www.leukaemiacare.org.uk
using this and whether you would
like to use it differently. This
self-management approach will
hopefully help you to regain some
control over your daily activities,
roles and responsibilities.
24 www.leukaemiacare.org.uk
In 2015, a study was conducted written word as women, and many
which looked at women with low women enjoy porn as much as
sexual desire. Half of the women men.
in the study were given self-help
There are thousands of books
books to read, whilst the other
available that would be
half were given erotic fiction. The
classified as erotica with many
study revealed that both groups
subcategories from erotic
made equal gains in the following:
romance to erotic BDSM. Many
sexual desire, sexual arousal,
are available on popular book
lubrication, satisfaction, orgasms,
websites such as Amazon,
pain reduction and overall sexual
Waterstones or your local
functioning.
independent book shop. Your local
The term erotica is used for library is likely to have its own
written words that arouse and section of books that you could
excite the reader and could borrow or even e-books that you
be consumed in the following could download to your e-reader.
formats:
• Romance novels
• Fan fiction
Podcasts
26 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 27
Treatment related side effects
that may affect your sex life
Written by Nurse Advisor Fiona Heath
28 www.leukaemiacare.org.uk
changes in skin colouring, hair including stress, marriage
loss, hormonal changes, energy problems, or depression.
levels, fatigue and the functioning
If you are having sexual
of sexual organs all influence
problems, talk to your healthcare
feelings about sexuality and
professional. Don’t be afraid to
sexual appeal.
ask questions and seek answers.
Relationships Many of these problems can be
treated.
A transplant can also place a
huge strain on the intimate Guidelines for
relationship you have with your
partner. It is sometimes hard
resuming sex
to make the switch from being Your transplant team will be able
the patient or caregiver back to to give you personalised advice
seeing your partner as a sexual about when it’s safe to have sex
being. The most important thing after your stem cell transplant.
is to maintain honest, open
• You should have a single
communication with your partner
partner rather than multiple
about what both of you need and
partners in order to minimise
can achieve. You may need to
the risk of getting an
get to know each other again in
infection.
a sexual sense. Going on dates,
massage, cuddling, showering or • Your partner should be well,
bathing together may be helpful that is, they should not have
with this. Activities such as cold sores, influenza, a cold
touching, hugging, and kissing or a sexually transmitted
provide feelings of warmth and disease.
closeness even if intercourse
is not involved. Professional • Your platelet count should be
sex therapists can recommend more than 50 x 10/9/L.
alternative methods. Emotions • Use condoms for three
can also affect sexual functioning, months after your transplant
30 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 31
Sex positions when you are
fatigued
32 www.leukaemiacare.org.uk
person diagnosed with a blood
cancer can cause anxieties
and stress which can manifest
in problems with orgasming.
Achieving orgasm does not
have to be the ‘end goal’ of sex.
Concentrate on enjoying what you
are doing.
34 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 35
Sex from behind
36 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 37
Sex in a seated position
38 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 39
Missionary
40 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 41
Other sexual acts you may want
to consider when fatigued
Outercourse, or non-penetrative
sex, is any sexual activity
which doesn’t involve sexual
penetration. This could include
the following activities:
• Mutual masturbation
• Kissing
• Cuddling
• Erotic massage
• Masturbation or ejaculation
onto a partner’s body part or
parts
42 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 43
Anal sex
44 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 45
Sex toys
46 www.leukaemiacare.org.uk
products of this type. The items
will arrive in plain packaging so
nobody will know what you are
buying. There are toys available
for people to use alone or as a
couple.
48 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 49
Advice for men
50 www.leukaemiacare.org.uk
Priapism Priapism and leukaemia
Priapism is defined as a long- Priapism in its own right is a very
standing and painful erection rare disease, and so for priapism
that lasts longer than four hours to be caused by leukaemia is
without sexual stimulation and is extremely uncommon. About two
unrelieved by ejaculation. thirds of adult cases of priapism
are caused by the use of agents
The word "Priapism" has its roots to treat erectile dysfunction and,
in Greek mythology. The term in children, the major cause
is named after a Greek god of of priapism (67%) is sickle cell
fertility called Priapus, who is anaemia. Generally speaking,
said to be a son of Zeus. A jealous leukaemia is only responsible
female cast a spell over Priapus’ for around 20% of all the cases
mother whilst she was pregnant, of priapism, and the incidence
causing her son Priapus to be in adult leukaemic patients is as
born with this affliction for which little as 1-5%. Approximately half
he was disowned by his mother. of these have chronic myeloid
Priapus is often represented in leukaemia (CML) as it is far more
ancient statues and paintings common to have priapism with
with a disproportionately large chronic leukaemia than acute
and permanent erection. leukaemia.
In reality, priapism is a very There are three different types of
serious condition and is priapism, all of which vary in the
considered to be a medical underlying biological cause:
emergency that requires
immediate treatment. An erection Low-flow priapism (ischemic)
that lasts too long can cause
Low-flow priapism occurs when
permanent damage to the penis,
blood becomes trapped in the
with the risk of impotence being
erection chambers, meaning
as high as 50% in males affected
it is not able to leave the penis
by priapism.
after an erection. This is the most
common and represents over 95% means that the penile tissue
of cases. becomes deprived of oxygen, often
leading to long term damage.
Symptoms of low-flow priapism
include: Another contributing factor to the
congestion of blood flow out of
• Erection lasting over
the penis is the result of physical
four hours or at times
pressure upon the abdominal
unconnected to sexual
veins by an enlarged spleen
interest or stimulation.
(splenomegaly), a comparatively
• Pain in penis that gets common symptom of leukaemia.
progressively worse.
Stuttering priapism
• Rigid penile shaft, but the tip
Stuttering priapism is a more
of the penis (glans) remains
uncommon type of low-flow
soft.
(ischemic) priapism. It is a
It is low-flow priapism that recurring form of low-flow
can present in men affected by priapism which is identified by
leukaemia (as well as sickle-cell episodes of unwanted and/or
disease and malaria). painful erections that last for
three hours or more. It occurs
How does leukaemia cause low- repeatedly with intervening
flow priapism? periods where the penis relaxes
Priapism in leukaemia is caused and subsides from its swollen
by an abnormally high number state. This type of priapism is
of white blood cells in the blood, more likely in males who have
which can occasionally cause inherited a genetic disorder
the blood to thicken and clog which changes the shape of their
up the small veins, leading to red blood cells (e.g. sickle cell
decreased blood flow out of the anaemia) as these abnormally
penis and stagnation of the blood. shaped cells can temporarily
When blood becomes stagnant, it block the blood vessels.
cannot replenish oxygen, which
52 www.leukaemiacare.org.uk
High-flow priapism (non- medication in tablet form is
ischemic) usually effective as an immediate
relief method.
This type of priapism is rarer than
low-flow and is usually not as However, if this doesn’t work,
painful. The cause of this type of other treatments to help reduce
priapism is usually from an injury your erection might be:
to the penis or the perineum
• Decongestive medications
(the area between the scrotum
injected directly into your
and anus). This then prevents
penis.
the blood in the penis from
circulating normally. • Aspiration – where the
penis is numbed with local
Symptoms of high-flow priapism:
anaesthetic, using a needle to
• Erection lasting over drain the excess blood.
four hours or at times
• Surgery whilst you are asleep
unconnected to sexual
under general anaesthetic to
interest or stimulation.
draw out the blood through a
• Erect but not fully rigid penile small incision.
shaft
Due to the relative rarity of
• Often painless priapism occurring as a symptom
of leukaemia, there are currently
How is priapism treated?
no standard protocols for its
Treatment of priapism depends treatment or management in
on the type and the cause. leukaemia patients, and there
Your doctor will evaluate your is still debate over what method
symptoms and run tests to decide is most effective. However, all
whether it is ischemic or non- methods look to reduce the
ischemic, as well as the possible excess burden of white blood cells
cause. in the blood causing the blockage
(hyperleukocytosis).
If the erection has lasted for
four to six hours, decongestive A rather out-dated technique
54 www.leukaemiacare.org.uk
Managing infection
Men who have had a stem
cell transplant can be more
susceptible to thrush and cystitis
(infection of the urinary tract). It
is important to wash and go to the
toilet after sex to try and prevent
these infections. For cystitis,
drinking plenty of water can help
flush the infection from your
system and cranberry juice may
ease your symptoms too.
56 www.leukaemiacare.org.uk
Viagra they have a reduced libido.
Since April 2018, Viagra has been ‘Viagra’ is common name for
available "over the counter" in referring to a tablet that helps
pharmacies and even in some to treat erectile dysfunction. The
supermarkets. Here we look at medication’s actual name is
what Viagra is and its availability Sildenafil. It was launched in 1998
for leukaemia patients. by drugs company Pfizer and was
originally formulated to treat high
Before the "little blue pill" blood pressure. Since its launch in
was made available without 1998, it is claimed that 62 million
a prescription, men had to men have tried the drug.
visit their GP and have a full
examination before being able to How does Viagra work to treat ED?
access the drug on prescription.
Sildenafil increases blood flow
For men who didn’t want to speak
to the penis to help men get or
to their GP, many were accessing
maintain an erection. According
the treatment online which came
to the NHS website, 2/3 men have
with its own problems including
an improvement when using this
counterfeit tablets.
treatment.
Now, men can speak to a
Men who are taking Sildenafil
pharmacist and buy tablets
must take the treatment up to
over the counter (without
four hours before sex, ideally
a prescription) costing
around an hour before. The
approximately £20 for four.
medication alone will not cause
What is Viagra? an erection and a man must be
aroused for it to work.
Viagra is a treatment for men,
over the age of 18, that are How do you take it?
experiencing erectile dysfunction
Although the common image for
(ED). This dysfunction could
this treatment is a little blue pill,
include difficulties in getting
Sildenafil can also be supplied in
an erection during sex, trouble
a liquid format.
maintaining an erection. Some
men also take this drug because
58 www.leukaemiacare.org.uk
diagnosis, is there anything •
else affecting your life right
•
now?
•
• You’ll probably be asked
questions on the following •
subjects so it’s important to
be honest about whether you •
drink heavily, use cocaine, •
smoke cigarettes or use
opiods for recreational use. •
• Will I be referred to a
specialist?
• Being overweight
• High cholesterol
• Diabetes
60 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 61
Advice for women
62 www.leukaemiacare.org.uk
• feel ready for sexual
intercourse then vaginal
dilators should be inserted
two to three times a week.
• Hormone replacement
therapy: Chemotherapy given
as part of the transplant
conditioning regimen can
cause women to go through
the menopause much
earlier than usual. Hormone
replacement therapy
may help to alleviate the
symptoms of menopause
such as hot flushes and it can
help to increase sex drive.
Why do people get hot flushes reduce hot flushes. If you plan to
after treatment? try acupuncture, you should talk
to your consultant to ensure that
Some women will get hot flushes
this is the right thing to do.
after treatment because the
cancer treatment has placed Other tips for managing hot
them into the menopause. flushes at night include avoiding
hot drinks before bed, avoiding
The menopause is when a woman
exercise before intimacy or even
stops having periods. Usually,
taking a cool shower before you
the menopause will happen
become intimate. You could also
over the age of 45 but cancer
try having a fan on your side of
treatment may put some women
the bed to help you to cool down.
into the early menopause. Some
patients mistake their leukaemia Physical arousal can also trigger
symptoms for the menopause as hot flushes. If this happens, take
the hot flushes and night sweats a moment to explain to your
could be attributed to either partner what is happening and
condition. that you need to cool down before
continuing.
Hot flushes can interfere with
quality of life. One of the most
basic ways that hot flushes can
interfere with your life is when
you share your bed with another
human being.
64 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 65
Vaginal dryness
66 www.leukaemiacare.org.uk
or vaginal rings. You may prefer consider.
one type over the other and you
Vibrator therapy
may have to try all three to find
out what you’re most comfortable There are some US based
with. gynaecologists who have begun
to prescribe vibrator therapy
Compared to moisturisers or
to those experiencing vaginal
lubricants, it is not a fast-acting
dryness. The theory behind
option and you may need to use it
this is that to increase vaginal
in conjuction with another option
moisture, you need to increase
until the oestrogen takes effect.
blood flow to the area and using
This is a long-term option as the
a vibrator can do just this. In this
symptom typically returns if the
setting, it doesn’t necessarily
treatment stops.
matter whether you orgasm or
HRT not through using the vibrator
but orgasms will help with the
HRT stands for hormone
production of natural oestrogen.
replacement therapy. After
They can also help a person to
entering the menopause, the
feel better about themselves and
ovaries stop producing oestrogen
a partner. They can also reduce
which causes symptoms such
stress and help you to relax.
as hot flushes, mood swings and
vaginal dryness. Pain during vaginal penetration
68 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 69
Your relationship with yourself
and others
Body image and self- being diagnosed with a blood
cancer can also have an effect
esteem on an individual’s self-esteem.
How can low self-esteem affect You have been through a life
my sex life? changing event. In the case of
acute leukaemia, you’ve been
Low self-esteem can manifest
given news about an illness that
itself in a number of ways,
needs treating very quickly. In the
including:
case of chronic leukaemia, you
• Not wanting to be seen naked have been given a diagnosis that
or semi-naked will be a part of you for the rest of
your life. Studies have shown that
• Only willing to have sex in the many cancer patients display the
dark or under covers signs of post-traumatic stress
• Inability to become aroused disorder (PTSD).
70 www.leukaemiacare.org.uk
Improving your own qualities about you that your
friends, family and loved ones
self-esteem really like about you, even if you
There are a few strategies that you struggle to see it.
could employ to try and improve
how you feel about yourself and There is a full guide on the Mind
how you feel about your body. website https://www.mind.org.uk.
72 www.leukaemiacare.org.uk
Support groups Lymphoma Action
Macmillan forums
74 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 75
Useful contacts
and further support
76 www.leukaemiacare.org.uk
Turn2Us British Complementary
Help with finding financial Medicine Association
assistance. Website with a Member organisation for
benefits calculator and a search complementary therapists that
tool for local benefits advisors offers information and a therapist
and grant-awarding charities by finding service.
location or occupation. 0845 345 5977
https://www.turn2us.org.uk/ office@bcma.co.uk
www.bcma.co.uk/
Look good, feel better
Organisation that runs skin care Complementary and Natural
and make up workshops for Healthcare Council
people with cancer. Maintains a register of
01372 747 500 complementary therapists
www.lookgoodfeelbetter.co.uk and set standards for practice.
info@lgfb.co.uk Provides a therapist finding
service on their website.
020 3668 0406
British Association for
Counselling and Psychotherapy info@cnhc.org.uk
(BACP) www.cnhc.org.uk
Professional association for
counsellors and psychotherapists Learn mindfulness
that provides information about
On line course run in partnership
talking therapies and a find a
with the Mental Health
therapist finding service.
Foundation and recommended by
01455 883300 the NHS.
www.bacp.co.uk/ https://www.bemindfulonline.
bacp@bacp.co.uk com/
78 www.leukaemiacare.org.uk
Helpline freephone 08088 010 444 79
Leukaemia Care is a national charity dedicated
to providing information, advice and support to
anyone affected by a blood cancer.
Want to talk?
Helpline: 08088 010 444
(free from landlines and all major mobile networks)
Office Line: 01905 755977
www.leukaemiacare.org.uk
support@leukaemiacare.org.uk
Leukaemia Care,
One Birch Court,
Blackpole East,
Worcester,
WR3 8SG
Registered charity
259483 and SC039207