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Sex on chemo: A user’s guide to cancer and your love life

A while back I wound up somewhat unexpectedly in a private online discussion of sexual etiquette which in turn led to a discussion of male sexuality on chemotherapy. Obviously, this is me speaking as a cis-gendered heterosexual male, but I suspect a lot of this reasonably transfers to other male-identified sexual orientations. (Some of this may even transfer to female-identified sexuality, though I wouldn’t claim to understand that from the inside at all.)

I also make the assumption, perhaps incorrect, that this information applies to other chronic illnesses or conditions that interfere with male sexuality. Take this commentary for what is it worth.

Be warned: the following material is very sexually explicit. It’s not intended to be prurient, but it is extremely frank and uses a fair amount of direct phrasing and descriptions of specific sexual acts and practices, as well as some commentary about my personal preferences and behaviors.


First of all, chemotherapy brings on pernicious erectile dysfunction. In my case, while for the most part I can achieve self-stimulated orgasm without extreme difficulty, I rarely if ever can achieve even a partial erection. Not even with pharmaceutical intervention. Which I am very loathe to use, because of all the other drugs running around inside my system.

Chemo is also like the world’s worst STD. Not that you can get cancer from a sex partner experiencing chemotherapy. But rather, any bodily emissions are considered cytotoxic, systemically toxic, and possibly caustic, due to both the primary pharmaceutical load and the drug breakdown by-products. Oncologists are deeply paranoid about the possibility of chemo pregnancy. (Think Thalidomide.) As a result, they generally counsel absolute abstemption from sex, without acknowledging outercourse or any other aspects of nonprocreative sex such as older age, infertility or nonheteronormative lifestyles. For liability purposes, any endorsement of sexual behavior of any kind opens the door to a pregnancy-related lawsuit against the doctor and their institution. Also in my experience, as well as reported by other cancer patients, oncologists really don’t like to talk about sex.

So basically, a person on chemo is the Toxic Avenger brought to life. In addition to issues of ejaculate and even male pre-come, this includes urine, feces, sweat, saliva, blood, bile, etc. Literally any body fluid. I am advised, for example, to flush twice any time I use a toilet, and not to tongue kiss. At the same time, due to my being immunocompromised, I am forbidden from performing cunnilingus or analingus because of the realities of bacterial transmission.

This pretty much leaves me with the options of shared/parallel, mutual or assisted masturbation, along with finger-to-skin, and mouth-to-skin contact (on my part) outside of the oral and genital areas. On chemo, the ED is so profound that even hand jobs from a sex partner are rarely particularly effective. Fellatio is still pleasurable, but should be carefully indulged in due to the possibility of sudden ejaculation. However, I can, for example, still suckle at a lover’s breast.

Given that I’m astonishingly oral in my preferences and not especially penetration-oriented, this all isn’t quite as painful as it might sound. Nonetheless, it is pretty frustrating. I expect it would be for most men, especially those who are erotically focused on penetrative sex with their partner(s).

All that being said, here’s my personal perspective on the erotic possibilities of self-directed male masturbation during mutual sex, specifically in a time of medical challenge.

I like to use a lover’s body to stimulate my penis. Dry-humping front or back, frottage, breast play, etc. There can be a lot of mutuality in those contexts. I also like to masturbate while kissing or suckling at the breast, which can be very hot for the woman depending on her preferences. Setting up a peep show scene or an “I like to watch” scenario can be very stimulating. Masturbating to ejaculation on my lover’s breasts or belly or ass is also a lot of fun. I do not, however, lick or suck at the ejaculate, as that reintroduces the drugs and their by-products into my system by an oral path. Likewise me masturbating my lover or using favored sex toys can be a terrific path. I suspect shared pornography viewing would be pretty hot in this respect, assuming your sexuality runs that way.

In other words, there’s a lot of room for mutuality even when the man is self-pleasuring. It mostly depends, like all other sex, on close communication (verbal or nonverbal) and good reading of the other person’s cues.

There is no easy path here. Chemo runs the gamut from annoying to debilitating, with heartbreak at every step. But you can still indulge your sensuality within the limits of your desire and energy.

Revised 2013-01-10