Sex, fertility and Hodgkin lymphoma

Having Hodgkin lymphoma and its treatment can affect your sex life and make it harder for you to get pregnant or father a child in the future.

How Hodgkin lymphoma affects your sex life

Hodgkin lymphoma can impact your relationships and sex life, but not always. The symptoms and treatment of Hodgkin lymphoma can lead to physical changes in your body and alter how you feel about yourself.

Feeling anxious and stressed is common, and mood can affect your interest in having sex. But there is no physical reason why Hodgkin lymphoma or its treatment should stop you from having sex.

You may have times when you don’t feel like having sex because you are too tired, or you have other side effects of treatment.

Speaking openly with your partner and sharing your concerns or worries can help. Talk to your doctor or healthcare team for more advice.

Contraception and protecting your partner during sex

Always use reliable contraception when you are having treatment for Hodgkin lymphoma. You should not become pregnant or father a child while having chemotherapy or other cancer treatments. This is because some treatments can harm the baby and increase the risk of miscarriage. You may need to continue using contraception for a little while after your treatment has finished. Your doctor will discuss this with you.

It is not known for sure whether cancer drugs, such as chemotherapy, can be passed on through semen or secretions from the vagina. Because of this your doctor might advise you to use a barrier contraception, such as condoms. This is usually only while you are having treatment. You should use the barrier method when having vaginal, anal or oral sex.

Women and infertility

Treatment for Hodgkin lymphoma can make it harder for you to get pregnant in the future. Before treatment, your doctor will talk to you about your risk of infertility.

If you have a partner, you may want to speak to your doctor together so that you can both discuss any fears or worries. Don’t be afraid to ask questions. Being well informed can help you cope.

Chemotherapy

If you are a woman, chemotherapy may affect your fertility by:

• changing or stopping your period
• damaging your ovaries
• reducing the number of eggs your ovaries produce
• causing hormonal changes

Chemotherapy can make it difficult for you to get pregnant naturally by causing you to have an early menopause. Menopause is when your periods stop permanently. It is not always possible for your doctor to be certain whether this will happen. It will depend on:

• how fertile you are before treatment

• your age

• the treatment you have

Radiotherapy

You may have radiotherapy to your pelvis or tummy (abdomen) if you have lymphoma in that area. The pelvis is the lower part of your abdomen between your hips. It contains the pelvic organs, including the bladder , lower bowel, ovaries and womb .

Radiotherapy to the pelvis can cause infertility and changes to your vagina such as dryness, fibrosis and narrowing of the vagina.

It is sometimes possible to move the ovaries out of the treatment area before radiotherapy begins. This is called ovarian transposition.

Hormone replacement therapy

Your doctor might offer you hormone replacement therapy (HRT) to reduce menopausal symptoms. This includes:

• hot flushes and sweats

• dryness of the vagina

• less interest in sex

• dry skin

• low energy

• mood swings, difficulty concentrating or feeling low

HRT replaces oestrogen and progesterone, the hormones your body normally makes. Having HRT will not stop you from becoming infertile because it does not help your ovaries to make eggs. But you may still have a period each month.

HRT can also help to prevent long term problems like thinning of the bones (osteoporosis) and heart disease. It can cause a small increase in the risk of some cancers but the benefits usually outweigh this risk.

You can take HRT as a tablet or a patch, like a plaster. 

Men and infertility

Hodgkin lymphoma treatment can make it harder for you to father a child in the future. Your doctor will talk to you about this before starting treatment.

Chemotherapy

If you are a man, chemotherapy can affect your fertility by:

• reducing the number of sperm you make

• affecting the ability of the sperm to fertilise an egg

• affecting the production of the hormone testosterone

This may be temporary or may mean you can no longer father a child.

Radiotherapy

You may have radiotherapy to your pelvis if you have lymphoma in that area. This can affect your sex life and your fertility.

Radiotherapy to the pelvis can cause painful ejaculation, problems with erections and lowered interest in sex. This usually recovers after treatment has finished but talk to your healthcare team if you have any concerns.

Your doctor might suggest using a shield to try to protect your pelvis and groin area during radiotherapy.

Infertility after a stem cell transplant

A possible long term side effect of a stem cell transplant is infertility in men and women. This is because of the high dose chemotherapy you have. Your doctor will tell you if it is likely that you will become infertile.

If you have a partner, you might want to see your doctor together so you can both discuss any fears or worries. Don’t be afraid to ask questions. Being well informed can help you cope.

Ways to preserve your fertility

There are options available for men and women to preserve their fertility. It is important to discuss your fertility with your doctor before treatment.

Fertility options for women

If you want to have children after your treatment you might be able to freeze your eggs or embryos. There is research looking into ways to help women keep their fertility when having chemotherapy and radiotherapy.

Fertility options for men

It is usually possible for you to have sperm collected and stored before you start treatment. This is called sperm banking. It means you could be able to have children in the future through fertility treatment. Ask your doctor or specialist nurse to refer you to a fertility clinic.

Coping with infertility

It can be distressing to find out that your Hodgkin lymphoma treatment can cause infertility. Even if you hadn’t thought about having children before, losing your fertility can be very difficult to cope with. It can also affect how you feel about yourself.

It takes time to adjust. You need to give yourself time to come to terms with it.

Talking about fertility and sexual difficulties during cancer treatment

Talking to your friends and relatives about your cancer can help and support you. However, your sex life is very personal. You may find it difficult to talk with your partner or your doctor about any sexual difficulties you have from treatment. It is also normal for people who are not currently in relationships to have worries about sex and fertility during cancer treatment.

You might find it easier to talk to someone outside your own friends and family. Some people find it helpful to talk to a therapist or counsellor.