Changes in sexual health after transplant are common and can come as a surprise for both patient and partner alike.

Not everyone experiences these changes, but in one study by Syrjala et al, nearly half of men and 80 percent of women reported lower sexual activity five years after transplant.

Sexual Difficulties in Women after Transplant

The chemotherapy and/or total body irradiation (TBI) you receive before transplant can cause:

• damage to the ovaries
• premature ovarian failure (less common in women who undergo a reduced intensity transplant)
• early menopause
• blood vessel damage that reduces the ability of the vagina to stretch and interferes with lubrication

In addition, vaginal graft-versus-host disease can make the vaginal opening sensitive and sore.  

The problems often reported by women after transplant include:

• decreased interest/low desire
• decreased physical response/arousal
• pain during sex
• difficulty reaching orgasm
• changes in body image and perceived attractiveness
• worries about germs and infection

• vaginal moisturizers
• water or silicon based lubricants designed for intercourse
• hormone replacement therapy
• vaginal dilators

If you are experiencing vaginal graft-versus-host disease, topical steroids with estrogen may help. In severe cases, surgical intervention may be required.

Discuss these therapies with your doctor or a sex therapist to determine which may help you. You can get a referral to a sex therapist from the American Association of Sex Educators, Counselors and Therapists [1] or by phoning (202) 449-1099.

Women who can resume sexual relationships during the first year after transplant tend to have fewer problems later on.

Watch a video about sexual health in women after transplant.

Sexual Difficulties in Men after Transplant

The chemotherapy and/or total body irradiation (TBI) you receive before transplant can:

• reduce testosterone (most men recover normal levels within two years)
• damage small blood vessels in the penis
• damage nerves over time 

In addition, chronic GVHD sometimes affects the genitals creating sores on the penis.

Some men report problems after transplant such as:

• decreased interest in sex
• problems getting and/or keeping an erection
• difficulty reaching orgasm
• pain with erection and climax
• performance anxiety
• change in body image/perceived attractiveness
• worry about germs, infection, hurting partner

Therapies available that can improve sexual function in men include:

• testosterone replacement therapy 
• oral drugs to treat erectile dysfunction 
• intracavernosal injection therapy which increases blood flow to the penis.
• transurethral therapy (MUSE), vacuum therapy and a surgically implanted penile prosthesis which can help you achieve an erection.

If you are experiencing changes in sexual health after transplant, consider consulting with a sex therapist. These are professionals who are skilled at helping couples regain a comfortable sex life. You can get a referral to a sex therapist from the American Association of Sex Educators, Counselors and Therapists [1] or by phoning (202) 449-1099.

Watch a video about male sexual health after transplant.

(To view this page in Spanish click here [2])

Next Page: Peripheral Neuropathy [3]

Updated August, 2023