Question: 

Is it safe to have sex when you have multiple myeloma and bone lesions in your pelvic bones? 

Answered by hematology oncologist and multiple myeloma specialist Tanya Wildes, MD:

Concerns about sex and physical intimacy can be an uncomfortable subject to talk about, but opening up to your doctor is an essential first step, as sexual health is an important component of your overall health and well-being. Physical and emotional changes before, during or after cancer treatments are common. Hormone therapy, chemotherapy or surgery can all impact a person’s sexual wellness, and adjustments may be needed throughout the journey. 

First, do you want to be sexually active? If yes, then working through the potential barriers and finding solutions with your doctor (and partner) is where to begin.

Whether sex is safe for you depends on many factors and isn’t always a yes or no answer. For someone with multiple myeloma and bone lesions in the pelvis, it comes down to pain or discomfort. 

Listen to your body

Stay in tune with your body and pay attention to any warning signs. If something hurts, stop and take notice. If you have clearance from your doctor and intimacy brings you comfort, closeness and pleasure, it is generally OK if you are feeling up to it. 

Consider pain and increasing discomfort as red flags; they are vital indicators to help guide your decisions about sex and intimacy. 

For multiple myeloma and bone lesions in the pelvic bones, pain can indicate a vulnerability in the bones. You are less likely to be at risk if you have no pain or pelvic discomfort. If you are having pelvic pain or increasing discomfort, however, and want to be intimate, there are a few things to talk with your doctor about (no matter the cancer type), including:

• Treatment type. What kind of treatment are you receiving, and what potential impact could it have on your sexual health? For people with multiple myeloma and bone lesions, treating the cancer and using bone-strengthening medications together can help reduce the risk of bone damage.

• Low blood counts. If undergoing cancer therapy and blood counts are low, it may be recommended to avoid intercourse due to the risk of infection or bruising.

• Pain or discomfort. Anything that causes increased pain or discomfort should signal that a change of approach to intimacy is needed. After a discussion with your doctor, other ways of expressing sexual intimacy and closeness could be an option.

• Pregnancy considerations. Various factors will determine what fertility restrictions, recommendations or birth control may be needed before and during treatment.

• Risk of infection. For sexually transmitted infections, individuals under drug cancer care should take the same precautions as everyone else. Ask what precautions and preventive measures are best to implement for other types of infection risk.

• Medications and their potential side effects. Certain medications may impact sexual desire, arousal, physical comfort, sexual function or mental health. Talk with your doctor about your concerns and potential solutions to help with adverse side effects. 

The impact of cancer and cancer treatments on your sexual health and drive is going to be multifaceted. Because each person is unique and has individual factors to consider, discussing your specific concerns with your doctor is your best path forward. 

Keep an open line of honest communication with your doctor and health care team. They are the most familiar with your diagnosis, medications, treatment type, physical state and healing process. If additional help is needed at any point in your journey, they can assist you in finding the support best suited to your situation.