Review of contraception practices with female cancer patients is important at cancer diagnosis, throughout the treatment pathway and into survivorship. The importance of contraceptive measures should be explained and a referral for specialist contraceptive advice may be required (Royal College of Obstetricians and Gynaecologists 2011a). Avoidance of pregnancy may be advised due to the risks of cancer treatments teratogenic to the developing fetus.

The presence of menstrual cycles after treatment with chemotherapy and/or radiation or surgery may be an indicator of fertility potential only. Resumption of cyclic menses is not a reliable indicator of fertility and the need for contraception measures. Following cancer therapy treatment‐induced amenorrhoea may be transient or permanent. Some women with regular menstruation are unable to conceive and others without menses may still have oocytes and be able to reproduce (Quinn and Vadaparampil [234]).

Appropriate birth control choices should be discussed because hormonal contraception may be contraindicated with certain tumour types, particularly hormone‐responsive tumours. Provision of information regarding non‐hormonal contraception such as barrier methods, intra‐uterine devices and surgical/radiation sterilization may be advised (Royal College of Obstetricians and Gynaecologists [244]).

Various cancer treatment modalities may impact on female fertility. Surgery may result in the removal of reproductive organs or damage to structures needed for reproduction. Radiotherapy can cause gonadal failure and induce tissue fibrosis. Chemotherapy‐induced gonadotoxicity can cause permanent amenorrhoea with complete loss of germ cells, transient amenorrhoea, menstrual irregularity and subfertility. The severity of gonadal failure depends on the specific chemotherapy agents used, the cumulative dose administered and the woman's age. The impact of biological therapy on reproduction is largely unknown (Quinn and Vadaparampil [234]).

Following a cancer diagnosis, the subject of fertility‐sparing treatment should be raised with all women of reproductive age who want to maintain their ability to conceive. Fertility preservation options will be based on cancer diagnosis, time available between diagnosis and the start of therapy, the treatments that have already taken place, the availability of sperm from a partner or donor and the patient's current fertility status and age (Quinn and Vadaparampil [234]).

Surgical impact (scars, altered sensation), radiotherapy, alopecia, weight gain and lymphoedema may influence body image, self‐esteem and sexual well‐being (Varela et al. [279]).

Premature or abrupt ovarian failure and menopause onset may result in distressing vasomotor symptoms such as hot flushes and night sweats. These may disrupt sleep, resulting in fatigue and a poorer quality of life, which may impact negatively on sexual interest and sexual functioning (Carter et al. [41]).

Use of systemic hormone replacement therapy (HRT) to manage vasomotor symptoms may be contraindicated in some cancer types. Consideration of referral to a menopause clinic may be necessary (NICE [197]).

Vaginal health management related to cancer or cancer treatment is an important aspect of cancer recovery for many women and may help to reduce or eliminate vaginal discomfort that may cause chronic vulval irritation, reduced sexual pleasure or non‐adherence to gynaecological examination as part of cancer surveillance. The primary goals in improving vaginal health subsequent to cancer treatment are the restoration of vaginal lubrication and a natural pH to the vulva and vagina (Carter et al. [41]).

Loss of sexual desire is a common sexual problem following cancer treatment in female cancer survivors. Body image concerns related to cancer and cancer treatments may interfere with a cancer survivor's connection with a partner both emotionally and intimately (Boquiren et al. [21]). Any treatment that produces chronic pain, fatigue, nausea or weakness can reduce interest in sex (Schover [251]). Reduced sex hormones related to premature menopause can lower sexual desire. Oestrogen deficiency can disrupt physiological sexual arousal responses, including smooth muscle relaxation, vasocongestion and lubrication (Buchholz et al. [33]). Prescription medications such as narcotics and medications that increase the levels of the neurotransmitter serotonin, in particular selective serotonin reuptake inhibitor (SSRI) antidepressants, can impact negatively on sexual desire and climax (Schover [251]).