Sexual Health and Fertility with Multiple Myeloma

How Multiple Myeloma Can Affect Sexual Health

Multiple myeloma sexual health concerns are common and valid. Symptoms from myeloma, such as fatigue and pain (https://www.myeloma.org/newly-diagnosed/do-you-have-myeloma), can affect desire and comfort. Stress surrounding a new diagnosis can also contribute, leading to changes in mood, sleep, and body image.

The sexual side effects of multiple myeloma may also result from treatment (https://www.myeloma.org/frontline-treatment-options). Side effects of medications and other therapies can include low libido, vaginal dryness, erectile dysfunction, pain with sex, and other challenges that impact libido and hormones. Steroids, pain medications, antidepressants, and sleep disruption can also contribute. If you have sexual health concerns, these are relevant discussions to bring up with your clinician and care team, just like other treatment-related side effects.

A healthcare team can help identify what is driving the change and which options may help, including symptom management, medication adjustments, pelvic health support, or counseling. The IMF also offers information on myeloma's connection to sexual dysfunction (https://www.myeloma.org/fatigue-depression-sexual-dysfunction), depression, and fatigue that may help you prepare for a conversation with your healthcare team.

How Multiple Myeloma Treatment Can Affect Fertility

The fertility effects of multiple myeloma treatment affect men and women. Some treatments may cause temporary infertility, while others may lead to permanent infertility. Age, baseline fertility, medication types, dose intensity, and treatment duration can all influence risk.

The impact for women may include changes to ovarian function, menstrual cycles, and hormone levels. Certain therapies can accelerate ovarian aging or reduce egg reserve. Some people experience a temporary pause in menstruation that later returns, while others may develop early menopause. Even when menstrual cycles return, fertility may still be reduced.

The fertility effects in men may include decreased sperm count, reduced sperm motility, and hormone changes that affect sexual function. These effects can be temporary or long-lasting depending on the treatment plan.

Your healthcare provider should discuss fertility preservation at diagnosis and continue to address reproductive health concerns through treatment and remission.

Pregnancy and Breastfeeding Considerations

Pregnancy planning with myeloma requires close coordination with the care team. Many myeloma medications (https://www.myeloma.org/multiple-myeloma-drugs)are not considered safe during pregnancy, and treatment timing may need to be adjusted.

Breastfeeding may also be affected by medications, treatment schedules, and overall health. If pregnancy or breastfeeding is part of your current or future plan, bring it up early so the team can discuss safety, timing, and alternatives.

Fertility-Preservation Options to Ask About

Fertility preservation is not one-size-fits-all, and it may not be possible for everyone based on timing and health status. It is important to discuss testing, preservation options, and realistic expectations with a specialist.

When it is feasible, options may include:

• Egg freezing: Patients may consider collecting and freezing unfertilized eggs for future use.
• Embryo freezing: You may also opt to freeze fertilized embryos, which can later be used for in vitro fertilization (IVF).
• Sperm banking: Patients can freeze their sperm prior to treatment. 
• Ovarian or testicular tissue preservation: While this is a less common option, it may be relevant in specific situations.

While it's important to understand all available options, your oncology and reproductive teams should guide decisions based on your myeloma treatment plan, health status, and timeline. A reproductive endocrinologist or fertility specialist can explain timing, success rates, costs, and whether rapid-start protocols may be appropriate.

How to Prepare for a Conversation With Your Healthcare Team

If these topics feel hard to raise, a simple script can help: “I want to talk about fertility and sexual health before we start or change treatment.” It may also help to ask:

• Which parts of the plan may affect fertility?
• Is fertility preservation still an option on this timeline?
• What contraception is recommended during treatment?
• What support is available for sexual side effects?

Let IMF Support You

You do not have to navigate these decisions alone. IMF provides education, support, and resources for people living with myeloma and care partners. To speak with a knowledgeable team member, call 1-800-452-CURE (2873). You can also explore supportive resources, such as mind-body wellness resources (https://www.myeloma.org/mind-body-wellness), for coping strategies that may help during treatment.