Cancer Survivors and Patients Need Individualized Contraceptive Counseling
November 1, 2025 5 minutes read
By Melinda Young
Clinicians increasingly are gearing their contraceptive counseling to the specific needs and desires of each patient. Cancer patients and survivors need person-centered contraceptive counseling that is geared toward their bodies and circumstances. They have individualized needs in contraceptive preferences, fertility desires, and sexual activity, according to a new Society of Family Planning Committee Statement.1 They know that one size does not fit everyone. But one highly effective form of contraception is not discussed as often, and that is vasectomy.
Cancer survivors often weigh the benefits of contraception against the risk that any medication could increase their risk of having a recurrence, says Eleanor Bimla Schwarz, MD, MS, professor of medicine and chief of the division of general internal medicine at the School of Medicine, University of California San Francisco. “These are very personal decisions, and what makes one method right for any individual may change over time,” Schwarz says. “I think the biggest concerns are for people with hormonally mediated cancers like breast cancer, who tend to be advised to avoid using hormonal contraceptives in the future,” she explains.
For those patients, the copper intrauterine device (IUD) might be a good option. For others, the best method would be one that their partner uses. “Women who have a history of breast cancer are more likely to rely on vasectomy because male partners are able to step up and have surgery after watching their partner have multiple surgeries already,” Schwarz explains. “Vasectomy is always a good option.” Other good options are the IUD or salpingectomy, but those are invasive procedures and might not be the best option for some women, she adds.
Another factor clinicians should consider is whether the patient would like to stop menstrual bleeding out of concern about anemia and vascular risks, Schwarz notes. Contraceptive counseling for cancer patients should emphasize that emergency contraception is safe for them. Clinicians also need to talk with patients about common risks and complications that can affect contraceptive choice, and the possibility of a vascular injury, venous thromboembolism, anemia, and bone loss because of cancer and chemotherapy.1
Clinicians also should address cancer survivors’ risk of venous thromboembolism (VTE) if they become pregnant, the Society of Family Planning Committee Statement says. While combined hormonal contraceptives with estrogen are associated with an increased risk of VTE, “the absolute risk of VTE while using any form of contraception is still lower than the four- to five-fold increased VTE risk for pregnant individuals compared to nonpregnant individuals,” the statement says.1
For cancer-surviving patients, contraceptives like the birth control pill taken daily without a week of placebo could cease menstrual bleeding and reduce iron depletion. The contraceptive ring or birth control patch could be useful, as well. If they are used continuously, they will stop the person’s period. Also, the levonorgestrel IUD could help reduce or stop menstrual bleeding. Depo-Provera injections can result in lighter or no menstrual periods.1,2
The committee statement also suggests clinicians talk with patients about intimate partner violence and how research shows that a person’s risk of intimate partner violence might escalate after a cancer diagnosis.1
The paper did not focus on barrier methods of contraception, but noted that vasectomy, spermicides, and contraceptive vaginal gel are safe, effective, and noninvasive for the woman.1
The challenge with a cancer survivor relying on a barrier method, including condoms, is getting the couple to align their goals, Schwarz says. This is when some couples may decide that the best contraception is a permanent procedure that the male partner has done, and vasectomy is their answer.
There are other instances when patients who no longer desire to get pregnant and are considering permanent contraception may want vasectomy included in the contraceptive discussion, says Marc Goldstein, MD, DSc (hon), FACS, a Matthew P. Hardy distinguished professor of reproductive medicine and urology and surgeon-in-chief of male reproductive medicine and surgery at Weill Cornell Medicine in New York, NY. Goldstein also is a senior scientist at the Center for Biomedical Research, the Population Council at Rockefeller University in New York.
“Vasectomy is so much safer, cheaper, and more effective than female sterilization [involving tubal ligation],” Goldstein says. “No man has ever died from a vasectomy, and there are no serious complications or long-term negative effects.”
Contraceptive counseling that includes mention of vasectomy to the couple should mention the complication of chronic scrotal pain that affects 1% to 2% of patients undergoing vas surgery.3 Known as post-vasectomy pain syndrome, it is diagnosed as at least three months of chronic, intermittent scrotal pain after vasectomy. The pain can have a delayed onset. Treatment includes nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and scrotal support and rest.3
“The only case to make for tubal [procedure] is if a woman needs to have surgery on her female organs, and they’re going in there anyway,” Goldstein says.
While researchers have struggled for decades to develop the first non-surgical male contraceptive, vasectomies remain popular, safe, and effective, he adds. “There are 1,000 sperms created every time a man’s heart beats,” Goldstein says. “Trying to stop 1,000 sperm per heartbeat — compared to one egg a month — is a huge problem, and that’s why development of male contraception is so much more difficult than female contraception.”
Also, contraceptives that stop production of sperm can affect shrinkage of men’s testicles, he adds. “If you stop all cells, you get dramatic reduction in the size of testicles, and men don’t like that shrinkage,” Goldstein says. “So, most efforts at male contraception are looking at altering the sperm’s ability to move,” he adds. “There is no good method of stopping sperm production that doesn’t have significant side effects, and we have so many more options for women.”
In recent years in the United States, there have been spikes in vasectomy procedures and a continuing increase in vasectomies, Goldstein says.4 One chief possible reason for the increase in vasectomies is the Dobbs v. Jackson’s Women’s Health Organization decision on June 24, 2022, in which the U.S. Supreme Court overturned Roe v. Wade and women’s right to have an abortion. Another possible reason is the increasing evidence that climate change is creating a more dangerous environment — both now and in the future. “A lot of people think this is a world they don’t want to bring children into anymore,” Goldstein says.
For people who want to maintain fertility but would prefer a nonhormonal contraceptive, their options include the copper IUD; vaginally administered, non-hormonal contraceptives like spermicides (Nonoxynol-9); vaginal pH modulators (Phexxi®); diaphragm; female condom; and cervical cap.5 Vaginal pH modulators inhibit sperm motility, Goldstein says. “They can impact yeast infections but appear to have minimal side effects,” he adds.
There are additional methods in development, including polyphenylene carboxymethylene (PPCM) — an on-demand vaginal gel that could provide both contraception and protection from sexually transmitted diseases.5
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Batur P, Brant A, McCourt C, et al. Society of Family Planning Committee Statement: Contraceptive considerations for individuals with cancer and cancer survivors part 1 — Key considerations for clinical care Joint with the Society of Gynecologic Oncology. Contraception. 2025;147:110870.
2. 5 types of birth control that stop periods. MedicalNewsToday. Last reviewed March 18, 2022. https://www.medicalnewstoday.com/articles/birth-control
3. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology, 22nd Edition. Jones & Bartlett Learning;2025:242.
4. Bole R, Lundy SD, Pei E, et al. Rising vasectomy volume following reversal of federal protections for abortion rights in the United States. Int J Impot Res. 2024;36(3):265-268.
5. Marinaro JA, Goldstein M. Non-hormonal contraception: Current and emerging targets. Adv Exp Med Biol. 2025;1469:245-272.
Clinicians increasingly are gearing their contraceptive counseling to the specific needs and desires of each patient. Cancer patients and survivors need person-centered contraceptive counseling that is geared toward their bodies and circumstances.
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