Many male cancer survivors experience sexual dysfunction or changes in their sex lives after a cancer diagnosis. These changes can be physical or mental. Many men are not comfortable discussing these issues with their healthcare team or with their partners, but being able to speak openly is important.
Common Side Effects of Treatment
Each type of cancer treatment—chemotherapy, radiation, surgery, and hormonal therapy—can cause possible sexual side effects. Side effects may vary depending on the type of cancer, the specific mode of treatment, and the individual’s response to treatment. Talk to your healthcare team about what you should expect from treatment.
Below are some of the most common side effects of each treatment type that causes sexual dysfunction.
Surgery to the pelvic area including surgery for prostate, anal, bladder, or testicular cancer can lead to the following:
- Damage to blood vessels or nerve endings resulting in difficulty having and keeping an erection, known as erectile dysfunction or impotence
- Loss or damage of sexual organs
- Orgasms that do not result in ejaculation
After surgery, ask your doctor if and when it is safe to have sex.
A common treatment for prostate cancer is hormone therapy. During hormone therapy, medications or surgery prevent the body from producing the male hormone testosterone. Lack of testosterone may cause these sexual side effects:
- Erectile dysfunction
- Lack of sexual desire
Chemotherapy does not usually directly affect sexual function, but the side effects of chemotherapy, such as nausea and fatigue, may lead to loss of sexual desire. Chemotherapy can also cause infertility. Men who plan to try to father children should ask a doctor about fertility preservation before beginning treatment.
Radiation to the pelvic region may cause the following side effects:
- Damage to blood vessels or nerve endings leading to erectile dysfunction
- Redness and pain at the treatment site
- Fatigue which may lead to loss of desire
Managing Side Effects
Below are tips for managing the most common side effects related to sexual dysfunction in men.
Erectile dysfunction can be either mental or physical. Your doctor can do a test to determine the cause. If the cause is mental, see the suggestions below for managing emotional issues. If the cause is physical, you have several options.
- Prescription medications can treat erectile dysfunction by increasing blood flow to the penis. (If erectile dysfunction is caused by nerve damage, medications such as these will not help.) Common medications include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
- Penile injections are shots delivered before sex into the penis to help cause and sustain an erection. Your doctor may wish to do a practice injection at a healthcare office to make sure they work for you.
- A vacuum constriction device (or pump) is a plastic tube placed over the penis. Air is then pumped out of the device, creating suction. This suction causes more blood to flow to the penis.
- Penile implants are prostheses (artificial devices) surgically placed inside the penis to help create an erection. There are three main types of penile implants:
- A semirigid penile implant is a flexible rod placed inside the penis that can be bent up or down.
- A two-piece penile implant is made up of an inflatable cylinder inside the penis and a pump inside the scrotum.
- A three-piece penile implant is made up of an inflatable cylinder inside the penis, a pump inside the scrotum, and a fluid supply in the abdomen.
- Source: The Mayo Clinic
- Being overweight may also cause erectile dysfunction. If you have gained weight during treatment, read Nutrition Tips for Managing Weight Gain.
Talk to your healthcare team about which of these options may be best.
Lack of Desire
During and after cancer treatment, many men report a lack of sexual desire. Lack of desire may come from hormonal changes or from other side effects that make sex unenjoyable.
- Rethink what sex and intimacy mean.
- Do not expect sex after cancer to be exactly the same as sex before cancer. Your body has been through a lot of changes.
- You most likely will still be able to reach orgasm. Depending on your treatment type, orgasms may no longer result in ejaculation, or you may have difficulty reaching orgasm.
- Be patient. It may take some time to discover what is comfortable and pleasurable for you.
- If you are taking anti-depressants or pain medication, talk to your doctor about adjusting your dosage.
- Both these medications can cause lack of desire.
- If low testosterone is causing your lack of desire, you may be able to take testosterone supplements. However, if you have prostate cancer or another hormone-driven cancer, testosterone supplements may not be safe. Talk to your healthcare team about your options.
- Other treatment side effects such as nausea, fatigue, and pain may interfere with your sex life.
- Visit Managing Cancer Side Effects to learn how to minimize and control side effects including nausea, fatigue, or pain.
Self-Esteem and Body Image
How you feel about yourself can affect your sex life. Cancer and cancer treatment can cause significant changes to your body. You may have hair loss, weight loss, weight gain, or scars. With these changes, you may not feel the same way about your body. This is all normal. Do not be critical of yourself. Your body battled cancer.
Below are tips for managing issues related to self-esteem and body image.
- Hair usually grows back after treatment ends.
- In the meantime, try a hat, bandana, or cap.
- When your hair does begin to grow back, use a gentle shampoo such as baby shampoo.
- Talk to your healthcare team about reaching and maintaining a healthy weight.
- Read Survivorship Nutrition for tips on how to eat healthy.
- Ask your healthcare team if it is safe for you to start an exercise program.
- The endorphins released during exercise can also make you feel better emotionally.
- Most surgeries leave some scars. Try using over-the-counter lotions and gels to help minimize incision scars. Moisturizers made with cocoa butter also minimize scars.
- After surgery for testicular cancer, some men choose to have testicular implants to regain the appearance of having both testicles.
- After surgery for colorectal, anal, or bladder cancer, some men need temporary or permanent ostomies.
- After healing from surgery, you can have sex with an ostomy. To learn more about this, visit the United Ostomy Associations of America.
You have to care for your mental health as well as your physical health. If you are struggling with anxiety or sadness, you probably don’t feel like having sex. Some options for emotional support include: peer partnering programs, support groups, and one-on-one counseling. Other survivors are often great resources for men experiencing sexual side effects of cancer. It can be difficult to talk about these issues, but having someone who has experienced the same journey can be beneficial. Visit Emotional Support Programs to learn more.
Cancer treatments can lead to infertility.
Men do have options to preserve their fertility. However, it is important to talk to your healthcare team about fertility and your options before you begin treatment. Many fertility-preserving options must be done before treatment begins.
Before beginning treatment, some men can freeze and bank sperm.
If you continue to have sex during treatment, be sure to use proper protection to protect against unplanned pregnancies and sexually transmitted diseases. Since cancer treatment can compromise your immune system, be sure to always use condoms to protect against STDs.
Talk to your healthcare team as soon as possible about all your options and your fertility status.
Talking to Your Partner About Sexual Dysfunction
Being able to talk openly with your partner about sex is very important. What worked for you both before cancer may not work now. You may need to start slowly and try different things to find what works for you both. If it has been a while since you’ve been intimate, start slowly with simple kissing and touching. Here are some basic guidelines for talking to your partner:
- Be honest.
- Always tell your partner if something hurts or is uncomfortable.
- If something feels good, let your partner know.
- Be patient with yourself and your partner.
- Set the scene by going on a romantic date or watching a movie together at home.
Talking to Your Healthcare Team About Sexual Dysfunction
Your healthcare team is made up of health professionals. You should feel comfortable telling them anything. There is nothing embarrassing about sexual dysfunction, as it can happen following cancer and its treatment. After fighting cancer, you deserve to have a healthy sex life.
You may wish to talk to healthcare professionals who specialize in areas related to sexual dysfunction including:
- Sex therapist
- Psychologist or counselor
Talking about sexual dysfunction can be difficult. Here are some sample questions to begin your conversation with your doctor:
- How will treatment affect my sex life?
- What can I do to manage sexual side effects?
- Will I have difficulty having an erection? What can I do to manage this?
- I no longer feel any desire to have sex. What can I do to feel like myself again?
- Could you recommend a specialist?
- Will treatment affect my fertility?
For more information on male sexual dysfunction:
Erectile Dysfunction: Mayo Clinic
Prostate Cancer and Sexual Dysfunction: Prostate Cancer Foundation