Men & Cancer – When Cancer Affects Your Sexual Health

by Phil Nguyen, MD

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In my practice, I regularly visit with cancer survivors who lament about the previously unknown side effects of their treatments. Many comment that they have meticulously adhered to their prescribed treatment programs, regularly visited their doctors, and improved their overall lifestyle habits. And the good news? These habits have greatly improved their health and their long-term diagnosis.

The unfortunate news? Survivors often realize that the very same treatment programs that have saved their lives are now affecting their sexual health and level of intimacy with their partners. Sound familiar? If so, you are not alone. The good news is that you shouldn’t lose hope. Cancer survivors who are experiencing erectile dysfunction CAN regain their sexual health.

ED and Cancer: The Facts
Oftentimes, ED is associated with other health conditions, not only because of the systemic health issues that they present but also because of medications that are prescribed to men to treat their conditions. This is the case with many cancer survivors, specifically those who have been diagnosed with prostate or rectal cancer.

All men, no matter what their overall health conditions, can and should have a healthy sex life.

Author of Article photo

Dr. Phil Nguyen

Prostate cancer survivors, in particular, should be aware that erectile dysfunction is a common residual side effect of related cancer treatments. Because the nerves that support the penis run through the prostate, any surgery or radiation that affects the prostate is likely to affect the penis, no matter how “nerve sparing” the treatment. According to the Prostate Cancer Foundation, about 50 percent of prostate cancer survivors who undergo external beam radiation experience ED for up to two years. For those who received brachytherapy, in which small radioactive rods are placed directly into the tumor, the number was around 25 percent.

Common Solutions and Their Drawbacks
What are the treatment options for cancer survivors with ED, and what are men to do if existing conditions and medications preclude them from taking common oral medications for their erectile dysfunction?

Oral medicines may not be appropriate for men with certain medical conditions. In addition to being contraindicative with many other medications, oral treatments do not merely affect the sexual organs; they can affect all the systems of the body and potentially produce dangerous side effects. For example, they can cause a disruption in the normal function of blood vessels in certain areas, including the head, skin, and stomach.

As I noted (and you likely have too), cancer survivors often find erectile dysfunction to be an upsetting side effect of treatment. However, because certain treatment options pose health risks to circulation and the overall system, men with this diagnosis frequently can’t treat their ED with oral medications.

But this is not where the story ends. There are alternatives that fill the gap between convenient oral medications and invasive surgery, such as a penile implant. All men, no matter what their overall health conditions, can and should have a healthy sex life.

Other Options
For men for whom oral medications pose dangerous health risks, there are treatment options available that are personalized and safe. One option is intracavernous pharmacotherapy (ICP) – an injection of a combination of FDA-approved vasodilators into the spongy tissue of the penis using an auto-applicator. ICP is minimally invasive and effective in producing consistent erections. And, as a localized treatment, there is little concern about its effects on the rest of the body and a low likelihood of contraindication. Other alternatives include intra-urethral suppository, prepared in the form of a pellet that is inserted into the urethra; penile prosthesis; and vacuum suction devices.

Scores of men have found success with a variety of ED treatments, and treatments are definitely not one-sizefits- all. The chosen treatment should be decided after careful consideration by a man and his doctor. And it is imperative that after cancer treatment is completed, survivors begin an ED program as soon as possible. Delaying such treatments may further result in the worsening of ED through disuse atrophy. As the old saying goes, “Use it or lose it.”

Men with ED don’t have to suffer in silence. With the proper diagnosis and treatment, men of all ages and health conditions can (and do) have a healthy sex life.

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Dr. Phil Nguyen is a family practitioner and expert in male sexual health. He serves as medical director and primary physician for Boston Medical Group’s San Francisco and Denver offices.

This article was published in Coping® with Cancer magazine, May/June 2010.