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Sex & Men with Cancer

by Nelson Bennett, MD

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Sexual dysfunction is common in male cancer survivors. The range of sexual issues cancer and its treatment can cause includes erectile dysfunction, decreased libido (sexual desire), and changes in the way a man experiences ejaculation and orgasms. Unfortunately, many of these threats to male sexuality are under-recognized, under-evaluated, and under-treated. It’s important to discuss with your doc­tor the potential side effects associated with your treatment so you’ll be better prepared to manage any sexual issues that arise.

Any type of pelvic surgery can affect the way you experience or­gasms or ejaculation. Surgery near the nerves responsible for the pleasurable feeling produced with orgasm can in­jure those nerves, altering the usual sensation you feel during an orgasm. If your prostate is removed, thus elimi­nating your major source of semen production, you should still be able to feel the pleasure of an orgasm, but little or no semen will be produced upon ejaculation. Some men report that these “dry orgasms” feel normal, while others say they experience an altered sensation.

Because the interior of the penis is composed of muscle, it is important to exercise this muscle by achieving erections. However, most men will experience erectile dysfunction follow­ing the removal of one or more pelvic organs, such as the bladder, prostate, or rectum. If you cannot achieve or maintain an erection on your own, your doctor may prescribe oral medications or recommend penile injections or vacuum pumps to assist your efforts.

The psychological implications of cancer can have as great an impact on a man’s sexual functioning as the physical side effects of treatment.

Author of Article photo

Dr. Nelson Bennett

Fortunately, erectile dysfunction fol­lowing surgery is not always permanent. Men who had nerve-sparing surgery have a 60 percent chance of regaining the ability to have erections without the aid of medication within two years af­ter surgery. It is important to note that men who had good erections before cancer surgery are more likely to regain good erections than men who had erec­tile problems before surgery.

Radiation Treatment
Many pelvic cancers, including prostate, bladder, and colon cancer, are treated with radiation, which can cause scarring and damage to the blood vessels that travel to the penis. This damage can result in erectile dys­function. Radiation can also injure the nerves that facilitate erections. Injury to these nerves can cause your erections to decrease in hardness.

Hormone Treatment
Some men require hormone therapy, or androgen deprivation therapy (ADT) , to slow the progression of their cancer. Hormone therapy works by either blocking your body’s production of the androgens (male hormones) needed to stimulate the cancer cells’ growth or by prevent­ing the cancer cells from using them. However, a common side effect of hor­mone therapy is decreased libido. In addition, decreased testosterone levels due to hormone treatment can negatively affect the hardness of your erections.

Psychological Considerations
Can­cer is a catalyst for many life changes, beginning with diagnosis and continu­ing throughout life. The psychological implications of cancer can have as great an impact on sexual functioning as the physical side effects of treatment. Men may experience depression, decreased self-esteem, fear, guilt, anxiety, and feelings of sexual inadequacy, all of which can greatly affect libido. In addi­tion, chemo-induced hair loss and other treatment-related bodily changes can deliver a blow to your self-esteem and interfere with your level of desire.

The good news is studies suggest that most people actually remain psycho­logically resilient in the wake of cancer. While that resilience is tested through­out the course of treatment and recovery, most people do adjust well.

From diagnosis to treatment, cancer can threaten a man’s sexual health. For­tunately, doctors are better equipped to evaluate and treat sexual issues than ever before. Having open and honest conversa­tions with your healthcare team prior to and throughout the course of treatment will help you get the support you need to manage sexual side effects and possibly minimize the impact of any treatment-related sexual difficulties in the future.

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Dr. Nelson Bennett is a urologist at the Lahey Hospital and Medical Center in Burlington, MA.

This article was published in Coping® with Cancer magazine, November/December 2014.