by Nelson Bennett, MD, FACS, and James Wren, MD
One out of every two men will be diagnosed with some form of cancer in their lifetime. This diagnosis will alter many aspects of their life – from the physical to the psychological. One area that many men are surprised to find affected by cancer and its treatment is their sexual function.
For male cancer survivors, sexual dysfunction may mean reduced libido, erectile dysfunction, ejaculatory dysfunction, and orgasmic changes. These sexual side effects may be short lived, or they may be long lasting. However, while it’s true that sexual dysfunction is still underdiagnosed and undertreated in people with cancer, many effective treatments are available to help you manage the sexual side effects of cancer. So, let’s take a closer look at how cancer treatment can affect your sexual health and what you can do to lessen its impact.
Cancer Surgery & Sexual Function
Certain cancers require surgical treatments that are associated with a high risk of sexual dysfunction due to how the surgery alters the male reproductive anatomy. These include prostate, bladder, rectal, and penile cancers, as well as some forms of metastatic testicular cancer.
Surgery for prostate, bladder, or rectal cancer can result in temporary or permanent injury to the nerves that are essential for producing erections. It’s best to talk with your doctor before undergoing these types of cancer surgery so you can get a good idea of what to expect from the procedure. For example, even with so-called “nerve sparing” surgery, there is a 40 percent chance your erectile function may not return to the level it was before surgery. You should also know that recovery of erectile function can take up to two years. However, you shouldn’t be completely disheartened. Numerous options are available to help you improve erectile function after these types of cancer surgery, including oral medications, penile injections, vacuum-assisted pumps, and penile prostheses.
If you are having surgery to remove the bladder or the prostate, the organs necessary for ejaculation will be removed as well. You will still feel the sensation of climax following these surgeries, but no semen will be released during orgasm. This is commonly referred to as dry orgasm. Many men report that climax still feels the same following surgery, but some may notice a decrease in sensation.
Even with so-called “nerve sparing” surgery, there is a 40 percent chance your erectile function may not return to the level it was before surgery.
In younger men who are diagnosed with testicular cancer, there may be a need to remove the lymph nodes surrounding the major artery and vein in the abdomen (the aorta and vena cava, respectively). The close proximity of these lymph nodes to the nerves that facilitate emission, or the production and release of semen from your reproductive glands, can result in impaired emission and reduced or absent semen upon ejaculation. Climax, however, is not affected.
The Sexual Side Effects of Radiation
Radiation is often used to treat prostate cancer, bladder cancer, and rectal cancer. Radiation to these areas can result in damage to the blood supply and the nerves that are essential for erectile function. In many men, this process happens slowly, as erectile problems following radiation develop over time. Treatment options are similar to those listed above for men who undergo surgery for these types of cancer.
In male cancer survivors who undergo whole-body radiation for cancer of the bone marrow or isolated testicular radiation for testicle cancer, low testosterone levels may occur. As testosterone is essential to libido and erectile function, men who experience low testosterone may experience decreased sexual desire as well as erectile dysfunction. Fortunately, testosterone can be replaced with topical medications or injections, leading to improved sexual function.
How Chemotherapy, Hormone Therapy, & Other Drugs Affect Your Sexual Health
Many cancers require chemotherapy treatment. Although effective at killing cancer cells, chemotherapy has unintended side effects that either directly or indirectly affect sexual health. Side effects like nausea, a weakened immune system, and reduced testosterone levels can impair libido and erectile function.
In the case of metastatic prostate cancer, men receive treatment that is deliberately intended to lower testosterone. This is known as androgen deprivation therapy, and it is a type of hormone therapy. While this treatment is effective at slowing the growth of prostate cancer, it unsurprisingly results in a decline in libido and erectile function.
For all types of cancer, many people experience pain related to the cancer itself or its treatment. This cancer-related pain often requires treatment with strong medications known as opioids. Opioids can cause a decline in testosterone levels via their action on the hormonal control center of the brain. This decline in testosterone can impair sexual function.
The Psychological Impact of Cancer
In addition to the physical side effects, cancer and its treatment can cause psychological side effects as well. These can range from impaired body image and self-esteem to depression, anxiety, guilt, and fear. The psychological impact of cancer can be felt from the time of diagnosis to well beyond treatment and cure. Psychological changes can result in reduced libido, erectile dysfunction, ejaculatory dysfunction, and changes in orgasmic sensation. If the psychological side effects of cancer are affecting your sexual health and function, talk to your doctor. Mental health counseling, with or without antidepressants or anti-anxiety medications, may help you overcome these issues.
All stages of cancer, from diagnosis to treatment, affect sexual health. Having an open and honest discussion with your healthcare provider, early in your cancer care, about the potential sexual side effects of cancer treatment is the first step to reducing cancer-related sexual dysfunction. You should also talk to your doctor if you begin experiencing sexual health problems at any point during your cancer treatment and recovery. Treatment options are available for cancer-related sexual dysfunction. Your doctor can help you decide which ones will work best for you.
A board-certified urologist and microsurgeon, Dr. Nelson Bennett (left) is an associate professor of Urology and codirector of the Andrology Fellowship at the Northwestern University Feinberg School of Medicine in Chicago, IL, where his clinical and research focus is on male sexual medicine and surgery. Dr. James Wren (not pictured) is an Andrology Fellow at Northwestern.
This article was published in Coping® with Cancer magazine, March/April 2018.