Cancer treatment for men: Possible sexual side effects

Treatment for certain cancers can affect your sexuality, causing a range of signs and symptoms that can make sex with your partner more difficult. But that doesn't mean you can't have a healthy sex life after cancer treatment. Knowing more about your cancer treatment and how it may affect sexual function can help you find a solution if problems develop.

Pelvic cancers: More likely to cause sexual dysfunction than do other cancers

Men with cancer in their pelvic area are more likely than are men with other cancers to report difficulty resuming sex after cancer treatment. Sexual side effects are most common after treatment for:

• Bladder cancer
• Colon cancer
• Prostate cancer
• Rectal cancer

Older men are more likely to experience sexual dysfunction after cancer treatment. That's because most older men, including those who haven't had cancer, will experience difficulty with sex at some time. So older men who've had cancer treatment may experience sexual side effects related to aging, rather than treatment. Or they may find that cancer treatment accelerates the sexual side effects associated with normal aging.

Erectile dysfunction: Most common sexual side effect of cancer treatment for men

A number of sexual side effects can occur as a result of cancer treatment, including:

• Inability to achieve or maintain an erection (erectile dysfunction)
• Difficulty climaxing
• Orgasm without discharge of semen (dry orgasm)
• Weaker, less satisfying orgasms
• Loss of interest in sex
• Pain during sex
• Less energy for sexual activity
• Feeling less attractive

Not every man with cancer will experience sexual side effects. Your doctor can discuss the level of risk you may encounter for your specific type of cancer and treatment.

Cancer can cause sexual side effects if the cancer involves sexual organs. Sexual difficulties can also result from side effects of cancer and its treatment, such as fatigue, pain or anxiety about your treatment. In addition, depressed feelings about having cancer could cause a loss of libido. Sometimes emotional factors may have sexual side effects in addition to the physical changes you undergo during treatment.

How cancer treatments affect your sexuality

Surgery, radiation therapy, hormone therapy and chemotherapy can all cause sexual side effects.

Surgery
Nerves in your pelvic area control blood flow to your penis. If you have a tumor in your pelvic area that needs to be removed, your surgeon must work carefully to avoid damaging nerves. A severed nerve can lead to weakened erections or the inability to achieve an erection. Operations that can cause erectile dysfunction include:

• Colon and rectal surgery. If you have colon or rectal cancer, you may require surgery called abdominoperineal resection to remove your lower colon and rectum.
• Bladder surgery. A procedure called radical cystectomy for bladder cancer involves removing the bladder, prostate, upper urethra and seminal vesicles.
• Prostate surgery. If you have prostate cancer, you may consider radical prostatectomy to remove your prostate and seminal vesicles.
• Penis surgery. Though rare, surgery to remove all or part of the penis (penectomy) is an option for men with penile cancer. If the penectomy is partial, you may still be able to achieve an erection.
• Lymph node removal. Surgery to remove many lymph nodes in the pelvic area (retroperitoneal lymph node dissection) may be used in men with testicular cancer or certain sarcomas.

Newer nerve-sparing operations are less likely to cause erectile dysfunction, though whether you're a candidate for that type of surgery depends on the size and location of your cancer. For some cancers, nerve damage can't be avoided if the surgeon is to remove all of the cancer. Men who undergo nerve-sparing prostatectomy may experience temporary erectile dysfunction, while the effects are permanent in men who are not eligible for the nerve-sparing surgery.

Nerves damaged during surgery may also cause you to experience a dry orgasm — an orgasm without ejaculation of semen. The semen your body produces may not leave your testicles, or it may be pushed into your bladder (retrograde ejaculation). Some men say that a dry ejaculation feels no different and, often, their partners don't notice or don't mind the difference. However, other men find that dry orgasms are weaker or feel less pleasurable than their orgasms before surgery.

Radiation therapy
Radiation aimed at the pelvis can cause erectile dysfunction, though it isn't clear why. Radiation may damage nerves in your pelvic area, block blood flow to your penis or decrease the levels of testosterone in your body. Radiation's side effects start slowly about six months to a year after treatment.

Whether you experience erectile dysfunction as a result of radiation therapy depends on the amount of radiation you receive and how much of your pelvic area is being treated — a greater level of radiation over a greater amount of your body is more likely to cause sexual side effects. Men who smoke or who have a history of heart disease, high blood pressure or diabetes also may be at a higher risk of erectile dysfunction after radiation therapy. These conditions may have already caused some artery damage, which can be made worse by the radiation.

The amount of semen you ejaculate may decrease after radiation therapy. You may feel pain during ejaculation after treatment, though it usually goes away over time.

Hormone therapy
If you have prostate cancer that has spread, your doctor might try to lower the level of the hormone testosterone in your body by removing your testicles (orchiectomy) or treating you with medications. Some prostate cancers rely on testosterone for fuel. By lowering your testosterone levels, your doctor hopes to slow or stop your cancer's progression. Men who have large prostate cancers might receive hormone therapy to shrink the prostate before surgery — to make it easier to remove.

Hormone therapy most commonly causes a loss of libido, but it doesn't happen to everyone. Some men find that they have a desire for sex, but are unable to get an erection or are unable to reach orgasm. Younger men tend to have fewer sexual side effects from hormone therapy. Hormone therapy can also cause you to produce less semen when you ejaculate.

Chemotherapy
You may experience a loss of libido and difficulty achieving an erection after chemotherapy. Some chemotherapy drugs reduce the amount of testosterone your body produces. You'll usually regain your sexual function within a few weeks of ending treatment.

What you can do to regain sexual function

Some sexual side effects of cancer treatment will resolve in a few weeks. Others may last for a year or two after treatment, and some will be permanent. Find out as much as you can about what's impeding your sexual function. This may help you feel more in control of the situation and help guide you to treatment options. You may also want to:

• Do some experimenting. You may find that certain situations reignite your sexual desire or help you get an erection. Pay attention to what works — whether it's stimulating your penis yourself or thinking about sexual fantasies. You might find your orgasms are more intense if you spend more time on foreplay.
• Talk with your doctor. Your doctor can give you more information on what's causing any sexual dysfunction you're experiencing. From there you can discuss treatment options, such as medications, implants or devices that can facilitate an erection. Keep in mind, though, that some doctors may be just as reluctant or embarrassed as you are to talk about sexual side effects. If so, ask your doctor for a referral to a specialist, such as a urologist or a sex therapist.
• Talk with your partner. Let your partner know what works best for you. Be honest about your concerns and feelings. If you're silent about what you're experiencing, your partner may feel rejected. Your partner can offer vital support as you recover from cancer treatment. She or he might also have ideas on how to help you regain your sexual function.
• Talk with other cancer survivors. Your health care team might be able to steer you to a support group in your town. Otherwise, connect with other cancer survivors online. If you're embarrassed about discussing sex face to face with strangers, the online environment provides more anonymity. Start with the American Cancer Society's Cancer Survivors Network.

Men who have had cancer treatment may find that it simply takes time to regain sexual function. Medications and other options for treatment work in some men and not in others. Sometimes it takes a year or two for nerves or blood vessels in your pelvic area to heal.

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