Male Sexual Health After Cancer

One area of life that might change after cancer and treatment is the ability to have or enjoy sex. This is sometimes referred to as male sexual dysfunction. Whether the cause is physical or emotional, there are often ways to treat and manage concerns about sexual functioning after cancer.

You’ll need to discuss treatment options with your health care team. Some men feel uncomfortable discussing sexual concerns with others. However, your health care team can answer questions, refer you to a specialist and help you find solutions.

When to Start Thinking About Sex After Cancer

Some survivors may decide to wait for a while after treatment before having sex. Others may be ready right away. There is growing evidence that staying sexually active, especially having erections regularly after cancer treatment, may help men avoid worse problems as time passes. There are ways to prepare physically and emotionally for having sex again.

Here are some signs that it is time to talk to your health care provider about sexual functioning after cancer treatment:

Inability to get or keep a firm erection (erectile dysfunction or ED).
Loss of desire for sex.
Difficulty reaching climax.
Having a dry orgasm or a climax without any semen.
Having urine leak out at climax instead of semen.
Orgasms (climaxes) that don’t feel as good as they did before cancer.
Pain in the penis or testicles during sex.

All of your physical and emotional concerns are important. Prepare talk with your health care provider. Write down questions and concerns about your sexual health before your medical appointments. If needed, ask for a referral to another health care professional who specializes in this area.

Effects of Cancer on Sexual Functioning

Certain types of cancer, such as those that affect organs in the pelvis, may put survivors at risk for problems. These include prostate cancer and cancers of the bladder, colon, or rectum. Men treated for prostate cancer have higher rates of dysfunction–up to 75 to 85 percent.

Sexual functioning challenges can become more common in men as they get older. For example, about half of men without a cancer history will experience erection problems by age 70. This means that older male survivors may experience sexual functioning problems later in life that are not related to cancer or the treatment they received.

Other factors can also affect sexual functioning. For example, men are more likely to develop erectile dysfunction if they are overweight, smoke, or drink heavily. In addition, other health problems like heart disease, high blood pressure, kidney disease or diabetes may also affect a man’s erections.

The emotional effects of cancer may contribute to survivors feeling anxious, depressed or self-conscious. This can also create stress for a partner. In some cases, the result may be challenges with sexual functioning. Working with a licensed mental health professional to deal with these types of emotions is often very helpful.

The following table lists some of the possible causes of sexual dysfunction and issues that can be discussed with your health care team:

Cancer Treatments	Physical Effects	Symptoms
Removal of testicles Hormone therapy for prostate cancer Intensive chemotherapy Radiation near testicles	Low testosterone levels	Loss of desire for sex Trouble feeling excited during sex Erectile dysfunction Trouble reaching an orgasm
Radical prostatectomy Radical cystectomy Abdomino-perineal resection Damage to blood supply of nerves after pelvic radiotherapy Toxic side effect of chemotherapy	Damage to nerves near prostate	Trouble getting and keeping erections
Damage to blood vessels during pelvic surgery Scarring of blood vessels from pelvic radiation therapy	Damage to blood flow to the penis	Trouble getting and keeping erections
Removal of lymph nodes in men with testicular cancer Surgery on some parts of the colon	Damage to nerves controlling outflow of semen during orgasm	Having a “dry orgasm” with a feeling of pleasure but no semen coming out of the penis Orgasms may not feel the same as they did before cancer
Radical prostatectomy Radical cystectomy	Removal of prostate and seminal vesicles	Having a “dry orgasm” with a feeling of pleasure but no semen coming out of the penis Some men leak urine at the moment of orgasm Orgasms may not feel the same as they did before cancer
Radiation therapy for prostate,bladder,or rectal cancer	Radiation near the prostate and seminal vesicles	Having an almost “dry orgasm” with a feeling of pleasure but little or no semen coming out of the penis Orgasms may not feel the same as they did before cancer
Partial or total penectomy to treat cancer of the penis	Removal of part or all of the penis	Erection possible after partial penectomy Orgasms and ejaculation continue to be possible, but after total penectomy, semen comes out of new opening on the area behind the testicles

Finding Help for Male Sexual Health

It’s best to talk to your health care provider about sexual functioning even before cancer treatment begins. After treatment, you can work with your health care provider after pelvic surgery or radiation therapy to try medical treatments that promote erections in order to optimize the chance of maintaining or recovering good sexual function. Counseling, medical treatments and surgery are all options to treat cancer-related sexual problems in men.

Sexual Functioning Concerns	How to Find Help
Loss of desire for sex after cancer	Have a member of your health care team check your medications for possible side effects. See a urologist or an endocrinologist to find out if your testosterone may be low. If there are no physical causes, see a licensed counselor to find out if problems could be related to feelings of depression, anxiety, a change in self-esteem, or tension with your partner.
Erection problems (erectile dysfunction or ED)	See a urologist or other provider who has had special training in treating men’s sexual problems. If you think your problem is caused by anxiety or stress and not physical damage from cancer treatment, talk with a licensed counselor.
Concerns about orgasm	Ask your health care team if this might be a side effect of one of your medicines. Discuss fertility concerns and treatment options with your healthcare provider. Try not to put pressure on yourself to have an orgasm. This may make it hard for you to relax. Give yourself time and focus on having fun with touch. After pelvic cancer surgery or radiation, men may leak urine at orgasm. A urologist can often prescribe medications or suggest options to avoid this problem.
Pain in the penis or testicles during sex	Consult a urologist if experiencing pain in the penis during erection. This may be a sign of inflammation or scarring, especially if the penis curves when it is erect. A sharp pain in the penis or testicles during climax can result from scar tissue after surgery or radiation therapy, chronic tension in muscles on the floor of the pelvis, or occasionally,an infection in the prostate. Consult a urologist.

Treatment Options for Erectile Dysfunction

Below are treatment options for erectile dysfunction along with some the pros and cons. Talk with your health care team about the best options for you. You can research information at WebMD Erectile Dysfunction Health Center.


Pills (PDE-5 Inhibitors)	Pros Easy to use Natural Only minor side effects Safe for most men unless they have severe heart disease or use nitrates Cons Expensive Do not work well for men who have severe ED, which includes many men after pelvic cancer surgery or radiation
Vacuum devices	Pros One-time purchase Covered by insurance Few side effects Cons Using the pump interrupts intercourse May not be comfortable Requires practice to use correctly Erection may not be firm enough or may bend at the base
Penile injections	Pros Very effective for most men Can be used before starting sex Cons Expensive Must learn self-injection May cause pain for some men, especially in the first year after pelvic surgery
Penile suppositories	Pros A small pill put inside the urinary opening that melts Same medicine as injections Cons Expensive Does not work for most men Can cause pain in the penis just like injection medicine
Penile prostheses	Pros Very effective for most men Becomes part of man’s body Inflatable types are not visible Erection looks and feels natural Covered by insurance Cons Involves surgery and pain during recovery If a part breaks, need to repair surgically Erections are slightly shorter than before Destroys natural erection reflex Not a reversible treatment
Herbs and vitamins	Pros Inexpensive Easy to get Cons No herbal remedy has been shown to improve erections May interfere with other medicines May have unknown effects. Many pills advertised on the internet are not the real thing or contain harmful chemicals.

Your health care team can help you learn more about how to treat concerns and improve your ability to enjoy sex again. There are many ways to enhance and share pleasure and closeness with your partner. Even survivors who no longer have sex are able to find ways to continue to enjoy affection and closeness with their partners.

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Male Sexual Health After Cancer

When to Start Thinking About Sex After Cancer

Effects of Cancer on Sexual Functioning

Cancer Treatments

Physical Effects

Symptoms

Finding Help for Male Sexual Health

Treatment Options for Erectile Dysfunction

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