Cancer treatment can cause physical and emotional changes, including to your sex life. Doctors call these types of changes "sexual side effects." They include changes in your interest in sex and your ability to take part in sexual activity.
Sexual side effects can be physical, mental, or emotional. Cancer treatment can affect your mood, body image, energy level, and sense of well-being. And all of these can affect your sex life.
If you know your type of cancer or treatment might change your sex life, talk with your health care team. Do this before starting treatment, if possible. It might affect which type of treatment is best for you. If you are very concerned, you might want to get a second opinion.
Sexual problems from cancer treatment
Changes from cancer or its treatment may happen during treatment or after it ends. These changes might go away or they might be permanent. Every man is different.
Physical effects from treatment are more likely with treatments that affect your sex organs directly. For example, treatment for prostate cancer, bladder cancer, or testicular cancer is more likely to affect your physical ability to have sex than some other treatments. But treatment for other cancers, such as leukemia, can make you feel tired or sick. This may result in you having little interest in sex.
Sexual side effects can include:
Less interest in sex
Difficulty getting an erection or keeping one for enough time to have sex with penetration. "Erectile dysfunction" and "ED" are other names for this problem.
Premature ejaculation, which is having an orgasm before you want to
Passing some urine (peeing) during an orgasm
Having a "dry" orgasm with no semen coming out. This can happen if semen flows backward, into the bladder, instead of out of the penis.
Pain during sex
If you have any of these problems before treatment, tell your health care team. If they know about the problems, they might be able to help or prevent the problems from getting worse. Also tell your health care team about any new problems or changes in your symptoms.
Treatments that can cause sexual problems
Some treatments are more likely than others to affect your sex life. The following treatments may cause sexual problems.
Surgery. Especially on the prostate, testicles, bladder, colon, and rectum. Surgery in these areas can damage the nerves that control erections. Ask your surgeon about "nerve-sparing" surgery. Surgery can also cause "dry" ejaculation. This might bother you, or it might not.
Having a colostomy, urostomy, or testicle removal can affect your confidence and body image. Colostomies and urostomies are openings in the body for bowel movements and urine. You wear a bag with the waste in it, and this might make you avoid showing your body to a partner.
Coping with ED after cancer treatment
You might lose the ability to have an erection and get it back later. But this could take years, if it happens. Tips to prevent or treat ED include:
Finding a surgeon who is experienced at nerve-sparing surgery. Unless nerves need to be cut to remove the cancer, the doctor might be able to avoid damaging them.
Doing pelvic floor exercises. These work the muscles in your genital area. They can also help you control your bowels and bladder if you have incontinence.
Taking ED medicines. Your doctor can help you choose the best ED medicine.
Radiation therapy. Radiation therapy to the pelvis, which is the area around the hips, can cause ED. This can happen from 6 months to 2 years after treatment. It might go away or get better in 2 to 3 years. Talk with your doctor about what to do while you have ED.
A prostate cancer treatment called "brachytherapy" involves putting small radioactive "seeds" near the tumor. Like other radiation therapy, this can cause ED. Talk with your doctor about what to do if this happens.
Radiation therapy can cause pain, tiredness, and loss of the ability to control your bowel movements or bladder. These problems might make you avoid sex or have less interest in it.
Finally, having heart disease, high blood pressure, or diabetes makes you more likely to have ED from radiation therapy. But you can also get ED without having these conditions.
Chemotherapy. Side effects of chemotherapy can affect how you feel, your self-image, and your interest in sex. Side effects include weight gain or loss, nausea, vomiting, and diarrhea. You might also lose the ability to get an erection, but this usually comes back with time.
Hormone therapy. Some prostate cancer treatments are designed to lower how much of the male hormone, testosterone, your body makes. This is done to fight the cancer, but it can cause low sex drive, ED, and problems having an orgasm. You might still be able to get an erection if you are a younger man, with or without taking ED medicines. This is because your body has more of its own testosterone at younger ages.
Other drugs. Some drugs for managing symptoms or other conditions may cause sexual problems. Examples include certain pain medicines, antidepressants, and blood pressure medicines called "beta-blockers."
You have a higher risk of sexual problems after cancer treatment if you are older or had problems before treatment. But it is important to talk with your doctor about sexual concerns no matter how old you are. Topics you might want to discuss include whether you want children, what your partner expects, and what you want. There are many ways to treat sexual problems, including those from cancer treatment.
Avoiding risks during treatment
Talk to your doctor about protecting yourself and your partner. For example, use a condom to protect your partner from being exposed to chemotherapy. These drugs stay in your semen for 48 to 72 hours. Also, use a condom if you had brachytherapy. The condom protects your partner if a radiation seed comes out.
You are less likely to make a partner pregnant when you are receiving chemotherapy. But it is still possible. Protect your partner and any future children by avoiding pregnancy until at least 2 months after chemotherapy.
Chemotherapy, radiation therapy, and some types of surgery can take away your ability to make a woman pregnant. The medical name for this is infertility. You might want to freeze some of your sperm or try another fertility-preserving option before treatment.
Emotions and sexual problems
Emotions about cancer and treatment can affect your interest in sex and your ability to be with your partner. Concerns that you might need to talk about with your doctor include:
Fear that the cancer will come back
Feeling sad, frustrated, or powerless
Feeling bad about changes in your body
Being stressed, depressed, or anxious
Your partner might also feel these emotions. Talk to each other about your feelings and concerns, including sexual health. Having these feelings without talking about them can get in the way of being intimate, both physically and emotionally.
Managing side effects
Relieving sexual side effects is an important part of cancer care. This is called palliative care or supportive care. Your health care team can recommend ways to manage symptoms. These recommendations depend on:
Your sexual history, including how healthy you are sexually and any problems or challenges you had in the past
If you have a spouse or partner
The types of sex you have and how it fits into your life
Your doctor will talk with you about any problems. They might also examine you and do tests.
Treatment options for sexual problems include:
ED medicines. These drugs can help you get an erection and keep it for long enough to have sex. These medicines include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). You can take these every day or just when you are interested in sex.
Penile injections. You might give your penis an injection or shot of medicine to get an erection. The medicines increase blood flow to the penis. You use a small needle. Medicines include:
Alprostadil (called Caverject, Edex, or Muse)
Papaverine (multiple brand names)
Penis implants. A doctor places a device inside your penis. You can use the device to get an erection when you want to.
Vacuum device on the penis. You place a small pump over your penis to help blood flow into it. This can help you get an erection.
Ask your doctor about the possible risks and side effects of the options you choose. Your health care team can also help with emotions that affect your sex life. Options include:
Talking with a counselor or sex therapist
Finding help in your community, such as a support group for men who are cancer survivors
Couples counseling can help you communicate well with your partner. Better communication may help with sexual problems related to emotions.