Sexual Health and Cancer Treatment: Men

Aprobado por la Junta Editorial de Cancer.Net, 09/2019

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.

Talk with your health care team about whether your diagnosis and/or cancer treatment may change your sex life. 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 during cancer

Changes related to your sexual health from cancer or its treatment may happen during or after treatment. These changes might go away or they might be permanent. Everyone 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 for other types of cancer. However, treatment for other cancers, such as leukemia, can also make you have little interest in sex by making you feel tired or sick. This is why it can be helpful to talk with your health care team about your specific diagnosis and what to expect.

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 problem, 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 sexual health during or after treatment.

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. Surgery involving the prostate, testicles, bladder, colon, and/or rectum 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.

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 in general 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 may 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. Ask your doctor about possible sexual side effects of any drug, including targeted therapy or immunotherapy, that is part of your treatment plan.

Hormone therapy. Some prostate cancer treatments are designed to lower how much of the hormone testosterone that 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 when at a younger age.

Supportive care/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 you want from your sex life, and your partner expects. There are many ways to treat sexual problems, including those from cancer treatment.

Avoiding risks during cancer treatment

Talk with your doctor about how to protect yourself and your partner from any risks from your cancer treatment. For example, such protections may include using 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 finishing 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. Be sure to let your oncologist know before cancer treatment starts if you are concerned about infertility. You might want to freeze some of your sperm or try another fertility-preserving option. Learn more about fertility and cancer.

Emotions and sexual problems

Emotions about cancer and treatment can affect your interest in sex and your ability to be intimate 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 with each other about your feelings and concerns, including how they can affect 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 long-term partner

  • The types of sex you have and how sex 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.

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.

Penile injections. You might give your penis an injection or shot of medicine to get an erection, using a small needle. The medicines increase blood flow to the penis. Medicines include:

  • Alprostadil (called Caverject, Edex, or Muse)

  • Papaverine (multiple brand names)

Penis implant. A doctor places a device inside your penis. You can use the device to get an erection when you want to.

Vacuum erection devices. You place a small pump over your penis to help blood flow into it. This can help you get an erection.

Penile constriction ring. A ring is placed around the base of the penis once you have an erection, to help keep the blood in the penile shaft. It may be used in conjunction with the other therapies listed above to help maintain the 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 talk effectively with your partner. Better communication may help with difficult emotions that interfere with intimacy and sex.

Related Resources

Dating and Intimacy

Fertility Concerns and Preservation for Men

Video: Sexual Health and Fertility in Cancer Care

How to Maintain Your Sexual Health During and After Lung Cancer

More Information

LIVESTRONG: Male Sexual Health after Cancer

OncoLink: Men’s Guide to Sexuality During and After Cancer Treatment