Sexual Health and Cancer Treatment: Men

Approved by the Cancer.Net Editorial Board, 12/2017

You may experience physical and emotional changes during and after treatment. These may affect your desire and ability to have sex.

Even treatments not targeting reproductive organs may affect:

  • Your mood

  • Your energy level

  • Your sense of well-being

  • Your body image

Talk openly about sexuality with your health care team before, during, and after treatment. They can evaluate symptoms and address your concerns. Sometimes, treatment for sexual problems can be started before cancer treatment begins for better results.

Symptoms and side effects

Sexual problems may develop during, right after, or years after treatment. And some men may have sexual problems before treatment. Tell your health care team about your symptoms. Include any new ones or a change in symptoms.

Potential sexual side effects include:

  • A decrease or loss of sexual desire

  • An inability to get or maintain an erection. This is called erectile dysfunction.

  • Premature ejaculation

  • Urination during ejaculation

  • Dry ejaculation. This means a man doesn’t release semen during an orgasm.

  • Backward ejaculation. This means semen flows backward into the bladder.  

  • Pain during sex

  • Hot flashes

Treatments that cause sexual problems

These treatments often affect a man’s sexual health, either directly or indirectly:

Surgery. Particularly procedures involving the prostate, testicles, bladder, colon, and rectum. Nerves that start an erection may be removed or damaged during surgery to these parts of the body. Or surgery may cause dry or backward ejaculation.

Meanwhile, a colostomy, urostomy, or testicle removal may affect a man’s confidence and body image. Colostomies and urostomies make exits in the body for waste and urine.

Some men regain erections after surgery. But this may not occur for up to several years. 

These strategies may increase the chance of regaining erections after surgery:

  • Pelvic floor exercises, which also help with incontinence

  • Drugs, including sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). These are taken at low doses each day.

Radiation therapy. Radiation therapy to the pelvis can cause erectile dysfunction. Typically, it develops slowly between 6 months and 2 years after treatment. Sometimes, it goes away or improves in 2 to 3 years.

Brachytherapy for a prostate tumor may also cause erectile dysfunction. With brachytherapy, a doctor implants radioactive seeds in or near the tumor.

Men with these conditions more commonly experience radiation therapy-related erectile dysfunction:

  • Heart disease 

  • High blood pressure

  • Diabetes

Additionally, radiation therapy can cause pain, fatigue, and bowel or bladder problems. These may dampen your desire to become intimate.

Chemotherapy. Side effects of chemotherapy often affect sexual desire and self-image. These include weight gain or loss, nausea, vomiting, and diarrhea.

Additionally, this treatment may have short-term effects on erections. Erections often return to normal over time.

Hormone therapy. Treatment for prostate cancer might lower or stop testosterone production. This can cause low sex drive, erectile dysfunction, and difficulty achieving orgasm. Many younger men starting hormone therapy are able to have erections with or without drugs.

Other drugs. Some drugs for managing symptoms or other conditions may cause sexual problems. Examples include certain painkillers, antidepressants, and beta-blockers. Beta-blockers are used for high blood pressure.

Older men more commonly experience sexual problems after treatment. Also, men who had sexual issues before treatment have a higher risk.

Treatment precautions

In advance, ask your health care team about risks to sexual health. Ask about ways to protect yourself and your partner. For example, chemotherapy stays in semen for 48 to 72 hours. Use a condom to protect your partner from exposure. Also, use a condom if you received brachytherapy. This provides protection if a radiation seed comes out.

During chemotherapy, pregnancy risk from sex without a condom is lower. However, this is unpredictable. Plan to avoid conception until at least 2 months after chemotherapy ends. And talk with your health care team about fertility-preserving options before treatment. This is important because some men are infertile after chemotherapy.

Emotional concerns that affect sexuality

Becoming aroused, erect, or being able to ejaculate are not the only sexual health functions affected by cancer treatment. The emotions surrounding cancer and its treatment can also influence your ability to feel close to your partner. Concerns that you may need to speak with your doctor about include:

  • Fear of recurrence, which is the return of the cancer

  • Feelings of powerlessness, sadness, or frustration

  • Negative feelings about changes to the body

  • Stress

  • Depression

  • Anxiety

  • Relationship conflict or lack of communication

Even your partner may experience these mental health challenges. It’s important to discuss sexuality and sexual health with your partner, as well as potential barriers to intimacy.

Managing side effects 

Relieving sexual side effects is an important part of cancer care. Your health care team can recommend ways to manage symptoms. Recommendations depend on several factors:

  • Your sexual history, including your sexual health and abilities in the past

  • The relationship with your spouse or partner

  • Your sexual lifestyle

You may also need a physical exam and blood tests. Additionally, more specialized tests might help identify issues causing erectile dysfunction.

Treatment options for sexual problems:

Oral drugs. Drugs can help a man get and maintain an erection. These include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Drugs can also help manage hot flashes. Learn more about hot flashes in men.

Penile injections. Some men self-inject medicine into the penis to achieve an erection. This is done using a small needle. These medications increase blood flow to the penis:

  • Intraurethral alprostadil (Caverject, Edex, or Muse)

  • Intracavernous papaverine (multiple brand names)

Penile implants. A doctor places a device inside the penis. This enables a man to have an erection.

Vacuum constriction devices. You place a small pump over your penis. This encourages blood flow and an erection.

Complementary therapies. Acupuncture, slow breathing techniques, and hypnosis may be helpful in managing hot flashes when oral drugs do not work.

Before use, ask your doctor about potential risks and side effects of any procedures, drugs, or devices.

Your health care team can also help you manage your emotional health and how it affects your sexuality. These team members may include oncology nurses and social workers. Some options include:

Couples counseling may help you communicate well with your partner. This often improves emotion-related sexual issues.

This information is based on ASCO recommendations for addressing sexual problems in people with cancer. Please note that this link takes you to another ASCO website.

Related Resources

Dating and Intimacy

Fertility Concerns and Preservation for Men

Managing Emotions

Moving Forward Video: Dating and Sexuality

More Information

LIVESTRONG: Male Sexual Health after Cancer

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