What causes sexual problems for men after cancer? 

Sexual problems can be caused by many kinds of treatment for cancer. Radiation, surgery, chemotherapy, and hormone therapy can all cause sexual problems. They can cause damage to nerves and blood vessels, remove glands and organs, cause scar tissue to form, and change the balance of sex hormones in your body. 

Who’s at risk?

Many men with cancer have sexual problems. Your risk depends on:

• The type of cancer and where it was in your body

• Your sexual function before you had cancer

• The kinds of treatment you had

• How long treatment lasted

• Your stress level and how you are coping with changes

Types of sexual problems for men after cancer 

Cancer treatments can cause many kinds of sexual changes. Some of these may get better or go away with time as nerves, blood vessels, and other tissues heal. The problems can include:

• Erectile dysfunction (ED). This means trouble getting or keeping an erection. Or your erection may not be as firm.

• Low sex drive. This means loss of interest in sex. It’s also called low libido.

• Shortened or curved penis. This may happen because scar tissue forms after surgery. Or it could be because of damage to nerves, blood vessels, or both.

• Changes in orgasm. It may take you longer to have an orgasm. You may have orgasms that are less intense. Or you may have no orgasm.

• Changes in ejaculation. You may still have an orgasm, but no semen comes out. This is also known as a dry orgasm. Or you may only have a small amount of semen.

• Backward ejaculation. This is also called retrograde ejaculation. It’s when semen travels up the urethra into the bladder, instead of down the urethra out of the penis. The semen comes out in your urine. This does not harm you.

• Other physical problems. You may have fatigue, pain, nausea, or shortness of breath after cancer treatment. These may lead you to not have sex, or make it harder to enjoy sex.

• Body image problems. You may have lost or gained weight, lost muscle, or gained breast tissue. You may have an ostomy bag on your belly. You may have scars or skin changes. Any of these can make you feel self-conscious and less interested in sex.

• Mood changes. Depression and anxiety after cancer treatment can cause loss of interest in sex. It may also cause erection problems. And medicines that can help treat depression and anxiety may affect your sex life while you’re taking them.  

Getting help and treatment 

Sexual problems may get better over time. But talk with your healthcare team to get help. There are many kinds of treatment that may help. To get treatment for sex problems, you may work with different kinds of healthcare providers, such as: 

• Your primary healthcare provider. Your primary provider may be able to treat some kinds of sexual problems. Or he or she can refer you to someone else.

• Endocrinologist. This is a doctor who treats hormone problems.

• Urologist. This is a doctor who treats problems of both male and female urinary systems, and male genitals.

• Counselor. A counselor may be a licensed social worker, psychologist, or psychiatrist. He or she can provide different kinds of talk therapy or behavioral therapy, and may be able to prescribe medicine.

• Sex therapist. A sex therapist can help you work with your partner to find new ways to enjoy sex, or find methods or positions that make sex less difficult. 

The types of treatment include:

• Pills. Medicines such as sildenafil citrate, tadalafil, and vardenafil can help you have and keep an erection by boosting blood flow in the penis.

• Penis shots or pellets. These treatments are done at home. For the shot, you or your partner uses a tiny needle to put a shot of medicine into the side of the penis. The shot starts to work in 5 to 15 minutes and gives you an erection. Another treatment is a small medicine pellet. You put the pellet into the opening at the tip of the penis. The pellet melts and the medicine goes into the penis to help you get an erection.

• Vacuum device. This is a tool that helps create an erection for intercourse. It works by forcing blood to go into the penis. You put your penis into a hollow, plastic tube. A small hand pump creates a vacuum inside the tube. This pulls blood into the penis and makes the penis firm. You then put a small rubber ring around the base of the penis. This keeps blood in the penis so the erection stays.

• Penile implant. This is a device that is put inside your body with surgery. You control an erection with a small pump that inflates and deflates 2 balloons that are put inside your penis.

• Pain medicine. This can help manage pain symptoms so that you can enjoy sex.

• Testicle implants. These are for looks only. They can help you feel better about the way you look if you have had 1 or both testicles removed.

• Testosterone therapy. This kind of hormone therapy can help boost sex drive and function.  

Talking with your partner 

Coping with sexual changes after cancer treatment can be upsetting. You may feel angry, sad, or scared. You may worry about disappointing your partner. But it’s important to keep in mind that there are many ways to have sexual pleasure. Talk with your partner about your concerns. Together you can work on new ways to give and receive pleasure. You can also work with a counselor or sex therapist. And remember that some sexual changes are short term. Your healthcare team can tell you more about how long sexual side effects may last, and can help you get treatment for them.