Male Sexual Dysfunction

Survivors sometimes experience sexual dysfunction after cancer treatment. Knowing what some of the causes are and being able to describe your symptoms to your health care team can help you manage sexual dysfunction.

Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources sections for questions to ask and for more resources.

Cancer and treatment can affect survivors in different ways. One area of life that might change is the ability to have or enjoy sex. These changes in men following cancer or treatment are sometimes referred to as male sexual dysfunction. Whether the cause is physical or emotional, there are often ways to treat and manage this condition.

If this happens to you, discuss treatment options with your health care team.

Some men feel uncomfortable discussing sexual concerns with a doctor or other members of the health care team. However, they can answer questions, refer you to a specialist if needed, and help you find solutions.

What are some indicators that may cause concern?

The following may be indicators or signs that it is time to talk with your doctor about concerns related to sex 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
• Orgasms (climaxes) that don't feel as good as they did before cancer
• Pain in the penis or testicles during sex

These types of symptoms are not generally considered to be medical emergencies. For this reason, you may wonder if you should bring them up to a member of your health care team. Keep in mind that all of your physical and emotional concerns are important. This is especially true if you are experiencing pain during sex or feeling that your intimate relationship has become less enjoyable.

Prepare in advance to talk with your doctor. Write down any questions and concerns about your sexual health before your medical appointments. There may be a need to request extra time for your appointment to allow enough time for a discussion. Share this information with your doctor and ask for answers to your questions. If he or she cannot help you, ask for a referral to another health care professional who specializes in this area.

When are problems with sexual functioning likely to appear?

Not all survivors will experience sexual problems. If they are going to happen, it is likely to occur during and after cancer treatment. Problems caused by radiation to the pelvis may develop months or even years after cancer treatment is done. Be certain to discuss any concerns with your doctor if you begin to notice any changes in your ability to have or enjoy sex. Because risk increases as men age, you may not notice sexual dysfunction until years after your treatment ends.

In some cases, a survivor may decide to wait for a while after treatment before having sex. Another man may be ready to begin having sex again right away. In any case, there may be things that can help you prepare emotionally as well as make the sexual experience more physically comfortable.

What causes sexual functioning concerns after cancer?

There are many different causes for sexual functioning concerns in male cancer survivors. Some are physical causes. Others may be due to changes in how you feel about yourself, your body, or other aspects of your life.

Certain types of cancer, such as those that affect sexual organs, may put survivors at risk for problems. Men treated for prostate cancer have higher rates of dysfunction--up to 75 to 85 percent. Sexual problems are most common in men whose tumors were in the pelvic area. These include prostate cancer and cancers of the bladder, colon, or rectum.

Different types of sexual functioning concerns in male survivors can result from:

• A drop in testosterone levels (the hormone made in the testicles) during hormone therapy for prostate cancer
• Damage to areas of the brain by cancer or treatment
• Radiation to the pelvic area affecting the prostate, bladder, colon, groin or penis
• Surgery removing pelvic organs such as the prostate, seminal vesicles, areas of the colon or the penis
• High doses of chemotherapy may damage sexual desire or the ability to have erections
• Side effects of medicines to treat pain, nausea, depression or anxiety

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, or diabetes may also affect fertility.

The emotional effects of cancer may contribute to survivors feeling anxious, depressed, or self-conscious. This can also contribute to stress with a partner. In some cases, the result may be challenges with sexual functioning. Working with a licensed counselor 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:

Are there successful treatments for men with sexual concerns?

There are a number of treatment options that can help men with sexual functioning concerns. It is important to discuss problems and concerns with your doctor as early as possible.

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 deep intimacy with their partners.

Of course, the most important factor in choosing a cancer treatment is its ability to control cancer. However, your sexual health is also important. If you are worried about sexual dysfunction after cancer treatment, talk with your health care team soon as you can about the different therapies that may be available to help you.

This document was produced in collaboration with:

Leslie R. Schover, Ph.D.

Professor of Behavioral Science, UT M. D. Anderson Cancer Center

Works Cited

American Cancer Society. Sexuality and Cancer: “For the Man with Cancer and His Partner.” Atlanta: American Cancer Society, 2001 (99-rev. 07/01-50M-no. 4658-HCP).

Schover, Leslie. Sexuality and Fertility after Cancer. New York: John Wiley & Sons, 1997.

Schover Leslie R., Rachel T. Fouladi, Carla L. Warneke, Leah Neese, Eric A. Klein, Craig Zippe, and Patrick A. Kupelian. “Defining sexual outcomes after treatment for localized prostate cancer.” Cancer 95 (1992): 1773-85.

Schover, Leslie, &. Thomas, Anthony J. Overcoming Male Infertility: A Guide for Men and Their Partners. New York: John Wiley & Sons, 2000.

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Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources section for links to more resources.

The following is a list of sexual functioning concerns and how to find help:

The following is a list of treatment options that may be available for erectile dysfunction along with some of the pros and cons for using them:

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Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

Online: Complete an intake form through the LIVESTRONG website.
Phone: 1.855.220.7777 (English and Spanish)
Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about fertility risks and preservation options, treatment choices, health literacy and matching to clinical trials. Emotional support services, peer-to-peer matching and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG has partnered with several organizations including Imerman Angels, Navigate Cancer Foundation, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)
www.cancer.org

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

U.S. Institutes of Health - National Cancer Institute (NCI)
www.cancer.gov

The National Cancer Institute's website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using this Web site and can tell you about NCI's printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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