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

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Male 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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Male Sexual Dysfunction: 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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Male Sexual Dysfunction: 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.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

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

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Male Sexual Dysfunction: 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 document for links to more resources. Type of Sexual Dysfunction Where to Look for Help Loss of desire for sex after cancer Discuss whether this is a possible side effect of your medicine with your health care team. If you think your testosterone may be low, see a urologist or an endocrinologist for a blood test. However, if you had prostate cancer, you cannot take testosterone safely. You can discuss other options with your health care team. If there isn't a physical cause, see a mental health professional to find out if it's related to feelings of depression, anxiety or low self-esteem. Erection problems (erectile dysfunction or ED) See a urologist or family doctor who specializes in men's sexual problems. You may find a clinic that focuses on erectile dysfunction. If you think your problem is caused by anxiety or stress and not physical damage from cancer treatment, you might want to talk to a mental health professional. Orgasm problems (hard to reach an orgasm, orgasm feels weak, no semen comes out at the time of orgasm) Discuss whether this is a possible side effect of your medicine with your health care team. Dry orgasms are mainly a problem if you want to get a partner pregnant. There are fertility options for men who have dry orgasms. You should discuss these with a member of your health care team. Try not to pressure yourself to have an orgasm. This may make it hard for you to relax. Give yourself time. Pain in the penis or testicles during sex If you have pain in the penis when you get an erection, it may be a sign of inflammation or scarring, especially if you notice that your penis curves when it is erect. In this situation, you can visit a urologist. A sharp pain in the penis or testicles during climax can result from scar tissue after surgery or radiation therapy, chronic tension in muscles on the floor of the pelvis, or occasionally, an infection in the prostate. If no infection is involved, this type of pain can be difficult to treat. See a urologist or a doctor who specializes in pain. Below is a list of some of the treatment options for erectile dysfunction and pros and cons for using them. Treatment Options for Erectile Dysfunction Pros Cons Pills (PDE-5 Inhibitors) Easy to use Natural Only minor side-effects Safe for most men unless they have severe heart disease or use nitrates Expensive Do not work well for men who have severe ED Vacuum devices One-time purchase Covered by insurance Few side effects Using the pump interrupts intercourse Band on penis may be uncomfortable Requires practice to use correctly Erection may not be firm enough for satisfying intercourse Penile injections Very effective for most men Can be used before starting sex Expensive Need to refrigerate medicine and take syringes Must learn self-injection May cause pain for some men Penile suppositories Same medicine as injections but put inside urinary opening as a small pill that melts. Expensive Only works for a few men Penile prostheses Very effective for most men Becomes part of man's body Inflatable types are not visible Erection looks and feels natural Covered by insurance Involves surgery and pain during recovery Can only be repaired surgically Erections are slightly shorter than before Destroys natural erection reflex Not a reversible treatment Herbs and vitamins Inexpensive Easy to get Do not always work May interfere with a man's other medicines May have unknown dangers When you talk to you a member of your health care team about your erectile dysfunction, they may offer different treatment options. Print this Topic Email this story

Male Sexual Dysfunction: Additional Resources

The resources listed below provide more detailed information and support services to help you with sexual dysfunction.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

Click a resource for more information:

• LIVESTRONG SurvivorCare Program
• National Cancer Institute (NCI)
• American Cancer Society

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.

The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.

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National Cancer Institute (NCI)
www.cancer.gov

Cancer.gov, the National Cancer Institute Web site, provides accurate, up-to-date information on many types of cancer and the challenges cancer can bring. You can also use the site to search for information by cancer type or topic, and you can access information about treatment-related issues. Information about financial and insurance matters is also included. You can learn how clinical trials work and search for a clinical trial in your area. This site has a detailed dictionary of cancer terms. Web site information and publications are available in Spanish.

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American Cancer Society
www.cancer.org

The American Cancer Society Web site contains 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, or you can join online groups and message boards. Some information on the Web site is available in Spanish, Chinese, Korean and Vietnamese. Information specialists can answer questions 24 hours a day by phone or email.

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