What causes sexual problems for men after cancer? 

Almost any kind of cancer treatment, including radiation, surgery, chemotherapy, and hormone therapy, can cause sexual problems. Treatment 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. It can also affect your sex drive and body image.

Who’s at risk?

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

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

• Your age when you had cancer treatment

• Your sexual function before cancer

• The kinds of treatment you had

• How long treatment lasted

• Your stress level and how you are coping with changes

• How long it's been since you had treatment

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. Others may slowly get worse or not become a problem until years after treatment. The problems can include:

• Erectile dysfunction (ED). This condition is when you have trouble getting or keeping an erection. Or your erection may not be as firm.

• Low sex drive. You may lose interest in sex. It’s also called low libido.

• Shortened or curved penis. This problem 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 pain with an orgasm.

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

• Backward ejaculation. This is also called retrograde ejaculation. It’s when semen goes 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 can also cause erection problems. And the medicines that can help treat depression and anxiety may affect your sex life while you’re taking them.

• Infertility. Sometimes cancer treatment leaves you unable to have children. Your treatment team should have talked with you about this possibility before treatment started. Still, don't assume you are infertile. If you don't want to start a pregnancy, talk to your healthcare provider about birth control.

Getting help and treatment 

Sexual problems may get better over time. But talk with your healthcare team about them. Though you might feel embarrassed, you may have to start the conversation. 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 healthcare provider may be able to treat some kinds of sexual problems. Or they can refer you to someone else.

• Endocrinologist. This healthcare provider treats hormone problems.

• Urologist. This healthcare provider treats problems of the urinary system and male genitals.

• Counselor. A counselor may be a licensed social worker, psychologist, or psychiatrist. They can provide different kinds of talk therapy or behavioral therapy, and they 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.

Some of the types of treatment that can be used for sexual problems include:

• Medicines. Certain prescription medicines can help you have and keep an erection by boosting blood flow in the penis. Others can help balance hormone levels, delay orgasm, or control pain.

• Penis shots or pellets. These treatments are done at home to help get or keep an erection. 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 tool can help with penile shortening or erection problems. 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. It pulls blood into the penis and makes the penis firm. You then put a small rubber ring around the base of the penis. The ring keeps blood in the penis, so the erection stays.

• Penile implant. This treatment might be an option if other treatments don't work. It's a device that's put inside your body with surgery. You control an erection with a small pump that inflates and deflates two balloons that are put inside your penis. Semirigid rods can also be put in the penis. They can be bent up to mimic an erection.

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

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 might want to work with a counselor or sex therapist. And remember that some sexual changes do get better over time. Your healthcare team can tell you more about how long sexual side effects may last and can help you get treatment for them.