How cancer treatments affect your sexuality

Surgery, radiation therapy, hormone therapy, chemotherapy and other medications can all cause sexual side effects.

Surgery

Nerves in your pelvic area control blood flow to your penis. If you have a tumor in your pelvic area that needs to be removed, your surgeon must work carefully to avoid damaging nerves. A severed nerve can lead to weakened erections or the inability to achieve an erection.

Operations that can cause erectile dysfunction include:

• Colon and rectal surgery. If you have colon or rectal cancer, you may require surgery called abdominoperineal resection to remove your lower colon and rectum.
• Bladder surgery. A procedure called radical cystectomy for bladder cancer involves removing the bladder, prostate, upper urethra and seminal vesicles.
• Prostate surgery. If you have prostate cancer, you may consider radical prostatectomy to remove your prostate and seminal vesicles.
• Penis surgery. Though rare, surgery to remove all or part of the penis (penectomy) is an option for men with penile cancer. If the penectomy is partial, you may still be able to achieve an erection.
• Lymph node removal. Surgery to remove many lymph nodes in the pelvic area (retroperitoneal lymph node dissection) may be used in men with testicular cancer or certain sarcomas.

Newer nerve-sparing operations are less likely to cause erectile dysfunction, though whether you're a candidate for that type of surgery depends on the size and location of your cancer. For some cancers, nerve damage can't be avoided if the surgeon is to remove all of the cancer.

Men who undergo nerve-sparing prostatectomy may experience temporary erectile dysfunction, while the effects are permanent in men who are not eligible for the nerve-sparing surgery.

Nerves damaged during surgery may cause you to experience a dry orgasm — an orgasm without ejaculation of semen. The semen your body produces may not leave your testicles, or it may be pushed into your bladder (retrograde ejaculation).

Some men say that a dry ejaculation feels no different and, often, their partners don't notice or don't mind the difference. However, other men find that dry orgasms are weaker or feel less pleasurable than their orgasms before surgery.

In addition, some operations may require placement of an opening (ostomy) that allows stool or urine to collect in a bag that attaches to your body. Wearing an ostomy bag may make you feel self-conscious and unattractive. Ostomy therapists and specialized clothing can help boost your self-confidence.

Radiation therapy

Radiation aimed at the pelvis can cause erectile dysfunction, though it isn't clear why.

Radiation may damage nerves in your pelvic area, block blood flow to your penis or decrease the level of testosterone in your body. Radiation's side effects start slowly about six months to a year after treatment.

Whether you experience erectile dysfunction as a result of radiation therapy depends on the amount of radiation you receive and how much of your pelvic area is being treated — a greater level of radiation over a greater amount of your body is more likely to cause sexual side effects.

Men who smoke or who have a history of heart disease, high blood pressure or diabetes also may be at a higher risk of erectile dysfunction after radiation therapy. These conditions may have already caused some artery damage, which can be made worse by the radiation.

The amount of semen you ejaculate may decrease after radiation therapy. You may feel pain during ejaculation after treatment, though it usually goes away over time.

Hormone therapy

If you have prostate cancer that has spread, your doctor might try to lower the level of the hormone testosterone in your body by removing your testicles (orchiectomy) or treating you with medications.

Some prostate cancers rely on testosterone for fuel. By lowering your testosterone levels, your doctor hopes to slow or stop your cancer's progression. Men who have large prostate cancers might receive hormone therapy to shrink the prostate before surgery to make it easier to remove.

Hormone therapy most commonly causes a loss of libido, but it doesn't happen to everyone. Some men find that they have a desire for sex but are unable to get an erection or are unable to reach orgasm. Younger men tend to have fewer sexual side effects from hormone therapy. Hormone therapy can also cause you to produce less semen when you ejaculate.

Chemotherapy

You may experience a loss of libido and difficulty achieving an erection after chemotherapy. Some chemotherapy drugs reduce the amount of testosterone your body produces. You'll usually regain your sexual function within a few weeks of ending treatment.

Chemotherapy can cause fatigue, increased bleeding or an increased risk of infection. During this time, your doctor may advise you to avoid sexual intercourse, or you may not feel the desire for sex.

Other medications

Many other medications are known to interfere with sexual function in men. Pain medications, if taken regularly, can lead to sexual dysfunction. A large number of medications that are used to treat some of the side effects of cancer also can affect sexual function. Ask your doctor if any of your medications may be leading to a problem with sexual function.