Male Sexual Health and Cancer

The male reproductive system includes the penis, testicles, prostate, seminal vesicles and other structures involved in sexual and reproductive function. Other parts of the body, such as the chest, nipples and skin, may also contribute to sexual response.

During sexual arousal, the body goes through a number of stages, including desire, arousal, erection, orgasm and satisfaction. Cancer and its treatments can cause physical and emotional changes that may affect one or more of these stages.

Changes in hormone levels, together with the physical and emotional effects of cancer, may cause:

  • Reduced sexual desire.
  • Persistent tiredness or fatigue.
  • Difficulty achieving or maintaining an erection.
  • Changes in ejaculation or orgasm.
  • Breast tenderness or enlargement.
  • Fertility problems.

Your doctor, specialist nurse or sexual health professional can advise you about the options available to prevent or manage these changes.

Sexual desire is closely linked to emotional wellbeing. Anxiety, depression, stress, fear of cancer recurrence and changes in body image can all affect sexual arousal. Talking about these concerns can be an important part of recovery.

Effects of Surgery in Men

Any major operation can affect sexual function, either temporarily or permanently.

Prostatectomy

A prostatectomy is surgery to remove the prostate gland.

Depending on the type of surgery and whether the erectile nerves can be preserved, it may result in:

  • Difficulty achieving or maintaining erections.
  • Changes in orgasm.
  • Absence of ejaculation (dry orgasm).
  • Changes in fertility.

Recovery of erectile function may take months or even years. Sexual rehabilitation treatments are available and may help.

Cystectomy

A cystectomy is surgery to remove the bladder.

It may affect the nerves and blood vessels involved in erection, particularly when extensive pelvic surgery is required.

Abdominoperineal Resection and Other Rectal Operations

Rectal surgery can affect the nerves responsible for erection and ejaculation, potentially causing temporary or permanent sexual difficulties.

Orchidectomy (Orchiectomy)

An orchidectomy is surgery to remove one or both testicles.

Removal of both testicles significantly reduces testosterone production and may cause:

  • Reduced sexual desire.
  • Erectile difficulties.
  • Permanent infertility.
  • Hot flushes.
  • Loss of muscle mass.

Penectomy

A penectomy is surgery to remove part or all of the penis.

It can result in significant changes to sexual function, body image and self-esteem. In some situations, reconstructive procedures may be possible.

Surgery involving visible parts of the body, such as the face or neck, may also affect confidence and how a person experiences their sexuality.

Effects of Chemotherapy in Men

Chemotherapy and Sexuality

Chemotherapy uses medicines to destroy cancer cells. Many of its side effects can temporarily affect sexual wellbeing.

These may include:

  • Fatigue.
  • Nausea.
  • Weakness.
  • Emotional changes.
  • Reduced sexual desire.

In general, there is no medical reason to avoid sexual activity during chemotherapy. However, in situations such as very low white blood cell or platelet counts, your healthcare team may recommend temporary precautions.

Physical Effects of Chemotherapy

You may notice reduced interest in sexual activity because of fatigue or general treatment-related discomfort.

Some chemotherapy drugs may cause:

  • Peripheral neuropathy (tingling or numbness in the hands and feet).
  • Changes in body sensation.
  • Changes in body image due to hair loss or weight loss.
  • Temporary reduction in fertility.

Some medicines may also temporarily affect testosterone production or sexual function. Most of these changes improve gradually after treatment, although some may persist.

Fertility and Contraception

Chemotherapy may affect sperm production either temporarily or permanently.

Before starting certain treatments, it may be advisable to discuss fertility preservation options, including sperm banking (cryopreservation).

During treatment and for the period recommended by your healthcare team afterwards, effective contraception should be used because some cancer treatments may harm a developing baby if pregnancy occurs.

Effects of Radiotherapy in Men

Radiotherapy may cause side effects that temporarily affect sexual function.

These may include:

  • Fatigue.
  • Skin irritation or sensitivity in the treated area.
  • Changes in body image.

Pelvic Radiotherapy

Radiotherapy directed at the prostate, bladder, rectum or pelvis may cause:

  • Diarrhoea.
  • Nausea.
  • Urinary discomfort.
  • Rectal pain or bleeding.
  • Difficulty achieving or maintaining an erection.
  • Changes in ejaculation.
  • Reduced fertility.
  • Difficulty urinating.

Some erection problems may develop gradually over months or years after radiotherapy.

Several treatments are available, including:

  • Medicines for erectile dysfunction.
  • Vacuum erection devices.
  • Intracavernosal injections.
  • Sexual rehabilitation programmes.

Effects of Hormone Therapy in Men

Hormone Therapy and Sexuality

Some cancers, particularly prostate cancer, depend on male hormones to grow.

Hormone therapies work by lowering testosterone levels or blocking its effects.

The hormones most commonly involved are:

  • Testosterone.
  • Oestrogens (in specific situations).

Hormone therapy may be given through:

  • Injections.
  • Tablets.
  • Implants.
  • Orchidectomy (surgical removal of the testicles).

Effects of Hormone Therapy

Reduced testosterone levels may cause:

  • Reduced sexual desire.
  • Difficulty achieving or maintaining erections.
  • Reduced semen volume.
  • Hot flushes.
  • Loss of muscle mass.
  • Increased body fat.
  • Fatigue.
  • Emotional changes.
  • Reduced bone density.

Some men develop breast tenderness or enlargement (gynaecomastia). This may cause physical discomfort or affect body image.

The severity of these effects varies between individuals. In some cases, symptoms improve after treatment ends, while in others they may persist for longer periods.

Coping With These Changes

Current guidelines recommend actively addressing sexual difficulties related to cancer and its treatment.

Available options may include:

  • Sexual counselling.
  • Psychological support.
  • Couples therapy.
  • Treatments for erectile dysfunction.
  • Early sexual rehabilitation following certain treatments.
  • Supervised exercise programmes.
  • Treatment of hormonal abnormalities when appropriate.

Open communication with your partner and healthcare team can help identify solutions and improve quality of life.

Many people maintain or regain a satisfying sexual life after cancer, even when some physical changes are permanent.