Sexuality for the Man With Cancer

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Cancer, sex, and sexuality

When you first learned you had cancer, you probably thought mostly about survival. But after a while, other questions might have started coming up. You might be wondering “How ‘normal’ can my life be, even if my cancer is under control?” Or even “How will cancer affect my sex life?” It’s important to know that you can get help if you are having sexual problems after cancer treatment.

Sex and sexuality are important parts of everyday life. The difference between sex and sexuality is that sex is thought of as an activity – something you do with a partner. Sexuality is more about the way you feel about yourself as a man and is linked to intimacy or your need for closeness and touch.

Feelings about sexuality affect our zest for living, our self-image, and our relationships with others. Yet patients and doctors often do not talk about the effects of cancer treatment on a man’s sex life or how he can address problems he’s having. Why? A person may feel uneasy talking about sex with a professional like a doctor or even with a close sex partner. Many people feel awkward and exposed when talking about sex.

The information here is for all men who have or have had cancer – regardless of their sexual orientation. We cannot answer every question, but we’ll try to give you enough information for you and your partner to have open, honest talks about intimacy and sex. We’ll discuss how cancer and cancer treatment can affect a man’s sexual functioning and discuss how to cope with changes, if they occur. We’ll also share some ideas about talking with your doctor and your cancer care team. Last, we’ll give you a list of other places to get help in the “To learn more” section. These are other good sources of information.

Keep in mind that sensual/sexual touching between you and your partner is always possible, no matter what kinds of cancer treatment you’ve had. This may surprise you, especially if you’re feeling down or have not had any sexual touching or activity for a while. But it’s true. The ability to feel pleasure from touching almost always remains.

The first step is to bring up the topic of your sex life with your doctor or another member of your health care team. You have a right to know how your treatment will affect nutrition, pain, and your ability to return to work. You also have the right to know how treatment may affect your sexual function.

What is a normal sex life?

People vary a great deal in their sexual attitudes and practices. This makes it hard to define “normal.” Some couples like to have sex every day. For others, once a month is enough. Many people see oral sex (using the mouth or tongue) as a normal part of sex, but some believe it is not OK. “Normal” for you and your partner is whatever gives you pleasure together. Both partners should agree on what makes their sex life enjoyable.

It’s common for people coping with cancer to lose interest in or desire for sexual activity at times. Doubts and fears, along with cancer and cancer treatment effects, can make you feel less than your best. Sometimes, concern about your health may be much greater than your interest in sex. But as you get back to your usual routines, your interest in sex may begin to return.

There are some who think sex is only for the young, and that older people lose both their desire for sex and/or their ability to “perform.” These beliefs are largely myths. Many men and women can and do stay sexually active until the end of life. (See the “To learn more” section for more on sex and aging.) Still, it is true that sexual response and function may change over time with age. For example, women may notice changes as they get older, sometimes even before menopause begins. A decrease in sexual desire and problems with vaginal dryness may increase during and after menopause. Men also have changes that come with age. More than half of men over age 40 have at least a little trouble with erections. The problem often worsens as men get older. For instance, among men who are 40 to 49, about 3 in 10 have some problem with erections (erectile dysfunction or ED). In groups of men 70 and older, nearly 9 in 10 are having some problem with erections.

Sometimes, sexual problems center around anxiety, tension, or other problems in a relationship. Other times, they may be the result of a physical condition, a medical condition, or medicines that cause or worsen sexual problems.

Besides age, there are some other risk factors for erectile dysfunction or other sexual problems, including:

  • Smoking
  • Diabetes
  • Heart and blood vessel disease
  • High blood pressure
  • High cholesterol
  • Certain blood pressure medicines and anti-depressant medicines

But most sexual problems can be treated. There are medicines, therapy, surgery, and other treatments to help people deal with most kinds problems they may have. If you want to keep your sex life active, you can very likely do so. Still, sex may not be quite the same for older men as it was when they were younger. But keep in mind that the best measure of your worth as a sexual partner is the pleasure you and your partner find together.

If you’re in a relationship and one of you has a sexual difficulty, it affects both of you. If you’re dealing with sexual problems, it works best when your partner can be part of the solution.

What is a healthy sexual response?

The sexual response of men and women has 4 phases:

  • Desire
  • Excitement
  • Orgasm
  • Resolution

A person usually goes through the phases in the same order. But the sexual response can be stopped at any phase. For instance, you don’t have to reach orgasm each time you feel a desire for sex.

Desire is an interest in sexual activity. You may just think about sex, feel attracted to someone, or be frustrated because of a lack of sex. Sexual desire is a natural part of life from the teenage years on.

Excitement is the phase when you feel aroused or “turned on.” Touching and stroking feels much more pleasurable and intense when a person is excited. Excitement also results from sexual fantasies and sensual sights, sounds, scents, and tastes. Physically, excitement means that:

  • The heart beats faster.
  • Blood pressure goes up.
  • Breathing gets heavy.
  • Blood is sent to the genital (or “private”) area. The surge of blood creates an erection, or a stiff penis. (In a woman, the surge of blood makes the genital area and the clitoris swell. The vagina becomes moist and gets longer and wider, opening up like a balloon.)
  • The skin of the genitals (“private parts”) turns a deeper color of red or purple.
  • The body may sweat or get warmer.

Orgasm is the sexual climax. In both men and women, the nervous system creates intense pleasure in the genitals. The muscles around the genitals contract in rhythm, sending waves of feeling through the body. In men, these muscle contractions cause ejaculation (or release) of semen.

Resolution occurs within a few minutes after an orgasm. The body returns to its unexcited state. Heartbeat and breathing slow down. The extra blood drains out of the genital area. Mental excitement subsides.

If a person becomes excited but does not reach orgasm, resolution still takes place, but more slowly. It’s not harmful to become excited without reaching orgasm, though it may feel frustrating. Some men and women may feel a mild ache until the extra blood leaves the genital area.

Refractory period: Men have a certain amount of time after orgasm in which they are physically unable to have another orgasm. This time, called the refractory period, tends to get longer as a man ages. A man in his 70s may need to wait several days between orgasms. Women do not have a refractory period. Many can have multiple orgasms, one after another, with little time in between.

Last Medical Review: 08/19/2013
Last Revised: 08/19/2013