Sexuality for the Man With Cancer

+ -Text Size

TOPICS

Special concerns linked to certain cancers and their treatment

Urostomy, colostomy, or ileostomy

An ostomy is a surgical opening created to help with a body function. A urostomy takes urine through a new passage and sends it out through an opening on the belly (abdomen) called a stoma. A colostomy and ileostomy are both openings on the abdomen for getting rid of body waste (stool) from the intestines or bowels. In an ileostomy, the opening is made with the part of the small intestine called the ileum. A colostomy is made with a part of the colon (the large intestine).

You can reduce the effect these ostomies have on your sex life if you take some common-sense steps. First, make sure your appliance (pouch system) fits well. Check the seal and empty your ostomy bag before sex. This will reduce the chance of a major leak. If it does leak, be ready to jump into the shower with your partner and then try again.

A nice pouch cover can make an appliance look less “medical.” You can get covers or patterns to make your own from your enterostomal therapist or ostomy supply dealer.

Another choice is to wear a special small-sized ostomy pouch during sex. Or if you have a 2-piece system, turn the pouch on the faceplate so the emptying valve is to the side. If you wear an elastic support belt on your faceplate, tuck the empty pouch into the belt during sex. You can also wear a wide sash around your waist to keep the pouch out of the way. Another way of keeping the pouch from flapping is to tape it to your body. Some men feel more comfortable wearing T-shirts to cover their appliances.

To reduce rubbing against the appliance, choose positions for sex that keep your partner’s weight off the ostomy. If you have an ostomy but like to be on the bottom during sex, try putting a small pillow above your ostomy faceplate. Then, your partner can lie on the pillow rather than on the appliance.

You can get more detailed information based on your type of ostomy in our separate documents called Urostomy: A Guide, Ileostomy: A Guide, and Colostomy: A Guide. (See the “To learn more” section.)

Laryngectomy

Laryngectomy is surgery that removes the voice box. It leaves you unable to talk the normal way, and you breathe through a stoma (opening or hole) in your neck. Since the air you breathe can’t be purified by the nose’s natural filter, a special type of stoma cover is needed. Besides catching dust and particles, the stoma cover hides the mucus that leaks out of the stoma. A scarf, ascot tie, or turtleneck can look nice and hide the stoma cover. Even during sex, a cover may look more appealing than a bare stoma.

During sex, a partner may at first be startled by breath that hits at a strange spot. On the positive side, one patient quipped, “Now when I kiss, I never have to come up for air!”

You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing cologne or after-shave lotion.

Sometimes problems in speaking interfere with communication between couples. If you have learned to speak using your esophagus, talking during sex is not a big problem. But it does take more effort, and you lose some of the emotional nuances. A speech aid built into the stoma might also work well. But neither method lets you whisper in your partner’s ear. If you use a hand-held speech aid, communication during sex is likely to be awkward and distracting. Still, you can say a great deal without words by guiding your partner’s hand or using body language.

Talking is not needed in many sexual situations. But with a new partner, you may want to talk about the kinds of touching and positions you like before you start making love. You may also want to pre-select ways of signaling important messages you may want to share during sex.

Treatment for head and neck cancer

Some cancers of the head and neck are treated by operations that remove part of the bone structure of the face. Because these scars are so public, they can be devastating to your self-image. Surgery on the jaw, palate, or tongue can also change the way you talk. Recent advances in facial replacement devices, tissue grafting, and plastic surgery give many people a more normal look and clearer speech. Even ears and noses can be made out of plastic, tinted to match the skin, and attached to the face. All of these things can be a great help to a person’s appearance and self-esteem.

Limb amputation

Treatment for some cancers can include surgically removing (amputating) a limb. Amputations may call for some changes in lovemaking. For example, a patient who has lost an arm or leg may wonder whether to wear his artificial limb during sex.

The answer depends on the couple. Sometimes the prosthesis (or artificial part) helps with positioning and ease of movement. But the straps that attach it can get in the way. Without the prosthesis, the partner with an amputation may have trouble staying level during sex. Pillows can be used for support.

Amputations may create ongoing pain or pain where the limb used to be (this is called phantom limb pain). These side effects can interfere with sexual desire and distract a person during sex. If this is a problem, talk to your doctor about how to better control your pain.

Loss of one or both testicles

Testicles are as symbolic of manhood as breasts are of womanhood. Although some men are not upset about the new way they look, others may fear a partner’s reaction. This is often more true of men who are not in a long-term relationship.

Testicle removal for prostate cancer

Men treated for prostate cancer that has spread beyond the local area may have both testicles removed so that they stop making the hormone testosterone, which feeds the cancer. But the structure at the top and back side of the testicles (the epididymis) is still there, so the scrotum (sac that holds the testicles) doesn’t look completely empty.

Testicular cancer

In men with testicular cancer, the surgeon usually removes the testicle with cancer and leaves the normal one. Very few men ever develop a second tumor in the other testicle. Since this operation also removes the epididymis above the testicle, that side of the scrotum looks and feels empty.

Men with testicular cancer are usually young. They may be single and dating. They may be athletic and feel embarrassed by the missing testicle when showering or in locker rooms. To get a more natural look, a man can have a testicular prosthesis put in his scrotum during surgery. The prosthesis approved for use in the US is filled with saline (salt water), and can be sized to match the remaining testicle. When seen in an intact scrotum, it can look like a normal testicle. The only evidence left of the operation is the scar, which is often partly hidden by pubic hair. When part of the scrotal skin must be removed, a testicular prosthesis might not be able to make the scrotum look natural.

Penile shrinkage

After prostate surgery, a man may be shocked to find that his penis is shorter than before. For up to about 6 months after surgery, it may even seem to have shrunk inside the body, much like when a man is in cold water. Penile shrinkage is common after surgery, and it’s often not something a man is told about beforehand.

The cause of penile shrinkage is unknown. There’s some thought that it may be less of a problem if nerve-sparing surgery is done. While the nerves that control erection are recovering they are more active, and it’s these same nerves that pull the penis back into the body. But studies have shown that the penis can keep getting shorter for up to a year after surgery, so there are probably other causes, too. For instance, blood flow changes, scarring, and changes in penile tissue that result from loss of erections may play a role.

There’s no way to prevent or treat penile shrinkage at this time. Some studies have suggested that early penile rehabilitation (discussed in the “How pelvic surgery to treat cancer can affect erections” section) can help decrease shortening, especially when vacuum devices are used. (Vacuum devices are discussed in the “Dealing with sexual problems” section.) But more research is needed.

Cancer of the penis

When a man has cancer of the penis or of the bottom end of the urethra, the best treatment may be removing (amputating) part or all of the penis. These operations are rare, but they can have a devastating effect on a man’s self-image and his sex life. If cancer of the penis is found early, local radiation or chemotherapy creams can sometimes be used to treat it. These treatments often have little effect on sexual pleasure and function. But in most cases, the only way to stop the cancer is to remove the affected part of the penis.

Partial penectomy removes only the end of the penis. The surgeon leaves enough of the shaft to allow the man to direct his stream of urine away from his body.

Men are usually surprised to learn that a satisfying sex life is possible after partial penectomy. The remaining shaft of the penis still becomes erect with excitement. It usually gets long enough to allow penetration. Although the most sensitive area of the penis (the glans or head) is gone, a man can still reach orgasm and have normal ejaculation. His partner also can still enjoy sex and may reach orgasm in the same way as before the surgery.

Still, surgeons recognize how devastating the loss of a man’s penis is. In general, they try to do surgery that preserves as much of the penis as possible. But it’s important that all the cancer be removed, and this can limit how much a surgeon can safely leave.

If the shaft and glans can’t be saved, the man must have a total penectomy. This operation removes the entire penis, including the base that extends into the pelvis. The surgeon creates a new opening for the urethra (the tube from the bladder) between the man’s scrotum and his anus (the outside opening of the rectum). The man can still control his urination because the “on-off” valve in the urethra is above the level of the penis.

Some men give up on sex after total penectomy. Since cancer of the penis is most common in elderly men, some have already stopped sexual activity because of other health problems. But if a man is willing to put some effort into his sex life, pleasure is possible after a total penectomy.

A man can learn to reach orgasm when sensitive areas, such as the scrotum, skin behind the scrotum, and the area around the surgical scars, are caressed. He or his partner may try placing a finger 1 or 2 inches inside the anus to caress the prostate. (See the picture in the “How the male body works sexually” section.) Some people prefer to use plastic or latex gloves with a water-based lubricant to touch this area, and short fingernails are a must. As long as the rectum or prostate is healthy and has not been injured by surgery, trauma, or cancer, many men find that this feels good. It does take some practice, since at first it may feel strange or cause the man to feel like he has to urinate.

Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement. You can help your partner reach orgasm by genital caressing with your fingers, by oral sex, or by using a vibrator.

Another option may be available in the future. Even though it’s very rare in the US, there are a few surgeons who will work to rebuild the penis after total penectomy if the man wants to try it. This is a complex procedure that requires microsurgery to attach nerves and blood vessels. Grafts must be taken from other parts of the body, such as the arm, leg, chest, back, or groin. Sometimes bone from a graft site is used to allow erection after surgery. In other cases, implants may be used. If you are looking into this option, you will want to find out about the surgeon’s experience with this procedure. You will also want to ask about success rates, scarring, and complications the surgeon has seen. Find out about sensation in the penis, and how many of the men are able to have sex after surgery. Keep in mind that there’s very little in the available medical research about success rates at this time.


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