Sexuality for the Man With Cancer

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How cancer treatment can affect sexual desire and response

These are some general changes in sexual desire and response that may be linked to cancer and cancer treatment. Specific changes linked to certain types of treatment are covered in more detail in the next sections.

Both men and women often lose interest in sexual activity during cancer treatment, at least for a time. At first, concern for survival is so great that sex may not be a priority. This is OK. Few people are interested in sex when they feel their lives are in danger. When people are in treatment, worry, depression, nausea, pain, or fatigue may cause loss of desire. Cancer treatments that disturb the normal hormone balance can also lessen sexual desire.

If there’s a conflict in the relationship, one partner or both might lose interest in sex. Many people who have cancer worry that a partner will be turned off by changes in their bodies or by the very word “cancer.”

Keep in mind that each part of a man’s sexual cycle is somewhat independent from other parts of the cycle. That’s why, after some types of cancer treatment, a man may still desire sex and be able to ejaculate but not have an erection. Other men may have the feeling of orgasm along with the muscles contracting in rhythm, even though semen no longer comes out.

Physical problems can affect desire and response

Premature ejaculation

Premature ejaculation means reaching a climax too quickly. Men who are having erection problems often lose the ability to delay orgasm, so they ejaculate quickly.

Premature ejaculation is a very common problem, even for healthy men. It can be overcome with some practice in slowing down excitement. A few of the newer anti-depressant drugs have the side effect of delaying orgasm. This side effect can be used to help men with premature ejaculation. Some men can also use creams that decrease the sensation in the penis. Talk to your doctor about what kind of help might be right for you.

Pain

Men sometimes feel pain in the genitals during sex. If the prostate gland or urethra is irritated from cancer treatment, ejaculation may be painful. Scar tissue that forms in the abdomen (belly) and pelvis after surgery (such as for colon cancer) can cause pain during orgasm, too. Pain in the penis as it becomes erect is less common. Tell your doctor right away if you have any pain in your genital area.

Hormone therapy can affect desire

Treatment for prostate cancer that has spread beyond the gland often includes changing a man’s hormone balance. This can be done in one or more of these ways:

  • Using drugs to keep testosterone from being made
  • Using drugs that block cells from using testosterone
  • Removing a man’s testicles (called orchiectomy)

The goal of hormone therapy is to starve the prostate cancer cells of testosterone. This slows the growth of the cancer. All of these treatments have many of the same kinds of sexual side effects, because they all affect testosterone.

The most common sexual problem with hormone treatment is a decrease in desire for sex (libido). Hormone therapy may also cause changes in how you look, such as loss of muscle mass, weight gain, or some growth in breast tissue. Be sure you understand the side effects and what you can do to help manage them. For instance, a program of exercise may help you limit muscle loss, weight gain, and tiredness. Talk with your doctor about any exercise program you may have in mind, or ask to be referred to a physical therapist, who can help you decide where to start and what to do.

Psychological effects of hormone therapy

Men who are on hormone therapy drugs to lower testosterone often feel like “less of a man.” They fear they may start to look and act like a woman. This is a myth. Manhood does not just depend on hormones but on a lifetime of being male. Hormone therapy for prostate cancer may decrease a man’s desire for sex, but it cannot change the target of his sexual desires. For example, a man who has always been attracted only to women will not find himself attracted to men because of this kind of hormone treatment.

Hormone therapy in men has been linked to depression. Talk to your doctor about this because it can be treated with anti-depressant drugs and/or counseling. There’s also growing concern that hormone therapy for prostate cancer may lead to problems with thinking, concentration, and/or memory. This hasn’t been well studied, but hormone therapy does seem to lead to memory problems in some men. These problems are rarely severe, and most often affect only some types of memory. More studies are being done to look at this.


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