Cancer Can Affect Male Sexual Desire and Response

Some general changes in sexual desire and response may be linked to cancer and cancer treatment. In fact, any person going through cancer treatment might lose interest in sexual activity during cancer treatment, at least for a time. Because treating the cancer is often the main concern, sex may not be a priority for you or your partner. When people are in treatment, things like worry, depression, nausea, pain, or fatigue may cause loss of desire. Cancer treatments that disturb the normal hormone balance can also lessen sexual desire.

This information is for adult males with cancer. If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

Sexual desire and response

A person's sexual response is a cycle of changes that occur in their body. There are 4 phases to sexual response:

  • Sexual desire (libido) is when a person has interest in having sex.
  • Sexual arousal is the excitement a person with sexual desire can have.
  • Orgasm (climax) is the peak of sexual excitement when pleasure is highest; ejaculation occurs in men during this phase (read more in Cancer, Sex, and the Male Body).
  • Resolution happens when the body recovers and returns to its usual state.

Keep in mind that the male sexual response cycle is somewhat independent from other parts of the response 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 or delayed 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.

Some anti-depressant drugs have the side effect of delaying orgasm. This 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

Changing hormone balance can affect desire. For example, treatment for prostate cancer that has spread beyond the gland often includes hormone therapyy to lower testosterone levels. The main ways to do this are:

  • Using drugs to keep testosterone from being made
  • Removing the testicles (called orchiectomy)

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

The most common sexual problem with hormone treatment is a decrease in desire for sex (libido). Hormone therapy may also cause other changes, such as loss of muscle mass, weight gain, or some growth in breast tissue. Be sure you understand the possible side effects and what you can do to help manage them. For instance, an exercise program 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 taking hormone therapy drugs to lower testosterone may feel less masculine. While hormone therapy for prostate cancer may decrease a man’s desire for sex, keep in mind it does not change who a male finds attractive.

Hormone therapy in men has been linked to depression. Talk to your doctor about this because it can be managed.

Some studies suggest that hormone therapy for prostate cancer also may lead to problems with thinking, concentration, and/or memory.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Male Sexual Dysfunction: A couple’s problem – 2003. Update Endocr Pract. 2003;9(No. 1). Accessed at https://www.aace.com/sites/default/files/2019-06/sexdysguid.pdf on January 31, 2020.

Carter et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. Journal of Clinical Oncology. 2018;36(5):492-513.

Katz A. Breaking the Silence on Cancer and Sexuality: A Handbook for Healthcare Providers. 2nd ed. Pittsburgh, PA: Oncology Nursing Society.; 2018.

Katz, A. Man Cancer Sex. Pittsburgh: Hygeia Media, 2010.

Khera M, Snyder PJ, Martin KA. Treatment of male sexual dysfunction. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction on January 31, 2020.

Moment A. Sexuality, intimacy, and cancer. In Abrahm JL, ed. A Physician’s Guide to Pain and Symptom Management in Cancer Patients. Baltimore, MD: Johns Hopkins University Press; 2014:390-426.

National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Survivorship [Version 2.2019]. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf on January 31, 2020.

Nishimoto PW, Mark DD. Sexuality and reproductive issues. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:551-597.

Zhou ES, Bober SL. Sexual problems. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2220-2229.

References

American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Male Sexual Dysfunction: A couple’s problem – 2003. Update Endocr Pract. 2003;9(No. 1). Accessed at https://www.aace.com/sites/default/files/2019-06/sexdysguid.pdf on January 31, 2020.

Carter et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. Journal of Clinical Oncology. 2018;36(5):492-513.

Katz A. Breaking the Silence on Cancer and Sexuality: A Handbook for Healthcare Providers. 2nd ed. Pittsburgh, PA: Oncology Nursing Society.; 2018.

Katz, A. Man Cancer Sex. Pittsburgh: Hygeia Media, 2010.

Khera M, Snyder PJ, Martin KA. Treatment of male sexual dysfunction. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction on January 31, 2020.

Moment A. Sexuality, intimacy, and cancer. In Abrahm JL, ed. A Physician’s Guide to Pain and Symptom Management in Cancer Patients. Baltimore, MD: Johns Hopkins University Press; 2014:390-426.

National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Survivorship [Version 2.2019]. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf on January 31, 2020.

Nishimoto PW, Mark DD. Sexuality and reproductive issues. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:551-597.

Zhou ES, Bober SL. Sexual problems. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2220-2229.

Last Medical Review: February 5, 2020 Last Revised: February 5, 2020

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