Effects of Testicular Cancer on Sexual Functioning

Testicular cancer doesn’t have to mean an end to your sex life. While issues may arise, many men experience satisfying sex following testicular cancer treatment.

Both survivors and oncologists emphatically agree that testicular cancer will not put an end to a man’s sex life. In fact, many men say that their relationship with their long-term partner strengthened following cancer. However, testicular cancer and treatment for testicular cancer can affect sex to some degree. The type of surgery you have, whether you underwent chemotherapy or radiation, and the emotional toll of having testicular cancer can all play a part. But there are many things you can do to lessen the impact of testicular cancer on your sex life.

Testicular Cancer: Sex After Surgery

While many men are able to have normal and satisfying sexual experiences after testicular cancer surgery, the procedures can have sexual side effects, including:

•  Erectile dysfunction. The surgery involved can be accompanied by the risk of damaging the nerves going to the penis and scrotum, which can lead to erectile and orgasm problems. However, there are now nerve-sparing surgical techniques that prevent these problems called Retroperitoneal Lymph Node Dissection (RPLND)

•  RPLND is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the navel. While laparoscopic methods (also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery) may be used, they have been considered less effective by some surgeons.

•  Ejaculation problems. Surgical procedures may also lead to retrograde ejaculation, a condition in which the ejaculate flows backward to the bladder. Although harmless, some men worry that their partner will miss them ejaculating, which is something that can be addressed by accessing a sexologist.  Documented experiences of some men claim that ejaculation feels different, but for many, it essentially feels the same but without the wet spot.  It is also noted that some say their orgasm is not as strong or pleasurable.

•  Low sexual desire. Some men need testosterone replacement therapy to restore levels of sexual desire and function, especially if both testicles have been removed or if hormone levels don’t return to normal following treatment. Testosterone replacement is available in a number of ways, including injection, hormone patch, a gel applied to the skin, or a medication that is rubbed on the gums.

Testicular Cancer: Body Image Issues

Many men feel a loss of masculinity and sexuality following treatment; however, for many men, these problems are temporary.
“Men make the assumption that the loss of one testis results in them being half a man.  Being a man is much more than simply having a penis and testicles, however if body image is a concern, testicular implants can help boost self-esteem, but will do nothing physically.

Testicular Cancer: Sex After Chemotherapy and Radiation

Following chemotherapy, most men experience loss of sexual desire and the ability to have an erection, but function usually returns to normal within a week or two. Also, although this is not proven to be detrimental, traces of chemotherapy drugs can be found in the sperm for the first few weeks following treatment. For this reason, condom use is recommended to prevent any transmission of these drug traces to sexual partners.

Most of the time, radiation therapy should not alter the ability to have an erection or an orgasm. But if it is given to the pelvic area, radiation does have the potential to damage key nerves and arteries, resulting in a softer erection. In addition, radiation may lower testosterone levels initially, but they can return to normal within six months of treatment. If problems continue, testosterone replacement may help.

Testicular Cancer: Fertility Concerns

Many men worry that with one testicle they will not be able to father a child. Infertility following chemotherapy or radiotherapy occurs about half of the time, however, even in cases where the cancer has spread, two to three years later their sperm count has returned.  It is suggested that in six to 12 months a sperm count should be performed,  If fertility is a concern, men also have the availability of having sperm banked prior to treatment just in case.

Testicular Cancer: Sex and the Psyche

For both physical and psychological reasons, it’s normal for people to lose interest in sex during the diagnosis, treatment, and recovery periods of cancer.  Erectile dysfunction (not being able to achieve an erection) or sexual functioning problems could be of a psychological nature from the trauma of what they’ve been through.

In fact, erectile dysfunction following testicular cancer has not been correlated with testicle loss, testosterone level, type of treatment, or sexual desire, but it has been connected to emotional issues.

Although there is a risk of sexual side effects associated with testicular cancer, the benefits of treatment far outweigh the risk of not treating the cancer, or not treating it in the best way. Don’t let your concerns over body image or sexual impact get in the way of your health. If there are side effects from treatment, there are many things you can do to improve your sexual ability.

Many men find it difficult to discuss sexual difficulties and by doing so fear judgement, breaches of confidentiality or discrimination. This often leaves men to their own devises which can result in exacerbating anxiety which will increase the difficulties being experienced.  A sexologist has the expertise to support you with the cancer diagnosis and decrease any further psychological impacts.

Adapted from “Sex After Cancer” by  Eleanor Roberts, PhD