Men, cancer and sexual health
A healthy sex life can be difficult to achieve even in normal circumstances, with the pressures of work, family and other stresses that come with day-to-day living. Add a cancer diagnosis and treatment regimen to the equation, and sexual relationships can prove an even bigger struggle. This is true for both men and women, but how they handle this often-taboo topic and the obstacles they confront are as different as their biological makeup.
For men, acknowledging that they are experiencing some loss in sexual function or reduced libido is often the biggest hurdle. It is also the first step toward overcoming the problem, says Brittany Hermann, a sex therapist at our hospital near Chicago. “Men don’t typically voice that they don’t feel well enough to have sex, because they feel like it’s a masculine thing,” she says. “But talking about it, especially with a health care professional, can help identify the problem, and potential solutions.”
Since April is Testicular Cancer Awareness Month, it’s a good time to clear up a common misconception—that testicular cancer and sexual dysfunction go hand in hand. “It does not typically cause impotence,” says Dr. Scott Shelfo, Medical Director of Urology at our hospital near Atlanta. Instead, testicular cancer—considered a “young man’s disease” because the average patient is 33 years old—can affect fertility, since the most common treatment is the removal of one or, in rare instances, both testicles. Those men with an interest in having children should seek out fertility preservation options. Testicle removal also can affect a man’s testosterone levels, which may impact sexual function and drive, but “the vast majority of testicular cancer patients do not have low libido or sexual dysfunction,” Dr. Shelfo says.
Generally speaking, changes in sexual function or libido most often come as a result of cancer treatment, Hermann says. For prostate cancer patients, for example, pelvic radiation and prostate surgery can impact their ability to get and maintain an erection. Those who receive hormone therapy that cuts their testosterone levels may notice a big difference in their sex drive. Other treatments may make them feel nauseous, lethargic and/or in pain, which can greatly affect a patient’s interest in sex. In fact, cancer and its treatment can lead to a wide range of sexual health issues, including:
- Erectile dysfunction (impotence)
- Inability to ejaculate or reach orgasm
- Loss of libido (sex drive)
- Emotional issues (e.g., anxiety, depression, guilt)
- Body image issues
- Concerns about sexual performance
The first thing men should know is that such changes are a normal part of the cancer experience.
“The brain can shut down sexual drive in times of crisis. It does that for a reason,” Hermann says. “It’s a protective instinct that allows us to focus on the immediate threat or concern.” Expecting those changes, and even preparing for them, can make a big difference in patients’ mental and emotional outlook during treatment. Hermann urges all patients to discuss sexual health and other quality-of-life issues with their doctor early on, so they can learn what symptoms they may be at risk for and get advice on how to deal with them.
While many patients may feel embarrassed about raising the topic, it’s certainly not for a lack of interest in the issue. Sexual health and intimacy is such a hotly discussed subject in cancer patient circles that, by popular demand, CTCA’s Cancer Fighter program for current and former patients recently launched an online forum on “sex and intimacy.” Patients are invited to write in anonymously with questions, and Hermann and CTCA nurse Heidi Larder respond with guidance and advice. Dozens of patients—both men and women—have already taken advantage of the opportunity.
“I'm a seven year prostate cancer survivor who is indeed grateful for the gift of life, but I struggle mightily with this ‘quality of life’ issue,” one male Cancer Fighter wrote. “I have no problem with libido, it's just that 14-18 weeks of tomo has rendered me impotent and incontinent. Believe me, I have tried every ED remedy from pill, to injection and every snake oil pitch in between, to no avail. Needless to say, this inability to perform has wreaked havoc on my confidence and depresses me intermittently. My wife tells me to ‘get over it already,’ but I'm just not ready to throw the towel in at the tender age of 61! She claims a disinterest in sex at 63 and feels my preoccupation with sex and inability to perform is ‘much ado about nothing.’”
Hermann and Larder responded by pointing out that there are a number of ways to define sex, and sharing love and intimacy with your partner does not have to involve penetration. Hermann says she often works to help patients redefine their sexual relationship, and to set small goals. If snuggling on the couch used to lead to sex, for example, it may be avoided after treatment to save a partner from rejection. She also shared these tips for men who may be experiencing sexual health issues during or after treatment:
Get educated: Understand how your cancer and treatment regimen may be impacting your body, and why. “I can’t put a big enough emphasis on how important awareness and education is to regaining your sexual health,” Hermann says.
Open up the lines of communication: Talk to your health care professional about any issues you may be experiencing, and perhaps even more importantly, talk to your partner. Not only will communicating help you and your partner get on the same page and fight cancer as a team, but it will also very likely clear up exaggerated misperceptions on how your partner may be feeling.
Seek out a third-party professional moderator: Having a trained professional who is not a friend or family member counsel you and your partner in a safe, comfortable setting can help you understand and overcome sexual health issues.
Learn more about how cancer can affect quality of life.