Sexuality and penile cancer
Many men continue to have strong, supportive relationships and a satisfying sex life after penile cancer. If sexual problems occur because of penile cancer treatment, there are ways to manage them.
Several conservative therapies may be used to treat early stage penile cancer, including topical chemotherapy, wide local excision, Mohs surgery, laser surgery, cryosurgery or brachytherapy. Men who have these treatments can usually still get an erection, have an orgasm and ejaculate. Their ability to have and enjoy sex is usually not affected.
For many men, having the penis removed is worse than the disease. Men treated with a partial penectomy often have enough of the penis left to have an erection suitable for penetration during sex. Although the most sensitive area of the penis (head or glans) has been removed, men can still have an orgasm, ejaculate and enjoy sex. At first, they may lose interest in sex and feel embarrassed about the reduced size of their penis.
Men who have a total penectomy cannot have an erection or penetrative sexual intercourse. This can have a serious effect on their self-image, sex life and intimate relationships. Some men are tempted to give up sex altogether after a total penectomy. However, men can still have sexual pleasure after a total penectomy. They may be able to have an orgasm when sensitive areas like the scrotum, skin behind the scrotum or upper thighs are stroked or touched. Sexual fantasies can help with sexual excitement and reaching orgasm. Men can also ejaculate into their urethrostomy (the opening made between the anus and scrotum that they urinate through). There are others ways a man can provide pleasure to his partner that do not involve intercourse.
Men who have had a partial or total penectomy may be able to have reconstructive surgery to allow penetration during intercourse. Reconstruction of the penis can also help a man to urinate standing up.
Some men might need help to deal with sexual concerns or problems. Health professionals who specialize in sexual problems can provide information and support to people with cancer and their partners. Sexual counselling can be done on a one-to-one basis, with a partner or in a group. Counselling can help people talk openly about their problems, work through their concerns and discover new ways of coping or finding sexual pleasure.
Erectile dysfunction (ED) is the inability to get and keep an erection firm enough to have sex. ED is a potential side effect of radiation therapy when external beam radiation is used to treat the pelvic lymph nodes. Radiation therapy may be used to treat men with penile cancer who do not wish to have, or cannot have, surgery. ED usually gets better after treatment is finished. ED is not a common side effect after brachytherapy.
Many men find they can have sexual pleasure without an erection. They may explore other ways of sexually satisfying their partner and themselves. Some men and their partners find it helpful to talk to a professional who is comfortable discussing sex issues and can give them information or counselling. There are several types of treatment available for ED. Most of the available treatments need a prescription from a doctor. Each treatment has side effects and should be used as directed.
Oral medication may be used for mild to moderate erection problems. These drugs enhance an erection and cause more blood flow into the penis. They are taken about an hour before sex and an erection may last up to one hour or longer.
Injections and suppositories
Drugs such as alprostadil improve the blood flow to the penis by causing blood vessels to widen (dilate). They keep blood in the penis for a while and produce an erection. The erection occurs fairly soon after the injection of the drug and may last for 30–90 minutes.
Men who cannot use medications may think about using a vacuum erection device. These devices can increase blood flow by drawing blood into the penis. Erections may be maintained for up to 30 minutes.
A penile implant is a device that is surgically placed into the penis to help it become erect. A penile implant is also called a penile prosthesis.
Dildos or vibrators
Some men may choose to use a dildo or vibrator with their partners. A strap-on dildo has a harness usually worn around the waist that connects the dildo (which resembles a penis) to the wearer’s body. This allows the wearer to go through the hip movements of having sex.
Some forms of penile cancer treatment can affect a man’s ability to father children. Infertility is the inability to conceive a child. Infertility can occur after the following treatments for penile cancer:
- surgery to remove the testicles (orchiectomy)
- Orchiectomy is only done in men whose penile cancer has spread to the testicles or scrotum.
- radiation therapy
Most men who develop penile cancer are over the age of 60. These men often have already completed their families. However, penile cancer can occur in men under the age of 40. Men who wish to father a child have several fertility options. It is recommended that men receive fertility counselling before treatment starts. Fertility options may include:
- sperm banking
- embryo freezing
- Researchers are also studying other fertility options.
If a man cannot use his own sperm, there are other ways for him to father a child:
- using donor sperm to fertilize his partner’s egg