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Sexual problems for men

Cancer and its treatments can affect a man’s sexual function. This may include not being able to get or keep an erection, or not being able to ejaculate. Many sexual problems related to cancer can be treated or managed.

Causes

Sexual problems can be caused by:

  • certain types of cancer, including prostate, bladder and colorectal cancers
  • surgery to remove a tumour that damages nerves or blood vessels in the pelvis or that changes hormone levels
  • radiation therapy to the pelvis
  • hormonal therapy
  • fatigue and pain

Emotional factors, such as the following, can also affect sexual function:

  • changes in self-image
  • anxiety, depression and stress
  • fear about sexual performance
  • fear of pain
  • unhappiness and embarrassment because of physical changes

Types of sexual problems

Symptoms can vary depending on the cause and type of sexual problem. Tell your healthcare team if you have any of these sexual problems.

Ejaculation problems

Cancer or its treatments can lead to ejaculation problems, including the following.

Painful ejaculation

Radiation therapy to the lower pelvis can lead to pain during ejaculation. It can also develop after major surgery involving the lower muscles of the pelvis, or the pelvic floor muscles. Fear of having pain may also lower sexual desire.

Retrograde ejaculation

Retrograde ejaculation is when semen flows backward into the bladder instead of going out through the penis during ejaculation. This happens when the bladder sphincter doesn’t work properly. The bladder sphincter is a muscle between the bladder and the urethra, which is the tube that carries urine from the bladder, through the penis, to the outside of the body. The bladder sphincter normally tightens before ejaculation so semen is forced into the urethra.

With retrograde ejaculation, less fluid is ejaculated, which may affect fertility. The urine is often cloudy with semen the next time the man urinates.

Surgery to treat testicular cancer may include removing the lymph nodes at the back of the abdomen. This surgery can cause nerve damage that leads to retrograde ejaculation.

Transurethral resection of the prostate (TURP) is a surgical procedure that removes prostate tissue through the urethra. TURP can cause retrograde ejaculation because the bladder sphincter is widened during this surgery.

Dry orgasm

A dry orgasm is when a man reaches sexual climax but doesn’t ejaculate semen.

Some surgeries always cause dry orgasms. These surgeries include radical prostatectomy or radical cystectomy, which remove the prostate gland and the seminal vesicles.

Other surgeries can damage the nerves that control the mixing of the sperm and fluid to make semen. These surgeries include abdominoperineal resection, which removes the lower colon, rectum and anus. Retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes in the pelvis. It is used to treat testicular cancer and often causes dry orgasms.

Erectile dysfunction

Erectile dysfunction (ED) is also called impotence. It is the inability to get and keep an erection firm enough to have sex. ED can be temporary or permanent. If the ED is caused by cancer treatment, often the younger a man is, the more likely he is to regain erectile function. Men under 60, and especially those under 50, have much higher recovery rates than older men.

Men can still have pleasure with an orgasm and be fertile with ED.

Cancer or cancer treatments that damage the pelvic nerves, pelvic blood vessels, brain or spinal cord can cause erectile dysfunction. ED can also develop if cancer or cancer treatments change hormone levels in a man’s body.

Some pelvic surgeries can damage the nerves needed for an erection. Depending on the type of cancer and the surgery needed to treat it, the surgeon may be able to spare the nerves during surgery. This is called nerve-sparing surgery.

In some cases, part of the penis is removed to treat penile cancer. A man can still have an erection if only part of the penis is removed. If all of the penis is removed, the man won’t be able to have an erection.

Diagnosis

Erectile dysfunction is usually diagnosed by a physical exam.

Your healthcare team will try to find the cause of ED by asking questions about previous treatment, other health conditions, and personal questions about your daily life, feelings and emotions.

Managing sexual problems

Once the type and cause of the sexual problem is known, your healthcare team can suggest ways to manage it. Information and counselling can help. Your team can also suggest relaxation exercises and techniques to reduce anxiety that may help.

The following measures may also help you manage sexual problems. Learn more about sexuality and cancer.

Physiotherapy

Your healthcare team or a physiotherapist may be able to help with painful orgasms. They can teach you exercises that stretch the pelvic floor muscles and return their tone to normal. A physiotherapist may also suggest internal massage of scar tissue and pelvic floor muscles to relieve pain.

Medicines

You will need a prescription from your doctor for most of the medicines available for ED. Each medicine has side effects and should be used as directed.

Some medicines treat ED by improving the flow of blood to the penis. Some of these drugs are taken by mouth (orally) as a pill. These include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). The drug adprostadil is given in 2 different ways. Medicated Urethral System for Erection (MUSE) gives alprostadil as a small gel pellet that is put into the urethra with a special plunger. Alprostadil (Caverject) may also be given as an injection with a needle into the side of the penis.

Devices and prosthetics

Vacuum erection devices may be an option for men who can’t use the drugs listed above. These devices can increase blood flow by drawing blood into the penis. A hollow tube is placed around the penis and the vacuum is applied. Once the man gets an erection, he puts an elastic band or ring around the base of the penis to keep the blood in the penis and maintain the erection.

A penile implant is also called penile prosthesis. It is a device that is surgically placed in the penis to help it become erect. Penile implants may be semi-rigid or inflatable. A semi-rigid implant has 2 bendable rods. They make the penis firm enough for the man to have sex, but the man has a permanent erection. Inflatable implants can be semi-inflatable or fully inflatable. The surgeon places 2 hollow rods in the shaft of the penis. A small balloon-like container filled with fluid is put in the lower abdomen and a small pump is implanted either at the head of the penis or in the scrotum. Squeezing the pump moves the fluid from the container to the rods in the penis and makes the penis hard. The man can release the fluid from the rods after sex and his penis becomes soft again.

Some men use dildos or vibrators. A strap-on dildo can be attached to the body with a strap around the waist. It allows the wearer to go through the hip movements of having sex.

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