What kinds of sexual problems might cancer patients face?

Unfortunately, cancer and its treatment can lead to sexual problems.

Treatments like radiation, surgery, and chemotherapy may interfere with the body’s ability to secrete sex hormones like testosterone and estrogen. Treatments can also disrupt the body’s sexual response cycle. For example, many cancer survivors cope with erectile dysfunction or trouble with lubrication.

Sexual issues may occur even if the cancer doesn’t affect sexual organs, as in the case of head and neck cancer survivors. Sexual dysfunction can also appear long after the treatment is completed; some male childhood cancer survivors develop erectile dysfunction years later.

Sexual function after cancer often depends on the type of cancer a person has and the type of treatment he or she receives. Sometimes, patients can consider sexual function when they plan their cancer treatment. (For examples, please click here.) However, finding the best way to treat the cancer should still be the priority.

The slides that follow discuss some of the more common sexual issues for cancer patients and survivors.

Diminished Sexual Interest or Desire

Some patients find that chemotherapy or medications have side effects that decrease their libido. They may feel fatigued from treatment, too exhausted to even think about sex. And they might suffer from emotional issues as well. Patients may feel anxious about having sex, with concerns about safety, pain, and body image. They may worry that a partner will not find them attractive if they have scars or if their body has changed, such as with a mastectomy. Depression can cause partners to distance themselves from each other.

Counseling, especially with a therapist who specializes in counseling cancer patients, may help some patients overcome their anxieties and cope with distress and depression. Couples with relationship issues can benefit from therapy as well. A qualified therapist can help partners learn to communicate more effectively and may suggest different strategies for restoring intimacy.

Vaginal Dryness

Cancer treatment causes vaginal dryness for many women. Some treatments induce surgical menopause, which decreases levels of estrogen (a hormone involved with vaginal lubrication) and testosterone (also involved in women in an adequate sexual response). Without sufficient lubrication, sex may become uncomfortable or painful. A lubricant or vaginal moisturizer may help.

Pain

Changes in the genital area, such as from surgery or radiotherapy, might make sex difficult or painful. Couples may need to make adjustments in their sexual activity. This may mean trying new positions or exploring other ways to be intimate, such as having oral sex, using sex toys, cuddling, kissing, or massaging.

In many cases, genital pain after cancer treatment improves significantly over time, as tissues heal.

Erectile Dysfunction (ED) and Ejaculation Difficulties

Some men are unable to get or maintain an erection rigid enough for sexual intercourse. This is common for prostate cancer patients, who may sustain nerve damage during treatment. It can also happen to men who are treated for bladder, penile, testicular, or rectal cancer. Penile rehabilitation programs, which may include oral medications and vacuum erection devices, are helpful for some men with ED.

Men may also have orgasm and ejaculation difficulties, such as anejaculation (dry orgasm) or retrograde ejaculation, in which semen is not propelled forward out of the penis.

Sexual Roles for Men Who Have Sex With Men

Some people see their sexual roles change after cancer treatment. Gay and bisexual men may have to change their role as a “top” (insertive) or “bottom” (receptive) partner. If a man is unable to get a firm erection, the top role can be difficult. If cancer treatment has affected his anus, he might experience pain if he is in the bottom role. (Read more: How might prostate cancer treatment affect the sexual health of gay and bisexual men?)

Patients are encouraged to discuss the sexual side effects of cancer therapy with their doctors. Healthcare providers can address a wide range of issues, from the physical to the psychological and emotional. Patients may choose to include their partners in these discussions as well.

Resources

International Society for Sexual Medicine

“Does treatment for head and neck cancers affect a person’s sexuality?”

https://www.issm.info/sexual-health-qa/does-treatment-for-head-and-neck-cancers-affect-a-persons-sexuality/?ref_condition=sexual-dysfunction

“Erectile Dysfunction a Concern for Childhood Cancer Survivors”

(December 9, 2018)

https://www.issm.info/news/sex-health-headlines/erectile-dysfunction-a-concern-for-childhood-cancer-survivors/

“How might cancer patients preserve their sexuality?”

https://www.issm.info/sexual-health-qa/how-might-cancer-patients-preserve-their-sexuality/

“How might prostate cancer treatment affect the sexual health of gay and bisexual men?”

https://www.issm.info/sexual-health-qa/how-might-prostate-cancer-treatment-affect-the-sexual-health-of-gay-and-bis/?ref_condition=sexual-dysfunction

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