Men being treated for cancer may experience changes that affect their sexual life during, and sometimes after, treatment. While you may not have the energy or interest in sexual activity that you did before treatment, being intimate with and feeling close to your spouse or partner is probably still important.

Your doctor or nurse may talk with you about how cancer treatment might affect your sexual life or you may need to be proactive and ask questions such as: What sexual changes or problems are common among men receiving this type of treatment? What methods of birth control or protection are recommended during treatment?

Whether or not you’ll have problems that affect your sexual health depends on factors such as:

• the type of cancer
• the type of treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• your age at time of treatment
• the amount of time that has passed since treatment
• other personal health factors

Many problems that affect a man’s sexual activity during treatment are temporary and improve once treatment has ended. Other side effects may be long term or may start after treatment.

Your doctor will talk with you about side effects you may have based on your treatment(s):

• Chemotherapy may lower your testosterone levels and libido during the treatment period. You may be advised to use a condom, because semen may contain traces of chemotherapy for a period of time after treatment. Chemotherapy does not usually affect your ability to have an erection.
• External-beam radiation therapy to the pelvis (such as to the anus, bladder, penis, or prostate) and brachytherapy (also called internal radiation therapy) can affect a man’s sexual function. If blood vessels or nerves are damaged, it may be difficult to get or keep an erection; this is called erectile dysfunction. If the prostate is damaged, you may have a dry orgasm.
• Hormone therapy can lower testosterone levels and decrease a man’s sexual drive. It may be difficult to get or keep an erection.
• Surgery for penile, rectal, prostate, testicular, and other pelvic cancers (such as the bladder, colon, and rectum) may affect the nerves, making it difficult to get and keep an erection. Sometimes nerve-sparing surgery can be used to prevent these problems.
• Medicines used to treat pain, some drugs used for depression, as well as medicines that affect the nerves and blood vessels may all affect your sex drive.

Health problems, such as heart disease, high blood pressure, diabetes, and smoking, can also contribute to changes in your sexual health.

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your healthcare team to learn what to expect based on your treatment(s):

• Chemotherapy (especially alkylating drugs) can damage sperm in men and sperm-forming cells (germ cells) in young boys.
• Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
• Radiation therapy to the reproductive organs as well as radiation near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility. Radiation may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can damage the pituitary gland and decrease the production of testosterone and sperm. For some types of cancers, the testicles can be protected from radiation through a procedure called testicular shielding.
• Surgery for cancers of the reproductive organs and for pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.
• Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants, involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment, such as immunotherapy and targeted cancer therapy, may affect your fertility.

Sexual health and intimacy are important parts of a person’s well-being. They are closely linked to how you see yourself and relate to others. It can be challenging after cancer treatment to face sexual health concerns, even if you’ve been with your partner for years. But talking about your concerns openly and honestly—letting your partner know what you’re going through and understanding how they feel—may help prevent frustration and confusion.

Common Concerns and Challenges

• Worrying about intimacy after treatment.
• Struggling with body image after treatment.
• Fearing that having sex will hurt, that you won’t be able to perform, or that your partner will find you less attractive.
• Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that can also affect your sex life. This can include not being able to get or keep an erection, pain, or loss of sensation.
• Experiencing menopausal symptoms, such as hot flashes, dryness or tightness in the vagina, or other problems that can affect your desire to have sex.
• Concerns about losing the ability to have children. Depending on the type of treatment, your age, and the length of time since treatment, you may still be able to have children. Talk to your doctor or a specialist if you’re concerned about fertility.

If you need help talking about sexual health, intimacy, or fertility, there are resources to help. The first step is talking with your doctor. He or she can help you with changes you’re going through that may be related to your cancer or its treatment. Your doctor can also refer you to programs or professionals who specialize in sexual intimacy counseling for cancer survivors.

How to Get Help

Whether you have concerns about having (or not having) children, physical problems relating to sexual health and intimacy, medication side effects, or your emotional state, professionals can help you.

• Psychologists, clinical social workers, and counselors can help you talk through and process problems you’re struggling with, like stress or body image issues. Professionals who specialize in infertility counseling can also help you with the emotional considerations of various options for building your family.
• Marital counselors are trained specifically to help people strengthen their marriages and partnerships by addressing challenges. Marriage counselors can help start and guide conversations between you and your partner.
• Faith or spiritual counselors can help you cope with concerns such as feeling alone, searching for meaning, and having doubts about your faith.
• Obstetrician-gynecologists (ob-gyns) are doctors who specialize in the female reproductive system and pregnancy. They can answer questions about fertility, birth control, menopause, and reproductive health. Your ob-gyn may refer you to a fertility specialist.
• Fertility specialists (also called reproductive endocrinologists) can determine your ability to have children and offer options for starting or building a family. They evaluate cancer diagnosis, treatment, and possible late side effects of treatment to determine fertility.
• Urologists are doctors who specialize in treating the urinary tract system and male reproductive organs.
• Social workers are trained to counsel you about treatment issues and interpersonal problems related to cancer. They can connect you with resources and services in your area.
• Sex therapists may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.

If you can’t find a program in your area, look into alternatives to in-person support, such as virtual support groups and therapy by telephone, video, or text.

People on your health care team have helped others cope during this difficult time and can offer valuable suggestions. You may also want to talk with a sexual health expert to get answers to any questions or concerns.

Most men can be sexually active during treatment, but you’ll want to confirm this with your doctor. For example, there may be times during treatment when you are at increased risk of infection or bleeding and may be advised to abstain from sexual activity. Depending on the type of treatment you are receiving, condom use may be advised.

Your health care team can help you:

• Learn about treatments: Based on symptoms you are having, your oncologist or a urologist will advise you on treatment options. For example, there are medicines and devices that may be prescribed once a sexual health problem has been diagnosed. Medicines can be given to increase blood flow to the penis. There are also surgical procedures in which a firm rod or inflatable device (penile implant) is placed in the penis, making it possible to get and keep an erection.
• Learn about condoms and/or contraceptives: Condoms may be advised to prevent your partner’s exposure to chemotherapy drugs that may remain in semen. Based on your partner’s age, contraceptives may be advised to prevent pregnancy.
• Manage related side effects: Talk with your doctor or nurse about problems such as pain, fatigue, hair loss, loss of interest in activities, sadness, or trouble sleeping, that may affect your sex life. Speaking up about side effects can help you get the treatment and support you need to feel better.
• Get support and counseling: During this time, it will help to share your feelings and concerns with people you are close to. You may also benefit from participating in a professionally moderated or led support group. Your nurse or social worker can recommend support groups and counselors in your area.

As you think about the changes that treatment has brought into your life, make a list of questions to ask your doctor, nurse, or social worker. Consider adding these to your list:

• What sexual problems are common among men receiving this treatment?
• What sexual problems might I have during treatment?
• When might these changes occur?
• How long might these problems last? Will any of these problems be permanent?
• How can these problems be prevented, treated, or managed?
• What precautions do I need to take during treatment? For example, do I need to use a condom to protect my partner?
• Should my partners and I use contraception to avoid a pregnancy? What types of contraception (birth control) do you recommend?
• Is there a support group that you recommend?
• What specialist(s) would you suggest that that I talk with to learn more?

Even for a couple that has been together a long time, staying connected after cancer can be a challenge at first. How do you start the conversation and express your needs when it comes to sex?

It is important to talk about your concerns, feelings, and beliefs about your sex life and what would make you feel better. It is also important to take your partner’s concerns,  feelings, and beliefs into consideration.

Having an open, honest conversation is key to moving forward. Here are some tips—

• Pick a private time to talk about sex outside the bedroom.
• Ask questions to understand your partner’s concerns better.
• Focus on your partner’s comments, not on what you plan to say in response.
• Repeat what he or she says in your own words.
• Be specific and positive about what you’d like to change.
• Acknowledge that your partner’s views matter to you.

By approaching the topic of sex and intimacy openly, you can avoid blame, keep the conversation positive, and give your partner a better sense of how you’re feeling.

Starting Fresh: Dating as a Survivor

After cancer, you may experience physical and emotional changes and concerns, especially around sex, that can affect how you feel about dating. It is normal to worry about how another person will react to physical things like scars or hair loss. You may also find it awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.

How and When to Bring It Up

You may wonder about the best way and time to tell a new person in your life about your cancer experience. There’s no one “right” answer on when to tell someone. Wait until you’re comfortable and trust the person with your feelings.

It may help to write down or practice what to say. Be ready to answer any questions. You may also want to talk to your doctor or a counselor about your dating concerns and fears of becoming intimate with a new partner.

Feeling Intimate After Treatment

It may be hard to feel intimate after cancer because of physical or emotional changes. When you’re struggling with your body image, remember to—

• Be proud of your body. It got you through treatment, after all!
• Think of things that help you feel more confident.
• Focus on the positive.
• Be open to change.

When Your Partner Is a Cancer Survivor

When your partner has cancer, it can be hard to understand what he or she is going through. Your partner also may have trouble understanding what you are going through. Ask yourself—

• Am I feeling overwhelmed? Stressed?
• Do I feel lonely or abandoned?
• How will my role or situation change after treatment?
• Do I think my partner and I should talk about our sexual relationship?