Testicular cancer and its treatment affects people in different ways. Sometimes it can change your ability to enjoy or have sex. This is called 'sexual dysfunction', and can include:
- Less interest in sex
- Not being able to get or sustain an erection (erectile dysfunction)
- Taking longer to achieve orgasm
- Having an orgasm without any semen or with urine instead of semen (ejaculation problems)
These problems can often be treated and managed.
Sexual dysfunction often involves the need to talk to your partner.
Causes
Surgery - orchiectomy
In testicular cancer survivors, sexual dysfunction differs based on the type of cancer treatment(s) you have had. A unilateral orchiectomy is a surgery in which one testicle is removed. Having one testicle removed is unlikely to cause any long-term sexual health problems. However, the psychological impact of the diagnosis and surgery can affect your sexual well-being. Sexual dysfunction can result from the stress and negative emotions about having cancer. As a result, you may have lower sex drive, not perform as well as before or enjoy sex less. These changes often resolve on their own as you recover and adapt to your diagnosis and treatment. However, speak to your oncologist or family doctor to find out what else can be done to help you feel better sexually.
If both of your testicles were removed, you will have less interest in sex, have problems with erections, or having orgasms. As a result, you will likely need androgen replacement therapy (a hormone added to your system). Be sure to spend time with your doctor (be referred to a urologist) to find the right kind of androgen replacement therapy for you. Finding the right type of androgen replacement therapy for you can take months because it is complex.
Surgery - retroperitoneal lymph node dissection (RPLND)
Another type of surgery for testicular cancer is called retroperitoneal lymph node dissection (RPLND). RPLND involves removing lymph glands at the back of your belly area where cancer may have spread. This surgery does not affect your ability to have an erection or an orgasm. However, sometimes there is a small risk that the nerves controlling ejaculation may be cut during the surgery. This can lead to changes in ejaculation such as dry orgasms (having an orgasm without any semen).
You may also feel less attractive due to large scars from a RPLND and may fear the reaction of your partner or future partners. It appears however, that couples (and future partners) adjust well to changes in body image and continue to enjoy sex. In the scientific literature, married men commonly report fewer of these anxieties and usually report no change in intimacy after recovery. Some men claim that their sex lives improved after their experience with cancer, since they were able to communicate better with their partners.
Radiation & Chemotherapy
Radiation therapy and chemotherapy are not known to cause permanent changes to sexual function (i.e., erection, orgasm, ejaculation). Some men may lose sexual desire (libido) due to fatigue from cancer treatment. Generally, changes in energy levels are not permanent, and many men regain their ability to enjoy their sex life.
What Princess Margaret Cancer Centre will do
Sexual health is part of overall health and healing. You can talk to members of your health care team about your concerns.
What you can do
Some men feel less confident about their sexuality after losing a testicle. Know that you have the option to implant a prosthesis (an artificial testicle) to replace the lost testicle. Talk to your oncologist (cancer doctor) about it.
