Sexuality & Fertility Issues
Manage effects on desire and reproductive health
Cancer and its treatment may affect how you feel about your sexuality. Sexuality refers to how you feel about yourself and your body and how you relate intimately to your partner. Lack of sexual desire is the most common sexuality issue among both men and women with cancer. For younger women, other issues include symptoms of early menopause, such as hot flashes and vaginal dryness, and pain during intercourse. Among men, erectile dysfunction is a primary issue. Fertility is a related issue and is especially important for those of childbearing age.
Why do sexuality issues occur?
A wide range of reasons can cause changes in sexuality during cancer treatment, and the reasons relate to the treatments themselves as well as to other side effects of treatment. Surgery has a variety of effects on sexuality. Removal of all or part of a reproductive organ decreases hormone levels, which can lead to an overall loss of sexual desire. Such surgery can lead to premature menopause in younger women and may make sexual intercourse painful or difficult for younger and older women. Surgery in the pelvic area in men can damage the nerves leading to the penis, causing erectile dysfunction. In addition, surgery that changes body appearance, as with removal of a breast or a testicle, can affect how a person feels about his or her body image, and a negative body image can change how you feel about your sexual desirability. Chemotherapy or radiation therapy to the pelvis may damage the ovaries in women or the testicles in men, both of which can reduce the amount of hormones produced. This loss of hormones may cause a loss of sexual desire in men and women, premature menopause in younger women, and erectile dysfunction in men.
Who is most likely to be affected by sexuality issues?
Treatment-related sexuality issues are most likely to occur in men and women who have had treatment directed at reproductive organs. Sexuality issues are also more likely in people who have untreated side effects that can reduce the interest in sex, libido and feelings of desirability; these side effects include fatigue, nausea and vomiting, pain, diarrhea and mouth sores.
When do sexuality and fertility issues occur?
The effects of chemotherapy or radiation therapy on the ovaries or testicles may be reversible, with function returning gradually over a few months after treatment has ended. In contrast, loss of function is permanent when these organs are surgically removed. Full recovery of erectile function after surgery may take one to two years. Resolution of sexual changes usually takes a while because both psychological and physical factors are involved.
How are sexuality issues managed?
Management of side effects that interfere with intimacy can help you feel better overall, which may help you feel more desirable and more interested in sex. For example, counseling (individual, couples and/or sex therapy) and physical exercise have been found to relieve menopausal symptoms (such as hot flashes and night sweats) in women, and this, in turn, can help enhance interest in sex and desirability.
Open communication with your partner is the key to maintaining a good intimate relationship. You and your partner should share concerns and fears and talk about ways to be intimate other than with sexual intercourse. You should both understand that it is safe to have sex during cancer treatment (unless your doctor tells you otherwise). If you are single during your cancer treatment, it is best to allow yourself some time to adjust to changes before you begin a sexual relationship.
Some drug treatments are available for physical sexual issues. For example, vaginal moisturizers and lubricants can help relieve vaginal dryness, and several drugs are available for erectile dysfunction. Drugs for erectile dysfunction may not be appropriate for every man, and men should talk to their doctors about the risks and benefits. Hot flashes in both women and men have been relieved with low doses of antidepressants.
How are fertility issues managed?
Infertility can be caused by some chemotherapy drugs (especially cyclophosphamide), radiation to the pelvic area or surgical removal of the reproductive organs. If you are of childbearing age, talk to your doctor about a referral to an infertility specialist before you begin treatment. You may have the option of preserving your eggs or sperm at an embryo or sperm bank to potentially be used at a later date once your treatment is complete.
When should I talk to my doctor about sexuality and fertility issues?
You should talk with your doctor before treatment begins to find out what to expect in terms of sexuality issues and what you can do to preserve fertility. If you have various options for treatment, make sure to talk about the side effects of each option. Ask your doctor when it is safe to resume sexual activity after treatment. During and after treatment, talk to your doctor or nurse if you have symptoms that interfere with sexual desire or sexual performance. If you feel uncomfortable talking with your doctor or nurse about your sexual symptoms, ask for a referral to an appropriate health care professional or support group.