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Side effects and sexual desire

Some side effects of cancer and cancer treatment can lower your desire for sex.

Pain

Pain in any part of your body can make you feel worried, depressed, or easily discouraged. If you have these feelings, you may find it hard to get excited about sexual activity.

Some men have pain in their genitals during sex.

• Ejaculation may cause pain if your prostate or urethra is irritated from cancer treatment.
• Orgasm may cause pain if you have scar tissue in your abdomen (belly) and pelvis after surgery (such as for colon cancer).
• Pain in the penis as it becomes erect is less common.

Tell your doctor right away if you have any pain in your genital area.

Other side effects

Other side effects that can lower your desire for sex include:

• Fatigue
• Nausea and vomiting
• Changes in how you look, such as rashes, hair loss, scars, or an ostomy

Hormone therapy and sex drive

Cancer treatments that lower your hormone levels can reduce your desire for sex.

Testosterone can fuel the growth of prostate cancer. If prostate cancer has spread beyond the gland, treatment often includes? hormone therapy to lower your testosterone levels. The goal of hormone therapy is to starve the prostate cancer cells of testosterone. This slows the growth of the cancer.

Your testosterone levels can be lowered by:

• Medicine that helps prevent testosterone from being made, or
• Surgery to remove your testicles (orchiectomy)

Both treatments affect your testosterone levels, so they have many of the same kinds of sexual side effects.

A decreased desire for sex (libido) is the most common sexual side effect of hormone treatment.

Hormone therapy can also cause physical changes, such as:

• Loss of muscle mass
• Weight gain
• Some growth of breast tissue

Psychological effects of hormone therapy

Some men who get hormone therapy to lower testosterone report feeling less masculine. While hormone therapy for prostate cancer may decrease your desire for sex, it doesn’t change who you find attractive.

Hormone therapy has also been linked to depression. If you feel sad or depressed, talk with your urologist or cancer care team about how it can be managed.

Some studies suggest hormone therapy for prostate cancer may also lead to problems with thinking, concentration, and/or memory.

Managing the side effects of hormone therapy

Ask your cancer care team about possible side effects from hormone therapy and how you might manage them.

For instance, an exercise program may help you limit muscle loss, weight gain, and tiredness. Talk with your cancer care team about an exercise program or ask to be referred to a physical therapist who can help you come up with a plan.  

Emotions and sex after cancer

Your emotions about cancer and treatment can also affect your interest in sex and your ability to be intimate with your partner. You might feel:  

• Afraid your cancer will come back

• Sad, frustrated, or powerless
• Bad about changes in your body
• Stressed, depressed, or anxious

Your partner might have many of these same emotions. Talk with each other about your feelings and concerns, including how these feelings might affect your sexual desire. Keeping these feelings to yourself can get in the way of being intimate, both physically and emotionally.

You might also want to talk with your doctor or cancer care team if your feelings are getting in the way of being intimate with a partner. They will have resources to help you, or they can refer you to a counselor or sex therapist.

Specific cancers and treatments that can affect sexual desire

Any type of cancer or cancer treatment can affect your desire for sex, at least for a while. But some cancers and treatments are more likely to cause long-term changes to the way you experience sex

Feeling good about yourself and feeling good about sex

Sometimes friends and partners withdraw when a person has cancer. This can be out of fear or uncertainty. It can help to talk with your partner about how each of you is feeling.

Sexual touching between you and your partner is always possible. It just may be different than before you got treated for cancer. It may be easy to forget this, especially if you’re both feeling down or have not had sex in a while.

Keep in mind that you might need extra help with the changes caused by cancer. Counseling and sex therapy may be good options.

Overcoming anxiety about sex

You might find it hard to be as spontaneous as you used to be. Try setting up time with your partner to relax, enjoy one another’s company, and talk about what each of you would like sexually. Just as you learned to enjoy sex when you first started having it, you can learn how to feel pleasure again during and after cancer treatment.

Masturbation is not a required step in resuming your sex life, but it might help. It can help you find out where you are tender or sore and what kind of touch you enjoy. Sharing this information can help you and your partner decide what next steps to take.

Depending on your situation, you may feel a little shy bringing up sex. It might be hard to let your partner know you would like more physical closeness or that you are anxious about having sex. But these conversations are an important step toward resuming a fulfilling sex life. So be as clear and direct as you can.

Making sex more comfortable

If you have pain or feel weak from cancer treatment, you might want to try new sex positions. Talk to your partner and learn different ways to enjoy sex that are more comfortable for you. The drawings below are some ideas for positions that may help as you resume sex.

There’s no one position that’s right for everyone. You and your partner can work together to find what’s best for you. Pillows can help as supports. Keeping a sense of humor can always lighten up your efforts.

Getting professional help

Many health care professionals, including cancer doctors and nurses, have little training in sexuality issues. Depending on the problems you are having, you might be referred to a different kind of specialist.

A urologist focuses on diseases of the urinary tract and male genitals, and sexual problems. Many urologists perform surgery or order medical treatments for erection problems. They also have the special equipment that may be needed to find the cause of an erection problem.

An endocrinologist is an expert in how hormones work in the body. If the most likely cause of a sexual problem is a hormone imbalance, an endocrinologist may be able to help.

There are many different programs and specialists that can help you find the answers you need. Ask your cancer care team or primary care provider for referrals to specialists who can help you.

Counseling and sex therapy

There are also health care professionals who can help you understand and manage the emotions that affect your sex life. Options include:

• Talking with a counselor or sex therapist.
• Finding help in your community, such as a support group for men who are cancer survivors.
• Seeing a couples counselor who can help you talk about tough issues with your partner, including emotions that interfere with intimacy and sex.

Sexual rehabilitation programs

Some cancer centers have experts on staff who can assess and treat sexual problems. Ask your cancer care team if your center offers any programs or where else you can get help.

Sex therapists and other types of counselors

Sex therapy is psychotherapy or counseling that focuses on solving a sexual problem.

Sex therapists may practice in a clinic or alone. Look for a sex therapist who is a licensed mental health professional (a psychiatrist, psychologist, social worker, or psychiatric clinical nurse specialist or nurse practitioner) with special training in treating sexual problems.

Psychotherapy can help you feel better about the changes in your body, help you and your partner communicate more clearly, and give you skills to better cope with your cancer and treatment. Couples counseling may be helpful, too.

Finding a well-qualified mental health professional is important. These are some of the different types of mental health professionals:

• Psychiatrist: This is a medical doctor (an MD or DO) with a specialty in psychiatry. They should also be certified by the American Board of Psychiatry and Neurology.
• Psychologist: Most psychologists who practice alone have a doctorate in psychology (PhD or PsyD) or in education (EdD). Psychologists do not have medical degrees and don’t write prescriptions. A psychologist with a master’s degree is usually supervised by someone with a doctorate. In most states, a psychologist must be licensed. Those who practice usually have degrees in clinical or counseling psychology.
• Social worker: A social worker usually has a master’s degree in social work (MSW). Many social workers have training in mental health counseling. Licensing laws vary from state to state.
• Marriage and family counselors: Some states have a category for licensed psychotherapists called marriage and family counselors. They usually have a master’s degree in psychology or a related field, plus training in counseling.
• Psychiatric clinical nurse specialists or psychiatric nurse practitioners: This is someone with a master’s or doctorate degree in psychiatric nursing. They are licensed professionally, although their ability to prescribe medicines varies from state to state.

Finding a sex therapist or counselor

Professional societies can often give you information about their members in your area who have special training in sex therapy. These are good places to start:

• American Association of Sex Educators, Counselors, and Therapists (AASECT)
  

• National Association of Social Workers (NASW)
  

You can also get a listing of professionals in your area by contacting your state’s psychological association or a state association for licensed marriage and family therapists.

The cost of counseling varies with the professional’s level of training and experience. Insurance coverage for counseling varies depending on the health insurance plan. Check with your insurance company to find out if your plan will pay for counseling and how much of the cost it will cover.

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