Potential problems for men

Sunday 31 October, 2010

Reviewed by: Dr Amanda Hordern, PhD

On this page: Impotence (erectile dysfunction) | Ejaculation/orgasm changes | Loss of part of your body | Fertility problems

Impotence (erectile dysfunction)

Some cancer treatments can cause erection problems because of nerve damage. For other men, it may not be due to the treatment, but the worry of having cancer can leave you feeling depressed and affect your ability to have an erection. Your sexual confidence may have suffered and this also affects your ability to get or maintain an erection.

Tips

  • If you have had treatment for prostate cancer, talk with your doctor about your ongoing ability to have an erection.
  • You can have sex with a half-erect penis. This works best with the partner on top guiding the penis inside. Men do not need a full erection to have an orgasm.
  • Help your partner reach satisfaction without penetration. Experiment with other sexual activities, such as all-over touching, oral sex or masturbation.
  • Other ways of getting an erection include taking tablets to increase the blood flow to the penis or injections to the penis that cause the blood vessels to expand and the penis to become erect.
  • A vacuum pump device can be used, which draws blood into the penis to make it firm. A rubber ring is then placed around the base of the penis to keep it firm. When you have finished having sex, the ring is taken off and the blood flows normally again.
  • Implants can be surgically placed in the penis. A pump is placed in the scrotum and squeezed when an erection is needed.

‘The first time we tried Viagra and were waiting for the hour or so to see if it would work, we thought, "This is a bit like being at the dentist and waiting for the anaesthetic to work".'  - Ian, 58

Preserving the nerves that control erections can help reduce the risk of impotence in men treated for prostate and rectal cancer. These nerves can only be saved if the cancer has not spread along the nerves. Nerve-sparing surgery works best with younger men who had firm erections before the surgery.

‘Male impotence requires sometimes conservative-minded partners to broaden their attitudes to what they have considered "normal" sexual practices.' - Bill, 53

Ejaculation/orgasm changes 

Men who have had radical surgery for prostate cancer may have dry orgasms (retrograde ejaculation). This may be as pleasurable as a normal orgasm but little or no semen is ejaculated. Some men say it is more intense and others say it does not feel as strong or long lasting. Sometimes it may be quite a different sensation.

Premature ejaculation may be a problem for some men who are feeling anxious about their sex life.

‘Impotence can be quite frustrating as the desire's there but the ability's not.' - Ian, 58

Tips

  • Concentrate on your enjoyment of sexual activity. Worrying about controlling your ejaculation may lead to erection problems or loss of interest in sex.
  • Talk to your partner about the problem. Even if you feel you ejaculate too quickly, your partner may be satisfied.
  • Avoid rushing through foreplay as your partner may not have sufficient stimulation or may feel rushed.
  • Increasing the frequency of ejaculations, perhaps by masturbation, may help control ejaculation and may increase the amount of semen ejaculated.
  • Sometimes medication or numbing gel can help with premature ejaculation.

Loss of part of your body

Removal of part of your genitals or a limb due to cancer treatment can change how you think about yourself; it could even make you feel ‘less like a man'. It will take time to get used to how your body has changed.

Tips

  • A prosthesis can be inserted into the scrotum to provide a normal appearance after surgery when testes have been removed.
  • Even if all or part of the penis has been removed (which is rare), it is still possible to have a satisfying sex life.
  • If a limb has been removed, try wearing your prosthesis during sex. If you remove your prosthesis, use pillows to support your affected limb or limbs.

Fertility problems

You may have temporary fertility problems after being treated with radiotherapy in the pelvic or groin area. Some men become permanently infertile. If the testes are outside the treatment area, they can usually be protected from the radiation.

Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move, however a man having chemotherapy could still make his female partner pregnant.

Pregnancy should be avoided during chemotherapy in case the drugs harm the unborn baby. Barrier contraception, for example condoms, must be used. Talk to your doctor about when it is safe to father a child after your treatment has finished.

Tip

  • If infertility is likely to be permanent, you may be able to store sperm before the treatment begins. Talk to your doctor about this.
for