Cancer treatments and their effects

Surgery

Any form of surgery can affect our sex lives, even if it does not involve the sex organs directly. It can affect your body image and how you think about your body.

For example, some people feel or say that their bodies have “let them down” because they used to feel fit and healthy. Some feel like different people and they’ve lost confidence. Others find they experience sexual sensations even though they have changes to their erections and orgasms. Everyone reacts differently.

Abdomino-perineal resection

An abdomino-perineal resection is one of several operations used to remove cancer of the colon or anus. This operation can affect the nerves that control erection and ejaculation.

In some cases of low rectal cancer the anus is removed and closed over permanently. A stoma is formed for bowel motions. For more information about stomas, click here.

Breast surgery

Breast surgery creates a body change that can affect sexual arousal in many ways – particularly if you were “turned on” by having your breasts and nipples touched. Some women say that the operation affects their image of themselves and they feel less womanly. You may find that you need a lot of time to talk through the feelings and emotions that breast surgery can cause.

For more information on emotions after breast surgery, see Breast Cancer/Te Matepukupuku o ngā U or Breast Cancer in Men.

Hysterectomy

Hysterectomy is the removal of the uterus (womb) and cervix. Sometimes one or both ovaries are removed as well. Once the womb is removed the surgeon stitches up the top end of the vagina. This makes it slightly shorter than it was before. While healing takes place you might prefer not to have intercourse or for your partner to be very gentle. Try different positions to find out which are most comfortable.

A hysterectomy may affect a woman’s experience of orgasm, as some of the nerves leading to the clitoris may be affected by the surgery. Most women find that they are still able to have orgasms, but the sensations may be different from before the operation. You may need to experiment with touch in different places around the clitoris and use lubricant to increase sensation.

Some surgeons specialise in doing surgery that is less likely to damage the nerves; this is known as nerve sparing surgery.

Incontinence

Incontinence can also be a problem. Click here for more information.

Oophorectomy

Oophorectomy is the name of the operation where your ovaries are removed. This produces a “surgical” menopause, so you will go through symptoms of menopause. It’s likely that you will notice these symptoms occurring more quickly than the gradual onset that occurs with natural menopause. Vaginal dryness is a common symptom of menopause. For more information on this and other symptoms or read "Early menopause and cancer".

In many cases replacement hormones (HRT) can return the body to near normal. You may find it helpful to talk this through with your doctor.

Orchidectomy

Orchidectomy is the name of the operation where one or both testicles are removed. If only one is removed (usually the case for testicular cancer) this will not cause infertility and does not usually affect your sexual function. For a short time after the operation, sexual positions that apply pressure to this area should be avoided. Some men say their orgasms feel different. The amount of ejaculated fluid is usually less than before.

A false testicle (prosthesis) can be inserted into the scrotum, which will give the appearance and feel of a normal testicle. Even though it looks normal, you may feel a change in your body image. Some describe feeling less masculine and needing time to talk through this change.

If you have both testicles removed (usually for advanced prostate cancer), you will be infertile and almost always unable to have an erection.

Prostatectomy

Prostatectomy is the removal of the prostate gland. Following radical prostatectomy you will no longer ejaculate semen so you will have a dry orgasm (no fluid is ejaculated). Some men say this feels totally normal, while others say that their orgasms don’t feel as strong, long-lasting or pleasurable as they did before. Modern surgical procedures aim not to damage the nerves in this part of the body, but even so many men will have erection problems. For more information you may like to read the Cancer Society’s booklet Prostate Cancer: A guide for men with prostate cancer. You can get a copy at your local Cancer Society or by phoning the Cancer Information Helpline 0800 CANCER (226 237).

Cystectomy

Cystectomy is the removal of the bladder. This can cause an inability to have an erection as nerves in the penis are cut when the bladder is removed.

Vulvectomy

Vulvectomy is where part or all of the vulva is removed. This is a rare operation that is sometimes necessary for women who have cancer of the vulva. Removal of the vulva can affect sensations during sex, especially if the clitoris has had to be removed. This surgery may alter how you view your femininity, body and sense of self.

Radiation treatment

Radiation treatment treats cancer by using highenergy rays (radiation), which destroy the cancer cells while doing as little harm as possible to normal cells. Radiation treatment commonly causes fatigue (tiredness that does not go away with rest), which may last for several weeks, months or even years. The tiredness from having radiation treatment can make you feel less like having sex. Your skin may also feel tender and you may not want that area touched. Radiation to the head and neck area could mean that any oral contact, including kissing and oral sex, is painful as your mouth is dry.

Effects of radiation treatment

Radiation treatment may affect sexual function when it’s given to the pelvic area for cancers of the prostate, anus, bladder, cervix, ovaries and uterus.

In men it can reduce the ability to have an erection. This will depend on the amount of radiation treatment given. The effects occur because of nerve damage, or because blood vessels that supply the penis become scarred and are unable to let enough blood through to fill the penis. About one-third to one half of all men treated in this way say their erections are not as strong as before. The changes can be slow at first, and may worsen during the first year or two following radiation treatment. Some men may be able to have erections but find they don’t last. Others are unable to have erections at all. Many men find there are ways to be sexual without having erections.

Radiation can cause irritation to the urethra that can reduce pleasurable sensation when a man ejaculates. Some feel a sharp pain as they ejaculate, caused by radiation irritating the urethra (to see a picture of the urethra, click here). This usually disappears within a few weeks after the treatment has ended.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) medication to destroy cancer cells. Some of the side effects of chemotherapy, such as sickness, depression, tiredness and lack of energy, can reduce your desire for sex. However, these side effects of treatment may be reduced or stopped with medication. With time your sex drive (their desire to have sex) is likely to return once chemotherapy is over.

If the chemotherapy causes hair loss, or weight changes or if you have a portacath (an implantable port or central venous line in your chest), you may feel “unsexy” at the time. Some of the tablets given to prevent sickness can cause a lack of desire. Once you stop taking the tablets your desire should return.

Effects of chemotherapy

Chemotherapy may make you feel tired or sick and you may not feel like having sex. Sex drive usually returns soon after treatment ends. Chemotherapy can sometimes reduce testosterone (the hormone that gives you sex drive), but this usually returns to normal after treatment finishes. Chemotherapy drugs can affect fertility. Before beginning chemotherapy you may want to talk to your doctor about keeping your sperm stored for the future.

Chemotherapy can reduce the amount of hormones made by the ovaries. You may notice changes in your monthly periods, which can sometimes stop altogether. It’s still possible to become pregnant even with irregular periods. Talk to your doctor about contraception. Chemotherapy can cause the symptoms of early menopause, including hot flushes, irritability, sleep disturbances, achy bones and vaginal dryness. Vaginal thrush is common if you are having chemotherapy, especially if you are taking steroids or powerful antibiotics to prevent infection. Your doctor can prescribe treatment for this.

Hormonal therapy

Some cancers are influenced by hormones naturally produced by the body, so treatment is given to change hormone levels. These changes in hormone levels can  make you feel less like having sex. 

Everyone’s sex drive is different and hormones are just one reason why you may not feel like being sexual. It’s common for people to have a changed sex drive – whether they have cancer or not - but if you start to be sexual, you may feel sexual.

If you have prostate cancer, it can be helpful to lower testosterone (the male hormone) as this can stop the growth of prostate cancer cells. This may be done by taking tablets or having injections or by removing the testicles. See the Cancer Society’s booklet, Prostate Cancer, for more details. You can get this booklet from your local Cancer Society, by phoning the Cancer Information Helpline 0800 CANCER (226 237), or by viewing it on our website.

Treatments to lower testosterone can have major effects on your sex life. You may find that you feel much less like sex and, when or if you do feel like it, you can’t have or maintain an erection. You may notice that you make less semen, have less facial hair and less muscle strength. Some people also develop breast swelling and tenderness.

“Through the treatment I lost all my sex drive. It’s a real downer. Luckily I can talk to my wife about this.” – Brent

Medicines that keep oestrogen levels down are often given as part of the treatment for breast cancer. They have fewer side effects than chemotherapy. Symptoms are similar to those of menopause, such as hot flushes, vaginal soreness, dryness or discharge, weight gain, vaginal changes and a lower sex drive. However, some people have no such side effects.

There are many other hormonal therapies and these may have side effects, such as tiredness or vaginal dryness, that can affect your sex drive. Other medicines are sometimes given to reduce the production of sex hormones, such as goserelin (Zoladex). Goserelin reduces the production of sex hormones by the ovaries, so periods stop, and women have menopausal symptoms while they are taking the drug. It can cause a reduction in sex drive. Usually it’s given for two years, and once the drug is stopped sex drive gradually returns to normal and the other side effects also disappear.

Goserelin is sometimes given to men in the treatment of prostate cancer. It may produce menopause-like symptoms.

Infertility

Infertility means that a man cannot get a woman pregnant and a woman cannot become pregnant.

Chemotherapy, radiation treatment and some types of surgery can cause infertility. Ask your doctor if your treatment is likely to cause fertility problems.

Your cancer doctor will be able to advise if there are ways to save your fertility before you start any treatment. In some cases it’s possible for a man’s sperm to be collected, frozen and stored before chemotherapy starts. This sperm can then be used at a later date. For women it may be possible for eggs to be removed, fertilised, frozen and stored. As this can involve the use of hormone drugs to make the ovaries produce more eggs, it may not be suitable for women who have hormone-related cancer. You can ask your cancer doctor or surgeon to arrange an appointment with a fertility specialist to talk about these options.

You may like to look at the website of an organisation such as Fertility Associates (www.fertilityassociates.co.nz) for more information.

For some people there is uncertainty, which is ongoing and difficult to cope with. If you want to have children and find that you are infertile, this can be devastating and can cause a whole range of emotions. The sadness, disappointment and sense of loss can be overwhelming. If you feel this way, ask your health professional or Cancer Society information staff about counselling.

Once your treatment has ended you may wish to explore the fertility options further. Specialised help is available, including counselling and guidance on alternatives to having your own children, for example adopting a child.