Chapter 27: Living with and beyond cancer
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Anatomy and physiology
The physiology of male sexual function necessitates interactions between vascular, neurological, hormonal and psychological systems. The initial obligatory event required for male sexual activity, the acquisition and maintenance of penile erection, is primarily a vascular phenomenon triggered by neurological signals and facilitated only in the presence of a sufficient hormonal level and psychological mindset (Cunningham et al. [64]). Figure 27.7 shows the anatomical structure of the male sex organs that are affected either by cancer or its treatments. The structure and/or function of the male sexual organs can be affected by the following cancers: bowel, bladder, and other male‐specific cancers such as prostate, testicular and, less commonly, penile.
Figure 27.7 Male organs of reproduction and surrounding structures. Source: Adapted from Tortora and Derrickson ([274]). Reproduced with permission of John Wiley & Sons.
While sexual dysfunction can be directly related to a primary diagnosis of cancer, aspects of male sexuality are often impacted to a greater extent by treatment than by the disease (Dizon and Katz [84]). One‐third of men report that they need help with changes in sexual feelings and relationships and their sense of masculinity following treatment (Hyde et al. [128]). Treatment can have wide‐ranging effects:
- Systemic treatments such as chemotherapy can temporarily or permanently damage testicular function and this may affect the man's fertility. Although sterility is not associated with many drugs, chemotherapy may reduce the number of sperm or their motility (Royal Marsden [245]). Chemotherapy can also temporarily lower testosterone and have a direct or indirect effect on sexual desire (Cancer Research UK [37]).
- Surgical treatments have differing impacts on sexual function depending on the organs involved. This is not an exhaustive list of surgeries but examples of those that can result in altered sexual function and reduced sexual well‐being for men who are treated for cancer.
- – A radical prostatectomy for prostate cancer involves the removal of the whole prostate gland, seminal vesicles and the draining nodes; this is performed through an incision in the lower half of the abdomen (BAUS [32]).
- – Retroperitoneal lymph node dissection for testicular cancer involves a midline incision of the abdomen, pushing the bowels aside so that the lymph nodes located within the retroperitoneum on the side of the testicular cancer that drains the testicle can be removed; the blood supply to the affected testicle and spermatic cord are also removed. This can cause retrograde ejaculation (Testicular Cancer Awareness Foundation [265]).
- – Surgical interventions such as cystectomy for muscle‐invasive bladder cancer or pelvic exenteration for rectal cancer where the bladder, rectum, anus and prostate gland are all removed also cause altered sexual function as the nerves that supply the penis are either removed or permanently damaged (Macmillan Cancer Support [161]).
It is important when assessing men's sexual health to understand also their pre‐existing health conditions, exacerbated by to their cancer treatment.
Sexual inactivity is not in itself problematic as long as the person is not dissatisfied, distressed or avoiding sex because of sexual difficulties. If they are, early identification of problems and simple strategies put in place in partnership with the man and/or couple may be effective (LCA [148]).
