Chapter 27: Living with and beyond cancer
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Impact of cancer treatment on sexual health
Infertility
Infertility results from reduced (or loss of) sperm production with or without altered ejaculation (retrograde/anejaculation). Prior to treatment/surgery, ensure a discussion has taken place of the potential impact of treatment on fertility. If the man desires, make a referral to onco‐fertility/reproductive health or andrology services for sperm cryopreservation.
Body image and threat to masculinity
Changes to physical appearance from chemotherapy (e.g. hair loss or skin and nail changes), surgical scars and altered anatomy (e.g. orchidectomy for testicular cancer, stoma formation in bladder and bowel cancers) can have a profound impact on a man's sense of self which in turn impacts his sexual health. The impact can be reduced by ensuring the man is informed in advance of treatment of the side‐effects. A prosthesis can be offered post orchidectomy. If necessary, refer the patient to psychological support or a psychosexual therapist.
Loss of sexual desire (libido)
This can occur as a direct result of cancer treatments such as hormone therapy, chemotherapy and/or surgery, or cranial or pelvic radiotherapy. Information in advance can help men manage their expectations and prepare them to cope with the changes. Referral to psychosexual counselling can help support the man and his partner adjust to the changes.
Ejaculatory changes
These can occur as a result of treatment. Testosterone supplementation may be considered for some men (those with testicular, bowel or bladder cancer) but not for men beginning treatment for prostate cancer. Giving information to men prior to treatment can help manage their expectations and prepare them to cope with the changes. Referral to a psychosexual therapist for support with ejaculatory difficulties should also be considered.
