Cancer and Sexual Health
Sexuality is a complex characteristic that involves the physical,
psychological, interpersonal, and behavioral aspects of a person. Recognizing
that "normal" sexual functioning covers a wide range is important.
Ultimately, sexuality is defined by each patient and his/her partner according
to sex, age, personal attitudes, and religious and cultural values.
Many types of cancer and cancer therapies can cause sexual dysfunction.
Research shows that approximately 50% of women who have been treated for breast
and gynecologic cancers experience long-term sexual dysfunction. Nearly 70% of
men who have been treated for prostate cancer experience long-term sexual
An individual's sexual response can be affected in many ways. The causes of
sexual dysfunction are often both physical and psychological. The most common
sexual problems for people who have cancer are loss of desire for sexual
activity in both men and women, problems achieving and maintaining an erection
in men, and pain with intercourse in women. Men may also experience inability to
ejaculate, ejaculation going backward into the bladder, or the inability to
reach orgasm. Women may experience a change in genital sensations due to pain,
loss of sensation and numbness, or decreased ability to reach orgasm. Most
often, both men and women are still able to reach orgasm, however, it may be
delayed due to medications and/or anxiety.
Unlike many other physical side effects of cancer treatment, sexual problems
may not resolve within the first year or two of disease-free survival and can
interfere with the return to a normal life. Patients recovering from cancer
should discuss their concerns about sexual problems with a health care
Factors Affecting Sexual Function in People With Cancer
Both physical and psychological factors contribute to the development of sexual
dysfunction. Physical factors include loss of function due to the effects of
cancer therapies, fatigue, and pain. Surgery, chemotherapy, and radiation
therapy may have a direct physical impact on sexual function. Other factors that
may contribute to sexual dysfunction include pain medications, depression,
feelings of guilt from misbeliefs about the origin of the cancer, changes in
body image after surgery, and stresses due to personal relationships. Getting
older is often associated with a decrease in sexual desire and performance,
however, sex may be important to the older person's quality of life and the loss
of sexual function can be distressing.
Surgery can directly affect sexual function. Factors that help predict a
patient's sexual function after surgery include age, sexual and bladder function
before surgery, tumor location and size, and how much tissue was removed during
surgery. Surgeries that affect sexual function include breast cancer, colorectal
cancer, prostate cancer, and other pelvic tumors.
Sexual function after breast cancer surgery has been the subject of much
research. Surgery to save or reconstruct the breast appears to have little
effect on sexual function compared with surgery to remove the whole breast.
Women who have surgery to save the breast are more likely to continue to enjoy
breast caressing, but there is no difference in areas such as how often women
have sex, the ease of reaching orgasm, or overall sexual satisfaction.
Sexual and bladder dysfunctions are common complications of surgery for rectal
cancer. The main cause of problems with erection, ejaculation, and orgasm is
injury to nerves in the pelvic cavity. Nerves can be damaged when their blood
supply is disrupted or when the nerves are cut.
Newer nerve-sparing techniques for radical prostatectomy are being debated as a
more successful approach for preserving erectile function than radiation therapy
for prostate cancer. Long-term follow-up is needed to compare the effects of
surgery with the effects of radiation therapy. Recovery of erectile function
usually occurs within a year after having a radical prostatectomy. The effects
of radiation therapy on erectile function are very slow and gradual occurring
for two or three years after treatment. The cause of loss of erectile function
differs between surgery and radiation therapy. Radical prostatectomy damages
nerves that make blood vessels open wider to allow more blood into the penis.
Eventually the tissue does not get enough oxygen, cells die, and scar tissue
forms that interferes with erectile function. Radiation therapy appears to
damage the arteries that bring blood to the penis.
Other Pelvic Tumors
Men who have surgery to remove the bladder, colon, and/or rectum may improve
recovery of erectile function if nerve-sparing surgical techniques are used. The
sexual side effects of radiation therapy for pelvic tumors are similar to those
after prostate cancer treatment.