Below we discuss how testicular cancer treatments may affect someone’s experience of sex and intimacy, and how to manage these changes.
Surgery – Removing one testicle won’t affect erections or orgasms but can affect testosterone levels. RPLND may damage nerves, causing semen to travel backwards into the bladder instead of forwards out of the penis (retrograde ejaculation). This still feels like an orgasm, but no semen will come out.
Chemotherapy – Chemotherapy drugs may remain in your system and be present in your semen for a few days. Your ability to get and keep an erection may be affected for a few weeks after chemotherapy. This is usually temporary. You may also find you have a lower sex drive (libido).
Radiation therapy – Radiation therapy to the abdomen may temporarily stop you making semen. You will still feel the sensations of an orgasm but will ejaculate little or no semen (dry orgasm). In most cases, semen production returns to normal after a few months.
Managing changes to sex and intimacy
- Be gentle the first few times you are sexually active after treatment. Start with touching, and tell the person you’re having sex with, what feels good.
- Talk openly with your doctor or sexual health counsellor about any challenges. They may be able to help and reassure you.
- Protect your sexual partners from any drugs in your semen by using barrier contraception, such as condoms, during chemotherapy and radiation therapy and for a number of days afterwards, as advised by your doctor. See Effects on fertility for information about avoiding pregnancy.
- Accept that tiredness and worry may lower your interest in sex, and remember that sex drive usually returns when treatment ends.
For more on this, see Sexuality, intimacy and cancer.
→ READ MORE: Effects on fertility
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Dr Benjamin Thomas, Urological Surgeon, The Royal Melbourne Hospital and The University of Melbourne, VIC; A/Prof Ben Tran, Genitourinary Medical Oncologist, Peter MacCallum Cancer Centre, Walter and Eliza Hall Institute of Medical Research and The University of Melbourne, VIC; Dr Nari Ahmadi, Urologist and Urological Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator, Gold Coast University Hospital, QLD; Anita Cox, Youth Cancer – Cancer Nurse Coordinator, Gold Coast University Hospital, QLD; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, WA; Dr Leily Gholam Rezaei, Radiation Oncologist, Chris O’Brien Lifehouse and Royal Prince Alfred Hospital, NSW; Dheeraj Jain, Consumer; Amanda Maple, 13 11 20 Consultant, Cancer Council SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW.
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