Sex after testicular cancer: what to expect

Worried how testicular cancer might affect your sex life? Trust us, you’re not the only one.

Sex is different for everyone. That was true before testicular cancer treatment, and it’s just as true after. Some guys find that little, if anything, changes after testicular cancer. Others experience changes to their sex drive or sexual function, such as the ability to achieve and maintain erections or ejaculate.

Some guys are bothered by the change; others aren’t.

Bottom line: if testicular cancer treatment is affecting your sex life and you want to do something about it, you have options.

How testicular cancer treatment might affect your sex life

Although 1 in 3 people who’ve been treated for testicular cancer report having a reduced sex drive (according to one study), most guys are able to enjoy an active, meaningful sex life after treatment.

Most treatments for testicular cancer, including surgery, will not affect your ability to have sex long-term, though in the short term you may have a diminished desire for sex. (For some guys, the emotional effects of testicular cancer have a bigger impact on their sex lives than the physical effects — more on that in a bit.)

It’s not uncommon to think of sexual function as a straightforward mechanical process: blood flows into the penis and we are ready for sex. But hormone levels, emotions, and psychological health all play a part in sexual performance. Testicular cancer can affect any of these aspects of sexual health.

Here’s what you can expect from different treatments for testicular cancer:

Surgery (orchiectomy)

• An orchiectomy to remove one testicle should not have any long-term impact on your libido (sex drive), performance (ability to have sex) or fertility (ability to conceive a child). In fact, your remaining testicle may end up producing more testosterone and sperm to make up for the one that was surgically removed.

• An orchiectomy to remove both testicles (very rare) will affect your sex drive, fertility, and ability to get an erection. We’ll cover some things you can do in the event that you need a bilateral (double) orchiectomy and want to get things hopping again afterward.

RPLND (retroperitoneal lymph node dissection)

• If the cancer has spread to nearby lymph nodes, you may need to have them surgically removed. This is often done at the same time as your orchiectomy.

• The procedure can damage the nerves that control the release of sperm, resulting in a dry or retrograde ejaculation during orgasm — that is, either no sperm is released or it releases backward into the bladder.

• This isn’t harmful, and it shouldn’t impact your ability to have sex. The only reason you may want to consult a doctor about it is if you want to conceive a child.

Radiation therapy (radiotherapy)

• Radiation therapy should not have a long-term effect on your ability to have sex or conceive a child. The side effects of radiation may temporarily diminish your sex drive, but this is entirely normal. In rare cases, radiation therapy can have similar effects on ejaculation as RPLND.

Chemotherapy

• You may experience a reduced sex drive or difficulty getting an erection while on chemo, especially if you’re prescribed a high-dose regimen, or if your treatment is combined with radiation therapy. These effects, however, are usually temporary and resolve on their own after treatment for most men.

If it’s taking longer than expected for your sex drive to bounce back, or if you’re having trouble getting an erection after testicular cancer treatment, there are steps you can take.

Sex during and after treatment

Don’t be shy. Talk to your doctor about how testicular cancer treatment might affect your sex life and what precautions you should take.

Questions to ask your doctor

• When is it OK for me to have sex again?

• How long should I use protection after testicular cancer treatment?

• What can I do to boost my sex drive afterward? (If that’s important to you —not all guys are concerned about this, and that’s OK too.)

• Should I bank sperm before surgery? (Bring this up if you think you might want to father a child someday.)

• How long should my partner and I wait to try for a baby? (Again, be sure to ask if having a child is important to you.)

Using protection during sex

It’s important to consistently use a condom or some other form of barrier protection while having sex — both during and after testicular cancer treatment. There are a few reasons for this:

• To protect you: chemotherapy and radiation take their toll on your immune system, putting you at increased risk of infection.

• To protect your partner: while the evidence isn’t conclusive, some experts think trace amounts of chemotherapy can build up in your semen, potentially exposing your partner to unwelcome side effects.

• To avoid pregnancy: there’s an increased risk of birth defects if you and your partner get pregnant while you’re being treated for testicular cancer.

Many experts recommend using protection for at least six months after treatment. Be sure to talk to your doctor about what’s best in your case.

Erection difficulties after testicular cancer

There are a few reasons you might experience erectile dysfunction — that is, difficulty getting and maintaining an erection — after testicular cancer. It could be a physical side effect of treatment, especially in rare instances where both testicles are removed. It could be a result of the emotional or mental strain you’re under. Chemotherapy can affect nerve and vascular function in some men. Or it could be a combination of everything you’re going through.

There are a number of treatments you and your doctor can suggest if you want to get your sex life back on track.

• Medication: there are different medicines your doctor can prescribe to help increase blood flow to the penis, making it easier to get an erection.

• Topical creams: these can be applied to the tip of the penis before sex.

• Penis pumps: also known as vacuum pumps, they fit over your penis and draw blood into the shaft. They can be used with or without a penis ring to help you maintain your erection during sex.

It’s also important to remember that it’s possible to have an active, satisfying sex life without getting an erection.

How your mental and emotional wellbeing can impact sexual health

It’s normal to feel stressed or anxious when you’ve been diagnosed with testicular cancer. In addition, many people wrestle with body confidence after treatment. This can have as much of an impact on your sex life as any physical treatment, if not more.

Remember, your mental and emotional well being are just as important to sexual health as your physical recovery. If you’re struggling with your body image after testicular cancer, give these practices a try:

• Every time you have a negative thought about your body, think of at least one thing you like about your body.

• Keep reminding yourself that you are more than your body, and that losing a testicle does not change who you are.

• Maintain healthy habits like eating well and getting lots of rest. Caring for your physical well being will have a big impact on your mental and emotional health, too.

Navigating relationships after testicular cancer

Talking with a partner or potential partner about changes to your sex life can be daunting. Intimacy and trust go hand in hand, so here are some tips to follow, depending on your relationship status.

If you have a partner

• Be as open and honest as possible. Talk about what has changed, what hasn’t changed, what does and doesn’t feel good during sex (for both of you), and how you can support each other.

• If you’re nervous opening up with your partner, write down what you want to say first.

• Consider sex therapy with a licensed counselor as a way to help the two of you navigate any challenges in the bedroom.

If you don’t currently have a partner

• Being honest and open with a potential partner is still the best approach, though how much you share and when you share it may depend on the status of your relationship and how serious you both are about each other.

• Talk about your experience with testicular cancer and any changes to your body before engaging in sex.

• Chances are, it will not change how the other person feels about you or affect how attracted they are to you. In the event that it does, you may want to reconsider your future relationship together. It is important that any potential partner accept you for you.

You may feel discouraged about your sex life after testicular cancer. Be patient with yourself — and don’t hesitate to seek out the help you need to get things back on track.