“The cure isn’t enough. Just the fact that more people are living,
that’s wonderful, but more people are living with really
awful stuff they now have to deal with.”
David Fuehrer, cancer survivor, from an interview in Newsweek
When facing a diagnosis of cancer, most men would give little thought to potentially facing male impotence during or at the end of a treatment regimen. It’s a side effect that potentially gets shunted aside in the face of more overwhelming concerns such as, “Will I survive this?”
That’s probably why, although sexual dysfunction during and after cancer treatment is real, it’s not talked about much.
This article discusses types of cancer that can affect men’s erectile functioning, as well as treatments that can cause issues with sexual functioning. Can men who are being treated for cancer take drugs like Viagra (I think the answer is, “yes, sometimes.”)? What about for lingering problems after cancer treatment is over? Do some cancer drugs affect how the body metabolizes drugs like Viagra, and if so, what should men do about it? Why should men be hopeful about having a healthy, enjoyable sex life after cancer treatment?
Prevalence of Male Impotence During Cancer Treatment
There is intimacy after cancer, but it’s predicated on one assumption: Oncologists and patients talking about the ways cancer affects sexuality and interventions that can help.
Abigail Jones, Newsweek, 7/19/17
The Journal of Clinical Oncology documents that there are nearly 12 million Americans who have had cancer and lived to talk about it. But most of the men who have lived through the disease are talking about one main side effect – erection dysfunction.
While the issue of male impotence may not be talked about, it’s fairly widespread.
According to the MD Anderson Center, approximately two-thirds of cancer patients had some sort of sexual dysfunction after undergoing treatment. 30% of these patients are not treated for the disorder. Newsweek puts the figure a lot higher, saying 60% of cancer survivors struggle with sexual dysfunction and 20% of these patients don’t receive treatment.
While drugs like Viagra may offer treatment options for these patients; however the bigger issue is that treatment teams simply sometimes fail to address the issue as part of the overall plan of care. Thus the issue of male impotence goes untreated.
What’s the Connection Between Impotence and Cancer?
Many cancer treatments cause side effects that affect the male and female sex drive. Surgeries or radiation to correct cancer in the pelvic region may even damage tissue, nerves, and the delicate vasculature in the male sex organs that allow them to work properly. In fact, according to the Journal of Clinical Oncology, prostate cancer is the second most prevalent type of cancer in men. Erectile dysfunction occurs typically after treatment for prostate, colorectal, or bladder cancers. In these cases, Viagra, Cialis, Levitra, or Stendra could potentially be prescribed as a remedy for male impotence.
Chemotherapy or hormone treatments can also cause disruptive physical changes in both men and women such as low testosterone or menopause that disrupt normal sexual function.
The Journal of Clinical Oncology also suggests that other types of cancer survivors struggle with male impotence. Having poor body image isn’t just tied to one type of cancer, and side effects from treatment, such as dry mouth or a disruption in saliva production, can have a negative effect on sex drive.
Too, there is simply the issue that the patient feels tired and sick, which can certainly lead to male impotence or a general lack of sex drive. Or, if a person has gained weight from medication, or has surgery scars, they may feel less desirable.
Cancer survivors must learn to adapt to an altered way of living after their treatment. That may facilitate changes in relationship patterns in addition to a number of other lifestyle changes that survivors must adjust to. An MD Anderson article put it this way:
Many cancer survivors are inhibited by the fact that the sex they have after treatment may not necessarily be identical to the sex they had enjoyed before, or they may be so distraught by the idea of not being able to perform as they once had that they just avoid it altogether.
Too, patients may feel reluctant to talk about male impotence, despite the fact that it is disrupting their (or their partner’s) enjoyment of life. Even physicians can sometimes stumble over the issue – this, despite the plethora of Viagra advertisements in every magazine in their waiting room.
A study in the Journal of Clinical Oncology points out the obvious, “Profound sexual dysfunction has been shown to have a significant negative effect on quality of life.”
Treating Male Impotence in the Cancer Patient
The question becomes, which of the team of specialists battling cancer are most prepared to address the issue of male impotence? Should it be the oncologist whose specialty is wiping out cancer? Or the family practice doctor who sometimes can be a little out of the loop during cancer treatments? Or the radiologist, internal medicine doctor, or other specialists on the team? It can be problematic, but it’s clear that the issue must be addressed.
The Journal of Clinical Oncology suggests the following troubling scenario:
Physicians receive little, if any, training about how to address sexual concerns, and oncologists are generally uncomfortable addressing sexual problems.87 Barriers to communication that were previously identified are lack of time and lack of preparation to discuss sexuality with survivors.88,89 The absence of frank dialogue about sexuality and cancer treatment is particularly problematic because it underscores many of the erroneous assumptions made by survivors. When sexual problems go unaddressed, survivors can interpret this to mean that sexual dysfunction falls in the category of treatment-related collateral damage that must be endured. This is perhaps one of the most unfortunate misperceptions that survivors live with—a mistaken understanding that there are no effective treatments for sexual dysfunction after cancer.
The varying nature of sexual dysfunction is tied to the type of cancer, treatment received, and your age and overall health. Cancer of the prostate is frequently tied to male impotence at some point during treatment, no matter if they’re receiving radiation, surgery, or hormone treatments. They often can lose the physical ability to ejaculate and can sometimes leak urine. Sex can be uncomfortable and some men experience a lack of desire. If patients aren’t properly prepared for these issues, the results can be devastating.
Intervening to provide treatment has included medications such as Viagra to improve sexual performance. This is particularly true after treatment for prostate cancer. As a secondary treatment, penile injection therapy can be tried, but it’s an invasive procedure not preferred by many patients. Doctors can also perform penile implant surgery, another invasive, but effective technique.
But sexual attitudes and cultural beliefs also affect patient care. For example, after surgery for prostate cancers, many men are counseled to masturbate to increase the blood flow to the organ. But what about cultural taboos related to masturbation?
Overcoming barriers to communication about male impotence is another hurdle that must be leaped before successful treatment can occur. A Newsweek article put it this way, “But once you survive cancer, what comes next?”
Sex During Cancer
OncoLink has a good resource called the Men’s Guide to Sexuality During & After Cancer Treatment. In it, they point out that men of all ages and with all types of cancers can struggle with male impotence. They may experience a lack of desire to sex, struggle with a healthy body image, in addition to struggling with male impotence. The guide stresses the importance of men asking candid questions and not being embarrassed or afraid to get the answers about how cancer treatments will affect their sexual health.
Generally, sexual contact is fine during and after cancer treatment, as long as the patient feels well enough. But the guide also points out that hand holding, massage, and touching is also comforting and feels good if the patient is struggling with illness from chemotherapy or radiation. However, if surgery has occurred or the patient has a low white blood cell count, your doctor may suggest refraining from sexual activity for a time.
Discussing these issues with your physician is key to maintaining sexual health during and after cancer treatment. Asking your physician for Viagra is just one of the treatments available that may help with male impotence.
Cancer Patients Should Not Suffer from Male Impotence
Patients and physicians must learn to address the issue of male and female sexual dysfunction after cancer treatment. It should be a standard part of patient education on long-term survivorship. Given that the cancer survivor has been through so much during treatment, it’s unfortunate that many are suffering in silence from sexual dysfunction simply because the issue is never addressed by their doctor. Physicians must learn to talk knowledgeably with patients about the issue, addressing it as a potential outcome or risk of receiving treatment. Making referrals to urologists or therapists should be standardized and offering patients fact sheets or information guides on sexuality after cancer treatment will help normalize the issue.
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