Changes to your sex life and sexuality are not uncommon following a diagnosis of cancer. This may be a result of side effects from your leukemia, lymphoma or myeloma, or may be a result from treatments you are receiving to treat your cancer. Fatigue, loss of interest in sex, pain, changes to how you look, and loss of fertility are side effects that are common in both men and women with a cancer diagnosis. However, there are some sexual side effects that are specific to men.
The main sexual side effect that men will experience with treatment for leukemia or lymphoma is difficulty getting or maintaining an erection (erectile dysfunction, or ED). Men who have had erectile problems in the past, or men who are older are at higher risk of developing ED following treatment. The physical ability to ejaculate or reach orgasm is usually unaffected in blood cancer patients.
Chemotherapy can cause some damage to the tissue of the testicles and lower your level of testosterone. You may have a decreased desire for sex and experience some ED. This is especially true for men who have received high-dose chemotherapy like the type used in bone marrow or stem cell transplants.
Radiation to the pelvic area can cause difficulty with erections in two ways. First, it may damage and scar tissue in the veins that force blood into the penis, making it difficult to get a hard erection. It may also cause damage to the nerves that stimulate an erection. It usually takes some time for this type of damage to become obvious, and it may become permanent.
Men can also experience some erectile problems as a result of graft versus host disease following allogeneic stem cell transplantation.
Few things in men’s sexual health have been as revolutionary as the discovery of medications to treat ED. Viagara, Cialis, and Levitra (or “Le Weekend” as my pharmacist friend calls it) have helped millions of men regain their sexual confidence and functionality. They work by increasing the amount of blood flowing to the penis, thereby causing a more firm erection. Depending on the cause of your ED, your healthcare provider may choose to put you on a testosterone replacement medication. Ask your healthcare provider if these options might be right for you.
Again, your physical ability to have an orgasm or feel pleasure from sex will not likely be affected by your cancer treatment. If you have an interest in sexual activity, but are having difficulty maintaining an erection, take some time to experiment with your partner, or by yourself, to see what will work for you. Even if you are only able to achieve a partial erection, penetrative sex may still be possible. Oral sex, use of sex toys, and sexual touching may also bring you pleasure if these are activities you feel comfortable with.
Also keep in mind that while you are undergoing treatment for your leukemia or lymphoma, your immune system will not be a strong as it usually is. You may be at higher risk of contracting a sexually transmitted infection or may have a flare up of genital herpes or warts if you have had these in the past. Safer sex using a condom for any type of sexual encounter with a partner may help to decrease the risk.
Talking about erection problems and sexual side effects with your healthcare provider or partner can be embarrassing and difficult. You may feel self-conscious about the changes your body is going through, and this can be very hard on your self-esteem.
Sexual side effects are no different from any other side effect in terms of speaking with a doctor or nurse. You have a right to be fully informed of what effects your treatment may have on your health. It may make you more comfortable if you start off the conversation in more general terms -- “I have been noticing some changes to my sex life,” or “I am not myself in the bedroom these days.” Once you have gotten the ball rolling, you may feel more comfortable getting into the specifics of your situation. You may also want to ask for a referral to someone who is specialized in sexual health.
In speaking with your partner, it is most helpful to be open about how you feel. This may be uncomfortable, and you may fear rejection or that you will be seen as “less of a man.” I can assure you, however, that your partner loves and cares for you for more than just your erection. The stress of a cancer diagnosis in itself can put a strain on even the healthiest of relationships, with or without changes to your sex life. It is important to say how you feel about the situation, express your feelings and fears, and hear those of your partner as well. Go slowly, listen to your body, and take your time.
Katz, A. (2007) Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Professionals. Oncology Nursing Society: Pittsburgh, PA.