Your sex life and testicular cancer

Treatment for testicular cancer can affect your sex life. This is usually just for a short time. 

Testicular cancer and its treatments can cause a loss of interest in sex. This is also called a low libido or sex drive. This can be for a few different reasons including tiredness after treatment. 

Some people with testicular cancer worry that:

• you can pass on cancer cells to your partner during sex
• ejaculation might make your cancer worse

These things are not true. Cancer isn't infectious. Ejaculation doesn't make it worse in any way.

How does treatment affect your sex life?

Most people are able to have a normal sex life after having testicular cancer. You will need time to get over surgery, or any other treatment.

The side effects you have will depend on what treatment you have.

Removing one testicle (orchidectomy)

Most men with testicular cancer have surgery to remove the affected testicle. Having one testicle removed shouldn't affect your long term:

• ability to father children (fertility)
• sexual performance
• sex drive (libido)

The remaining testicle usually makes more testosterone (the male sex hormone) and sperm. This makes up for the removed testicle. But for some men their remaining testicle might not work so well. This could reduce your fertility. Your doctor will offer you sperm banking before surgery.

You might also feel less like having sex, at least for a while, after your surgery.

Removing both testicles (bilateral orchidectomy)

It isn't common to have testicular cancer in both testicles.  If you do have cancer in both testicles you need surgery to remove them both.

The testicles produce the hormone testosterone. After removal of both testicles, the level of testosterone in the blood falls quickly. This will affect your sex life and your ability to have children (fertility).

To maintain your sex drive and be able to get an erection you would need testosterone replacement therapy.

Testosterone can be replaced by:

• injections into the muscle of your arm or leg every 2 to 3 weeks
• skin patches (like plasters) that give a small dose through the skin all the time
• gel that you rub onto your skin every day

Removing lymph nodes (retroperitoneal lymph node dissection)

You might need this surgery to remove lymph glands at the back of your tummy (abdomen). This operation is called a retroperitoneal lymph node dissection (RPLND). It is a large operation.

The operation can damage nerves that control the release of sperm (ejaculation). This could affect your sex life and your ability to have children in the future. 

You can still get an erection and have an orgasm. But a side effect of this surgery is dry ejaculation. The surgery can make you ejaculate backwards. This is called retrograde ejaculation. Your semen and sperm go back into your bladder instead of coming out of your penis.

Before you have surgery your doctor will talk to you about sperm banking.

Chemotherapy

Always use reliable contraception during your treatment. It is not advisable for your partner to become pregnant, as the treatment drugs could harm the baby.

It is not known for sure whether chemotherapy drugs can be passed on through semen Because of this some doctors advise people to use a barrier method (such as condoms, femidoms or dental dams) if you have sex during treatment. This applies to vaginal, anal or oral sex.

Generally, doctors advise a barrier method only for the time you are actually having the treatment and for about a week after your treatment.

Advice like this can be worrying, but this does not mean that you have to avoid being intimate with your partner. You can still have close contact with your partner and continue to enjoy sex.

Coping with changes to your sex life

It can be helpful to have more information about any problems or changes you experience. There might be also be practical advice or other treatments that can help.

Coping with a low sex drive.

Cancer and its treatment can make you lose interest in having sex.

Sex and cancer if you are single

If you are single and have cancer, you may have concerns about starting a new relationship, dealing with infertility or coping with rejection. 

Supporting your partner if they have cancer

You may be wondering how to deal with any changes in your sex life if your partner has cancer. This might include issues around communication, supporting your partner or contraception.

Coping with other problems caused by cancer and its treatment

Find out more about:

• difficulty getting an erection 
• problems after surgery to your pelvis or genitals
• sperm banking

Talking about sexual difficulties

With doctors and nurses

Your sex life is very personal. You may find it difficult to talk with a doctor or nurse about any sexual difficulties you have from treatment.

Doctors and nurses deal with these situations all the time. They are used to talking about them so try not to feel embarrassed.

You can ask them to refer you to a specialist counsellor or a sex therapist.

With your partner

You may be uncomfortable discussing sexual difficulties with your partner. You might think they could reject you or be angry in some way.

Your partner is likely to be relieved that you want to talk things over.

They could have been trying to find the right time to raise the subject themselves. You may feel even closer after you have talked any difficulties through.