Overview of sexual dysfunction in male cancer survivors
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Anne Katz, PhD, RN, FAAN
Anne Katz, PhD, RN, FAAN
- CancerCare Manitoba
- Winnipeg MB
For men with cancer, sexual dysfunction is a common issue that has a negative impact on quality of life, irrespective of their involvement in stable relationships or their sexual preferences. While sexual dysfunction can be directly related to the primary diagnosis of cancer, aspects of male sexuality are often impacted to a greater extent by treatment than by disease.
Most of the data on male sexual dysfunction are derived from men with a history of prostate cancer, though research suggests that men with other types of malignancies are also impacted negatively. This topic will discuss sexual dysfunction in male cancer survivors. A separate topic for female cancer survivors and a general overview of male sexual dysfunction are covered separately. (See "Overview of sexual dysfunction in female cancer survivors" and "Overview of male sexual dysfunction".)
MAJOR TYPES OF SEXUAL DYSFUNCTION IN MALE CANCER SURVIVORS
Erectile dysfunction — Erectile dysfunction (ED) is the most common concern for men treated for cancer. ED is defined as the persistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity that persists for at least three months . While ED is common, it may be secondary to another issue, such as the lack of desire or orgasmic issue, medications, or depression or issues with a negative body image. (See "Overview of male sexual dysfunction", section on 'Erectile dysfunction'.)
Sexual bother — When sexual dysfunction is perceived as a problem, causes embarrassment or shame, or reduces one's ability to enjoy life, it is often characterized as sexual bother. While it is associated with the presence of ED, bother can be identified in the absence of ED as well. In one study that included over 180 men who underwent a radical prostatectomy, sexual bother (measured using a validated instrument) increased from baseline at 12 months and was sustained at 24 months in men with and without ED . Of concern, only 7 percent of men with ED moved from "bothered" at 12 months to "not bothered" at 24 months. No clinical factors that predicted bother were identified.
Loss of libido — Loss of libido can be seen in men treated for cancer as a primary consequence of androgen deprivation therapy (ADT) or secondary to ED. Most men are used to living with a robust interest in sex, even though it does decrease with age, and loss of libido causes significant distress. Loss of libido may result in loss of masculine self-image and relationship conflict due to lack of emotional intimacy . (See "Overview of male sexual dysfunction", section on 'Decreased libido'.)
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- MAJOR TYPES OF SEXUAL DYSFUNCTION IN MALE CANCER SURVIVORS
- Erectile dysfunction
- Sexual bother
- Loss of libido
- Other concerns
- PREVALENCE AND RISK FACTORS
- Prostate cancer
- Testicular cancer
- Penile cancer
- Bladder cancer
- Gastrointestinal cancer
- Other cancers
- - Hematologic malignancies/stem cell transplantation
- - Head and neck cancer
- - Lung cancer
- SCREENING AND COUNSELING
- Sexual health questionnaires
- Importance of involving the partner
- Treatment team and referral
- Erectile dysfunction
- - Phosphodiesterase-5 (PDE-5) inhibitors
- Dosing strategy
- - Locally applied therapy
- - Vacuum devices
- - Penile implants
- Other sexual concerns
- Caution with testosterone replacement therapy
- SUMMARY AND RECOMMENDATIONS