Questions Adult Males Have About Cancer and Sex

Every person with cancer is different, and there are many different types of surgeries and treatments for cancer. Sexuality and intimacy have been shown to help people face cancer by helping them deal with feelings of distress, and when going through treatment. But, the reality is that a person's sex organs, sexual desire (sex drive or libido), sexual function, well-being, and body image can be affected by having cancer and cancer treatment. How a person shows sexuality can also be affected. Read more in How Cancer and Cancer Treatment Can Affect Sexuality.

Sexuality is very personal. Because each person's situation is different, we cannot list every possible problem here. It's important to ask questions so your cancer care team can answer them so your stress, anxiety, and fears can be lessened, and you can get help to manage any sexual problems you might have.

This information is for adult males with cancer. If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

Questions to ask about sex or your sexuality

People with cancer might be concerned about changes in appearance due to scars or hair loss, loss of a body part, sexual function, sexual performance, being able to have a child, and if it's safe to have sex. Depending on the type of cancer, surgery, and treatment needed, there are some situations when precautions need to be taken or when sex may need to be avoided for a while. This can be different for everyone, so we cannot list all possible situations here. It's important to ask questions so your cancer care team can answer them and your stress, anxiety, and fears can be lessened.

Don't assume your doctor or nurse will ask you about these and any other concerns you have about sexuality. You might have to start this conversation yourself. Many studies have found that doctors, nurses, and other members of a health care team don’t always ask about sexuality, sexual orientation, or gender identity during check-ups and treatment visits. Because of this, patients might not get enough information, support, or resources to help them deal with their feelings and sexual problems. But if you are concerned about how cancer or its treatment might affect (or has affected) your sex life, it’s important to bring it up and to get answers to your questions, even if it makes you uncomfortable.

After a cancer diagnosis

For a period of time when you are first diagnosed, your mind may not have been able to focus on anything except your cancer. You may have very few sexual feelings because many people are more concerned about the future than about having sex. In some cases, surgery or treatment is scheduled very quickly after a diagnosis. In other cases, you have some time (maybe several days or weeks) to let the diagnosis sink in. Here are a few questions you can ask to start the discussion with your cancer care team in the time between your diagnosis and surgery or treatment. Starting sexual discussions early might help you feel more comfortable talking about them throughout your cancer journey.

• What kinds of sexual problems might happen because of my cancer?
• Is it safe to have sex before my surgery and treatment?
• Do I need to use protection or birth control before my surgery and treatment?

Before surgery

If having surgery to remove a tumor or body part is in your treatment plan, here are some questions you might want to ask before the procedure. Keep in mind not all of these questions are right for everyone. What questions you ask depend on your age, stage in life, relationship status, and the type of cancer and surgery you're having. If you forget or don't think about asking them before surgery, it's a good idea to ask questions as soon as possible after surgery. This way, you know what to expect as you recover from your operation.

• How will this surgery affect my appearance?
• Does a body part or organ need to be removed? If so, will it be removed partially or completely? Can it be replaced, transplanted, or reconstructed?
• How big will my scar be?
• How will this surgery affect my sex life? Will it affect my sexual desire, response, or function? What can be done about these effects?
• How soon can I have sex after my surgery?
• Are there any types of sex or positions I should avoid when I start having sex again?
• Will I be able to have children after this surgery?

Before radiation therapy, chemotherapy, hormone therapy, targeted therapy, or immunotherapy

If having radiation, chemo, hormone therapy, targeted therapy, or immunotherapy is in your treatment plan, here are some questions you might want to ask before it starts. Keep in mind not all of these questions are right for everyone. What questions you ask depend on your age, stage in life, relationship status, and the type of cancer and treatment you're getting. If you forget or don't think about asking questions before treatment, it's a good idea to ask them as during your treatment visits or check-ups. It's also good to keep asking questions and following up on problems you've brought up at past visits.

• How soon will treatment start?
• What side effects can I expect?
• How will this treatment affect my appearance?
• Will I lose my hair? If so, when and how much?
• Will I gain or lose weight?
• Can I exercise during treatment?
• How might treatment affect my sex life? Will it affect my sexual desire, response, or function? What can be done about these effects?
• Do I need to use birth control while I'm getting treatment? For how long?
• Does my partner need to use birth control while I'm getting treatment? What about afterward? For how long?
• Can my cancer, medication, or treatment be passed to my partner through my body fluids?
• What safety measures do I need to take, and for how long?
• Will I be able to have children after treatment?

During and after cancer treatment

Many times sexual problems or side effects that affect your sexuality happen during treatment, and might continue for a while afterward. It's important to know what precautions might be needed at certain times. It's also important to report any side effects while you're getting treatment and during follow-up visits, as well as any changes you notice in sexual desire and function. Ask questions about them, because sometimes these problems come and go, and sometimes they can last.

Questions to ask during treatment about safety and protective precautions might be needed, such as:

• If you are getting certain types of radiation therapy where is it unsafe to be physically close to your partner.
• If you are getting certain types of chemo, targeted therapy, or immunotherapy that might be released in your body fluids, including sweat, saliva, and semen.
• If you are getting a treatment that might cause birth defects if your partner gets pregnant.
• If you have decreased white blood cells that cause you to have weakened immunity and make you more prone to infection.
• If you have a decreased platelet count that can make you prone to easy bruising or bleeding.

Other questions you might have during and after treatment could be related to:

• Problems you might be having in your sex life, such as problems getting or keeping an erection, problems with ejaculation, or if you feel like your sexual desire is lower.
• Side effects that might be affecting your sex life, such as anxiety, depression, sleep problems, fatigue, pain, numbness and tingling, nausea, or bowel or bladder problems.

You probably have many other questions that haven’t been addressed here. If the questions you had before starting treatment were not asked or answered, or if you can't remember the answers you were given, ask them again. If you're not sure a problem you're having is related to your treatment, ask about it anyway. Don’t be afraid or embarrassed to discuss them with your doctor or other members of your cancer care team. Write them down so you’ll remember to ask them. Remember, if your cancer care team doesn't know you're having a problem, and you don't tell them about it, they can't help you manage it.

Getting professional help

Many health care professionals, including cancer doctors and nurses, have little training in sexuality issues.

If your cancer specialist can’t help you, you can be examined by a urologist (a medical doctor trained in diseases of the urinary tract and male genitals) with extra training in how to treat sexual problems. Many urologists perform surgery or prescribe medical treatments for erection problems. They also have the special equipment that may be needed to find the cause of an erection problem.

When the most likely cause of a sexual problem is a hormone imbalance, a medical doctor called an endocrinologist can be consulted. Endocrinologists are experts in the complex cycles and systems that control hormone levels. Usually your primary doctor is best able to decide if you need the special knowledge of an endocrinologist to solve your problem.

If your cancer specialist or family doctor is not able to help you, they can refer you for help. There are many different programs and specialists that can help you find the answers you need.

Sexual rehabilitation programs

A center that specializes in treating cancer may have experts on its staff that can assess and treat sexual problems. Ask your cancer care team if any programs are offered or where you can go to get help.

Sex therapists and other types of counselors

Sex therapy is psychotherapy or counseling that's focused on solving a sexual problem.

Sex therapists may practice in a clinic or alone. Look for a sex therapist who is a mental health professional (a psychiatrist, psychologist, social worker, or psychiatric clinical nurse specialist or nurse practitioner) with special training in treating sexual problems.

Psychotherapy can help you feel better about the changes in your body, help you and your partner communicate more clearly, and give you skills to better cope with the cancer and cancer treatment. Couples counseling may be helpful, too.

Finding a well-qualified mental health professional is important. These are some of the different types of mental health professionals out there:

• Psychiatrist: This is a medical doctor (an MD or DO) with a specialty in psychiatry. They should also be certified by the American Board of Psychiatry and Neurology.
• Psychologist: Most who are practicing alone have a doctorate in psychology (PhD or PsyD) or in education (EdD). Psychologists do not have medical degrees and don’t write prescriptions. Psychologists with a master’s degree are most often supervised by one with a doctorate. In most states a psychologist must be licensed. Those who practice usually have degrees in clinical or counseling psychology.
• Social worker: A social worker usually has master’s degree in social work (MSW). Licensing laws vary from state to state. Some states have a category for licensed psychotherapists called “marriage and family counselors.” They usually have a master’s degree in psychology or a related field, plus training in counseling.
• Psychiatric clinical nurse specialists or psychiatric nurse practitioners: These nurses have a master’s or doctorate degree in psychiatric nursing. They are licensed professionally, although their ability to prescribe medicines varies from state to state.

The cost of counseling varies with the professional’s training and experience, and health insurance companies reimburse at different rates. You may want to check with your insurance company to find out if it will pay (and how much it will cover) for counseling or therapy.

Professional societies can often give you information about their members in your area who have special training in sex therapy. These are good places to start:

• American Association of Sex Educators, Counselors, and Therapists (AASECT)
  www.aasect.org

• National Association of Social Workers (NASW)
  www.helpstartshere.org

You can also get a listing of professionals in your area by contacting your state’s psychological association or a state association for licensed marriage and family therapists.