How treatment for testicular cancer might affect your fertility and sex life
It‘s normal to worry about the effects of testicular cancer and its treatment on your sex life, and your ability to father a child.
Effects of treatment on sex life and fertility
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Here’s how different treatments may affect you:
Removing a testicle won’t affect your sexual performance or your ability to father children. The healthy testicle (unless it’s very small) will produce more testosterone and sperm to make up for the testicle that’s been removed.
Men who have an operation to remove the retroperitoneal lymph nodes may get nerve damage, which causes retrograde ejaculation. This means that sperm goes backwards into the bladder instead of coming out through the penis. The sperm is then passed out harmlessly in the urine.
The operation doesn’t stop you from getting an erection but your orgasm will feel different because it’s ‘dry’ (dry climax).
Fortunately, new surgical techniques mean that this problem can usually be avoided. However, your specialist may still advise you to think about storing sperm if you need this operation.
Although chemotherapy won’t affect your ability to have sex, the side effects might reduce your sex drive for a while.
Chemotherapy often causes infertility, so your doctor will talk to you about storing sperm before your treatment. High-dose chemotherapy has a much higher risk of causing infertility.
Infertility is usually temporary. The rate at which the sperm count recovers varies from person to person. It generally starts to return to normal around 18 months after treatment. Men having high-dose chemotherapy may become permanently infertile.
Some men with testicular cancer have a low sperm count when they’re diagnosed. Sometimes, successful treatment with chemotherapy improves sperm production.
Radiotherapy to the nodes in the abdomen won’t affect your ability to have sex and doesn’t usually cause infertility. But your specialist might still suggest that you store sperm.
Contraception during treatment
While you’re being treated with chemotherapy or radiotherapy, it’s important to avoid getting anyone pregnant. This is because treatment can damage your sperm and possibly harm a baby conceived at this time.
Your doctor will usually advise you to carry on using contraception for about six months to a year after your treatment.
Effects of treatment on children fathered after treatment
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There’s no evidence that cancer treatments can harm children fathered after treatment is over. But doctors usually advise you to avoid fathering a child for about a year after your treatment. This allows time for your sperm to recover from any damage that treatment may have caused.
Many men who’ve been treated for testicular cancer go on to have families after they’ve recovered.
Your sex drive (libido)
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Being diagnosed with testicular cancer brings up a lot of different emotions. Some men may find that it affects their feelings of masculinity. Coping with all of this can make you feel less interested in having sex.
It’s also common for the side effects of treatment, such as tiredness or sickness, to have an effect on your libido.
Although it’s worrying at the time, this is usually temporary. You’ll rediscover your sex drive when your feelings are easier to cope with and you’re recovering from treatment.
Testosterone replacement therapy
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Removing one testicle doesn’t usually affect your sex drive as the other testicle makes enough testosterone to compensate.
Sometimes the remaining testicle won’t produce enough testosterone, or (rarely) a man has to have both testicles removed (because of cancer).
A lack of testosterone can affect your ability to get an erection and reduce your sex drive. It can also cause tiredness, low mood and problems such as thinning of the bones (osteoporosis).
It’s important to let your doctor know if you’re having these or other symptoms. Your testosterone level can be measured by a blood test. If it’s low, your doctor can prescribe testosterone replacement therapy. This will help improve problems such as a low sex drive and feeling constantly tired. It can be given as a gel, as an injection into a muscle, as an implant, or as a patch that is stuck on the skin.
Your doctor can give you more information about testosterone replacement therapy.
Support with sexual difficulties
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A common worry is that cancer cells can be passed during sex. Cancer isn’t infectious, so it’s perfectly safe for you to have sex.
Sexual difficulties are very personal. But talking openly to your partner, if you have one, about any problems you may be having can help. This can be difficult, but you might find that you understand each other better by having an open and honest conversation. Having testicular cancer doesn’t mean that your partner will no longer find you sexually attractive.
You can also talk to your doctor or nurse about any sexual difficulties. Try not to feel embarrassed. They’re likely to have experience of talking to other men with testicular cancer who have gone through similar problems.
Some hospitals also have counsellors who are specially trained to help people having sexual difficulties. Your doctor can refer you to a counsellor.
You can find lots more helpful information in our section on sexuality and cancer.
Possible methods to preserve your fertility
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Most men are still able to father a child after testicular cancer treatment. However, treatment can affect the fertility of some men. This may depend on the type and amount of treatment needed. Your specialist will be able to give you more information about this.
Being told you have cancer and that treatment may affect your fertility can be very difficult. Your fertility may not be uppermost in your mind – getting rid of the cancer is often the priority. But some men may find that the threat of losing their fertility is as difficult to accept as the diagnosis of cancer.
Storing sperm (sperm banking)
Sperm banking is a safe technique that’s been successfully used for many years. It involves the freezing of your sperm.
Even if your chances of becoming infertile are low, your doctor will usually advise you to store 2–3 samples of your sperm.
Sperm storage usually happens after you’ve had an orchidectomy but before further treatment starts. This is because treatment could damage your sperm and may make it unsuitable for future use. Occasionally, some men may be offered sperm storage before an orchidectomy if they have fertility problems or if their unaffected testicle is small.
You’ll have counselling at the fertility clinic before you have sperm banking. You’ll also have to sign a consent form that states how your sperm is to be used. Blood tests will be taken to check whether you have any diseases or infections, such as HIV or hepatitis.
If you want to have a child later in your life, your sperm can be thawed and used with fertility treatments. Sperm samples can be kept frozen until you’re 55. The NHS often pays for sperm banking for men with cancer, but in some hospitals you may have to pay for it yourself.
For some men, treatment needs to start immediately and there’s no time to take sperm samples. If your doctor feels that your treatment needs to start straight away, they will discuss this with you.
You can find more detailed information in our section on cancer treatment and fertility.
Newer fertility techniques
If you aren’t producing many sperm, or if your treatment started quickly and you couldn’t provide all the samples, your sperm can still be stored. A fertility treatment called ICSI (intra-cytoplasmic sperm injection), which only needs a single sperm to fertilise an egg, is now often used.
It’s also now possible to collect sperm by extracting a piece of testicular tissue or fluid. This can be done using a local or general anaesthetic. Small amounts of testicular fluid or tissue are removed by inserting a fine needle into the testicle, or by making a small cut in the scrotum. The fluid or tissue is examined for sperm in the laboratory. The sperm is then removed and stored for future use. Your doctor or nurse at the fertility clinic can give you more information about this technique.