Sex and fertility

Most men worry about whether treatment will interfere with their sex lives or their fertility.

Removing a testicle won’t make you infertile. Your other testicle usually produces enough testosterone and sperm. Surgery to the retroperitoneal lymph nodes may cause sperm to go backwards into the bladder and pass out harmlessly in the urine. You can store sperm before surgery.

Chemotherapy usually has a temporary effect on fertility. However, men having high-dose chemotherapy may become permanently infertile. You’ll be advised to store sperm before it starts. Radiotherapy to the lymph nodes in the tummy doesn’t usually cause infertility.

Treatments won’t make you unable to have sex. The side effects and emotional effects can reduce your interest in sex. If this doesn’t improve, your hospital doctor or nurse can give you advice.

You need to use contraception during treatment as it could damage your sperm. There’s no evidence treatments harm children conceived afterwards. But doctors usually advise carrying on with contraception for a time.

Tell your doctor if you have sexual difficulties after treatment, feel tired or have a low mood. If this is linked with low testosterone levels they can prescribe replacement therapy.

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Sex and fertility

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

Surgery

Removing a testicle won’t affect your ability to get an erection or 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. This can cause sperm to go backwards into the bladder instead of coming out through the penis. This is called retrograde ejaculation. 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 is now less common. However, your specialist may still advise you to think about storing sperm if you need this operation.

Chemotherapy

Chemotherapy won’t affect your ability to have sex, but 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 caused by chemotherapy is usually temporary. How quickly the sperm count recovers varies from person to person. It generally starts to return to normal around 18 months after treatment. Some men with testicular cancer have a low sperm count when they’re diagnosed. Sometimes, successful treatment with chemotherapy improves sperm production.

Men having high-dose chemotherapy may become permanently infertile. If you are worried about this, you can speak to your cancer specialist about your concerns.

Radiotherapy

Radiotherapy to the lymph nodes in the tummy does not affect your ability to have sex and does not 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 someone pregnant. This is because treatment can damage your sperm and could possibly harm a baby conceived at this time.


Effects of treatment on children fathered (conceived) after treatment

There’s no evidence that cancer treatments can harm children that are conceived after treatment. But doctors usually advise you to carry on using contraception for about a year after treatment to avoid fathering a child. 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)

Being diagnosed with testicular cancer brings up a lot of different emotions, such as fear, anxiety and anger. Some men may find that it affects their feelings of masculinity. It’s also common for the side effects of treatment, such as tiredness or sickness, to have an effect on your libido. Coping with all of this can make you feel less interested in having sex. This is understandable. You’ll rediscover your sex drive when your feelings are easier to cope with and you’re recovering from treatment.


Support with sexual difficulties

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. If you have a partner, talking openly to them 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.

You can also talk to your doctor or nurse about any sexual difficulties you are worried about. You may feel embarrassed, but they’ll have experience of talking to other men who have gone through similar problems. They will be able to talk about what support is available for you.

Some hospitals also have counsellors who are specially trained to help people having sexual difficulties. Your doctor can refer you to a counsellor. Many hospitals also have specialist nurses who can offer support.


Testosterone replacement therapy

Removing one testicle doesn’t usually affect your sex drive as long as the other testicle makes enough testosterone to make up for it. 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, an injection into a muscle, an implant, or a patch that is stuck on the skin. Your doctor can give you more information about testosterone replacement therapy.

We have more information about sexuality and cancer for men and useful support organisations on our database.

Back to Beginning to recover

Follow up

You’ll have regular appointments after treatment with possible blood tests, x-rays or scans. It’s very important you go to these.

After treatment

After treatment it takes time to recover. You may think about making changes that can help to improve your well-being.