Sex life and fertility

It is normal to worry about the possible effects of testicular cancer and its treatment on your sex life and fertility. Fertility is being able to make someone pregnant. Having more information and support may help to reassure you.

If you identify as gay bisexual or transgender

If you identify as gay, bisexual or transgender, you may worry your healthcare team will treat you insensitively.

Effects on your sex life and fertility caused by testicular cancer are similar, whatever your sexuality or gender identity.

But you may have some specific questions. Having your sexual or gender identity acknowledged may help you feel better supported. It also means your healthcare team can give you the right information and advice.

If you have a partner it can make it easier for them to come to appointments with you. Having your relationship recognised can make you both feel more supported.

Effects of treatment on sex life and fertility

Treatments used for testicular cancer do not usually affect your ability to have sex. But you may find your sex drive is reduced for a time. If you are having problems with your sexual difficulties, there is different support available (see below).

Most men are still able to make someone pregnant after testicular cancer treatment. But some men’s fertility may be affected. This can depend on the type and amount of treatment you have. Your specialist can give you more information about this.

Sperm banking

Even if your chances of becoming infertile are low your doctor usually advises you to store (bank) some sperm. They will talk to you about this before you have your operation. You usually store sperm after you have had an orchidectomy. It is important to have it done before you have any further treatment. This is because treatment could damage your sperm.

Occasionally, men may be offered the option of storing their sperm before they have an orchidectomy. This may be if they have fertility problems, or if their other testicle is small.

We have more information about sperm banking and preserving your fertility.

Orchidectomy

Removing a testicle will not affect your ability to get an erection or father children. As long as your other testicle is healthy, this will usually produce enough testosterone and sperm, unless it is very small.

Removing the retroperitoneal lymph nodes (RPLND)

Men who have an operation to remove the retroperitoneal lymph nodes may get nerve damage. It can cause sperm to go backwards into the bladder instead of coming out through the penis. The sperm then passes out harmlessly in the urine. This is called retrograde ejaculation.

The operation does not stop you getting an erection, but your orgasm will feel different because it is dry (dry climax). Surgeons can use newer surgical techniques to try and protect the nerves and reduce the risk of this. Your specialist may advise you to think about storing sperm if you need this operation.

Radiotherapy

Radiotherapy to the lymph nodes in the tummy (abdomen) does not affect your ability to have sex. It does not usually cause infertility. But your specialist might still suggest that you store sperm.

Chemotherapy

Chemotherapy does not affect your ability to have sex. But side effects might lower your sex drive for a while.

Chemotherapy for testicular cancer often causes infertility but it is usually temporary. High-dose chemotherapy with stem cell support has a much higher risk of causing infertility and infertility is often permanent.

If you need to start chemotherapy immediately and there may be no time to take sperm samples. But you may still be able to store sperm within the first few days of starting chemotherapy.

How quickly the sperm count recovers after treatment can vary and depends on things like:

  • your sperm count before chemotherapy,
  • the type and amount of chemotherapy you have.

Your sperm count generally starts to return to normal around 18 months to 2 years after treatment. But it can take up to 5 years to recover in some men. You can ask to have your sperm count checked.

Some men with testicular cancer have a low sperm count when they are diagnosed. Sometimes, successful treatment with chemotherapy improves sperm production.

If you are worried about the effect of treatment on your fertility, speak to your cancer specialist.

Contraception during treatment

While you are having chemotherapy or radiotherapy, it is important to avoid making someone pregnant. Treatment may damage your sperm and possibly harm a developing baby conceived at this time.

During treatment, it is best to use a barrier method of contraception, such as a condom. This will also protect your partner for the first couple of days after chemotherapy from any chemotherapy that might be in your semen.

After radiotherapy or chemotherapy has finished doctors usually advise you to continue using effective contraception for about a year.

Having children after treatment

There is no evidence that cancer treatments for testicular cancer can harm children conceived after treatment. Many men who have treatment for testicular cancer go on to have children after they have recovered.

Use effective contraception for about a year after radiotherapy and chemotherapy, to avoid making someone pregnant. This allows your sperm time to recover from any damage the treatment may have caused. If you are planning on having a family you can talk to your doctor or nurse about having your sperm count checked.

Your sex drive (libido)

Being diagnosed with testicular cancer brings up a lot of different emotions. This can make you feel less interested in sex or affect your confidence and sexuality. Some men feel it has affected their sense of masculinity or body image. Usually, these feelings go away gradually.

Treatments and their side effects, such as tiredness or sickness, also affect your sex drive.

It can take time to recover physically and emotionally. Your sex drive will improve when your feelings are easier to cope with, and you start recovering from treatment.

Testosterone replacement therapy

Removing one testicle does not usually affect your sex drive. The remaining testicle makes enough testosterone to make up for it. Sometimes, the remaining testicle does not produce enough testosterone. Or rarely, both testicles need to be removed because of cancer.

A lack of testosterone can affect your ability to get an erection and reduce your sex drive. This can also affect your body image. It can also cause tiredness, low mood, and problems such as thinning of the bones (osteoporosis).

Tell your doctor if you are having these or any other symptoms. They can measure your testosterone level with a blood test. If it is low, they can prescribe testosterone replacement therapy to improve your symptoms. Your doctor can give you more information about testosterone replacement therapy.

Support with sexual difficulties

Sexual difficulties are very personal. But whatever feelings or concerns you have it can help to talk to someone.

A common worry is that you can pass cancer on during sex. Cancer is not infectious, so it is safe for you to have sex.

  • Talking to your partner - if you have a partner, it can help to talk openly to them about any problems you are having. You might find you understand each other better by having an honest conversation.
  • Talking to a potential partner - if you are single, you may have some concerns about starting a new relationship, or having sex with someone new. If you want to make a strong commitment to a new partner you may want to discuss your situation.
  • Support from your healthcare team - talk to your doctor or nurse about any sexual difficulties you have. You may feel embarrassed, but they have experience of talking to other men who have gone through similar problems. Many hospitals have specialist nurses who can offer support. Some hospitals have counsellors specially trained to help people having sexual difficulties (sex and relationship therapists).
  • Support organisations - you can also contact support organisations like Orchid, The College of Sexual and Relationship Therapists, or join our online community.

We have more information about cancer and sex.

How we can help

Macmillan Grants

If you have cancer, you may be able to get a Macmillan Grant to help with the extra costs of cancer. Find out who can apply and how to access our grants.

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