Testicular cancer, sex and fertility

Treatment for testicular cancer does not affect your ability to have sex but it may affect your fertility or reduce your sex drive. This is usually temporary.

Effects of treatment on 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. This section explains how treatment may affect your sex life and fertility. There is also information on contraception during treatment, having children in the future, testosterone replacement and storing sperm (sperm banking).


Removing a testicle will not affect your ability to get an erection or make someone pregnant. The healthy testicle will usually produce enough testosterone and sperm, unless it is very small.

Removing the retroperitoneal lymph nodes (RPLND)

Surgery to remove the retroperitoneal lymph nodes may damage the nerves involved in ejaculation. This can cause sperm to go backwards into the bladder instead of coming out through the penis when you orgasm. The sperm then passes out harmlessly when you next pass urine (pee). 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, such as keyhole and robotic surgery, to try and protect the nerves and reduce the risk of this. But your doctor may still advise you to think about storing sperm if you need this operation.

Urinary sperm retrieval

If you are unable to store sperm before your operation and you have retrograde ejaculation, sometimes specialists can collect the sperm from your pee. They will give you a drink that makes your urine less harmful to your sperm. You will be asked to pee and then masturbate. After you ejaculate, you will have to pee again. The sperm is quickly collected from the urine, prepared and stored.


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 doctor might still suggest you store sperm.


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

Chemotherapy for testicular cancer usually causes infertility but it is usually temporary. Your doctor will talk to you about storing sperm before your treatment. High-dose chemotherapy with stem cell support has a much higher risk of causing infertility, which may be permanent.

If you need to start chemotherapy straight away, there may be no time to give and store sperm samples. But you may be able to store sperm within the first few days of starting chemotherapy.

How quickly the sperm count recovers after chemotherapy can vary. It can depend on:

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

Your sperm count usually starts to return to normal about 18 months to 2 years after treatment. But it can take longer for some people. You can ask to have your sperm count checked.

If you have a low sperm count before starting chemotherapy, the treatment can sometimes improve sperm production.

If you are worried about infertility, you can speak to your cancer specialist doctor.

Sex life and sex drive

Treatments for testicular cancer do not usually affect your ability to have sex. But a diagnosis of testicular cancer can cause a lot of feelings. This may affect your sex drive (libido) for a time.

Treatment side effects may also mean you have a lower sex drive. If you have a partner, let them know how you feel. It can take time to recover physically and emotionally.

If you find you have a low sex drive, this will usually improve as your feelings get easier to cope with and you recover from treatment. If you are having sexual difficulties, there is support available.

Testosterone replacement therapy

Removing one testicle does not usually affect your sex drive. The remaining testicle should make enough testosterone on its own.

Sometimes the remaining testicle does not produce enough testosterone. Or, rarely, both testicles have to be removed because of cancer.

A lack of testosterone can:

  • affect your ability to get an erection
  • reduce your sex drive
  • 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, your doctor may be able to prescribe testosterone replacement therapy to improve your symptoms. You can have it as a gel, an injection into a muscle, an implant, or a patch that you stick to the skin. Your doctor can give you more information about testosterone replacement therapy.

Sex and testicular cancer

Sexual difficulties are very personal. A common worry is that you can pass cancer cells on during sex. Cancer is not infectious, so it is safe for you to have sex. Whatever feelings or concerns you have, it can help to talk to someone.

  • Talking to a partner – if you have a partner, it can help to talk openly to them about any problems you are having. You might find that 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 meet someone new, you may want to give yourself some time to feel comfortable in the relationship before talking about any concerns you may have.
  • 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 speaking to others who have had similar problems. Many hospitals also have specialist nurses who can offer support. Some hospitals have counsellors who have had special training to help people who are having sexual difficulties. They are called sex and relationship therapists.
  • Talk to others in a similar situation – sometimes it helps to talk to someone who is going through the same thing. You can find support by visiting our testicular cancer forum.
  • Support organisations – ask your team about support groups. You can also contact support organisations such as Orchid and the College of Sexual and Relationship Therapists.

If you identify as gay, bisexual or transgender

Many sexual difficulties caused by testicular cancer are similar whatever your sexual orientation 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 feel unable to talk to your healthcare team about your sexuality, the LGBT Foundation has a helpline that can give you confidential advice and support.

We have more information about sex and cancer.

Booklets and resources


Treatment for testicular cancer usually does not affect your ability to make someone pregnant (your fertility). But even if your chances of becoming infertile are low, your doctor usually advises you to store (bank) sperm. You usually do this before having an orchidectomy. If this is not possible, it is important to do it before you have any further treatment.

If you are trans or non-binary, considering the possible effect on your fertility may feel even more overwhelming. But it is important to know your options about preserving fertility so you can make an informed decision. You can talk to your specialist doctor or nurse about any concerns you might have about this.

Having children after treatment

There is no evidence that cancer treatments can harm children you have (conceive) after treatment. It is usually possible to make someone pregnant if you have had treatment for testicular cancer, after you have recovered.

But doctors usually advise you to continue using contraception for about 1 year after radiotherapy and chemotherapy, to avoid making someone pregnant. This allows your sperm time to recover from any damage that 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 GP can also advise you on this.

Storing sperm (sperm banking)

Even if your chances of becoming infertile are low, your doctor will usually advise you to store some sperm. They will talk to you about this before you have your operation. If it is appropriate for you, you usually store sperm before you have an orchidectomy. But if this is not possible, it is important to do it before you have any further treatment. This is because this treatment could damage your sperm.

You will have counselling at the fertility clinic before you store your sperm. You also need to sign a consent form that states how your sperm will be used. You will have blood tests as well. These will check your general health, and for infections such as HIV or hepatitis.

Sperm banking is a safe technique that has been used for many years. It involves freezing your sperm. If you want to have a child later in life, your sperm can be used with fertility treatments. The usual period of time for storing sperm is 10 years. But, in some circumstances, you may be able to store it for longer. People affected by cancer may be able to store their sperm for up to 55 years.

Sometimes the NHS pays for sperm banking for people with cancer. But it varies across the UK, and in some hospitals you may have to pay for it yourself. Even if the hospital pays for storage to begin with, you may need to pay if you choose to store sperm for a longer period of time. The staff in the fertility clinic or your specialist doctor or nurse can explain more about this. If you have to pay, the average yearly cost is between £175 and £450 per year.

Sometimes treatment needs to start straight away, and there is no time to take sperm samples. If your doctor feels your treatment needs to start straight away, they will talk to you about this. You may still be able to store sperm if you do it in the first few days of starting chemotherapy.

If you are trans or non-binary, you may find the thought of giving a sperm sample very difficult. It may help to talk to a:

  • gender identity clinic, if you attend one
  • sexual health and well-being service that is trans and non-binary friendly. You can check if this is available in your area on Tranzwiki.

The fertility clinic at the hospital may also be able to give you advice and support.

Other sperm collection techniques

If you are not producing enough sperm, or you started treatment too quickly to give enough samples, you can still store sperm.

It is possible to collect sperm by taking a piece of testicular tissue or some fluid. Doctors can remove small amounts of testicular fluid or tissue by putting a fine needle into the testicle. Or they can make a small cut in the scrotum. They can do this using a local or general anaesthetic. The fluid or tissue is checked 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 these techniques.

We have more information about sexuality and cancer and cancer treatment and fertility.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

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We want everyone affected by cancer to feel our information is written for them.

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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

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Date reviewed

Reviewed: 01 May 2022
Next review: 01 May 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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