Erectile dysfunction (ED) is very common in men, particularly after the age of 50. So it's not surprising that it occurs in quite a few males who have cancer.
Sometimes, it is mainly anxiety about the cancer, and about what the future holds, which is the main cause of the ED. But other factors may include pain, tiredness and the debilitating effects of the illness and of its treatment..
The two types of cancer most likely to be associated with ED are:
- prostate cancer
- cancer of the lower bowel (rectum).
It is more common for the treatments of these cancers to cause ED than the cancer itself.
The prostate gland is located underneath the bladder and it produces a fluid that is part of semen.
Running through the middle of the prostate is the urine channel from the bladder. This means that prostate disease often disturbs bladder behaviour.
Prostate cancer is now the commonest cancer in men and its frequency is increasing. Partly this is because men are living longer, and prostate cancer has always been more common in older men.
There are many types of prostate cancer treatment. The type used depends largely on the stage of the disease.
A potentially curative treatment, radical prostatectomy is an operation to remove the whole prostate gland by surgery.
However, this carries a high risk of disturbing the nerves that go to the penis and therefore can cause ED.
It's difficult to say the percentage of men who suffer ED after the operation because the range of results published in the medical literature varies widely – from as low as 10 per cent to as high as 90 per cent.
The risk of developing ED is reduced when nerve-sparing procedures are used. This means that the surgeon makes a special effort to identify the nerve bundles to the penis as they pass alongside the prostate, and to avoid cutting them.
Unfortunately, even with the surgeon's best efforts, it is not always possible to avoid nerve damage.
ED treatments are potentially effective in men who have had a radical prostatectomy - although they may not all be equally so.
Oral therapy (ie tablets such as Viagra) seems to be less effective in men who have had non-nerve sparing surgery
Trial and error might be required to find the best treatment for an individual.
Transurethral resection of prostate
Some men will have less destructive surgery, called transurethral resection of prostate (TURP). It just involves putting a slim instrument up through the penis, and using it to 'nibble' away some of the prostate from the inside.
The aim of this is to relieve bladder symptoms and improve urinary flow rate, rather than to cure the cancer by removing the prostate gland completely.
In this type of surgery, the nerves are less commonly affected, so ED is less likely to be a problem. If it occurs, therapy with oral tablets should work quite well.
(Please note that TURP is also a common and effective treatment to reduce the size of non-cancerous enlargement of the prostate gland. So-called benign enlargement of the prostate gland is common in men from middle age onwards.)
Non-surgical treatments for prostate cancer
Some non-surgical treatments for prostate cancer can also cause ED and loss of sexual desire. These include radiotherapy (both from outside the gland and from inside it) and also a long list of anti-cancer drugs.
If you do get erection problems caused by radiotherapy or medication, then it is well worth trying any of the available anti-ED therapies, including the Viagra group of drugs.
Cancer of the bowel is another common cancer. If diagnosed early, it can have a very good outcome.
The bowel is very long. It is usually possible to remove the section that contains the cancer, and then join the ends of the bowel back together again. This avoids the need for an artificial opening, or 'stoma', on the tummy wall. The main exception is when the bowel cancer arises in the lowest part – within a few centimetres of the anus. If this is the case, there may not be sufficient healthy bowel below the cancer to allow the surgeon to join together the cut ends. A stoma is then necessary.
Bowel cancer in such a low position means it is usually impossible for the surgeon to avoid damaging some of the nerves in this region - and these will include the nerves to the penis. Erectile dysfunction can therefore be a consequence.
However, as is the case with prostate cancer, treatments for ED may well work – and the most effective one has to be chosen on an individual basis, depending how the patient reacts.
Although there are hundreds of different cancers, and there have been great leaps forward in treating many of them, for most people the 'Big C' is nearly always viewed with alarm.
Once a precise diagnosis is reached and the exact outlook is worked out, many people find things are not quite so bad as they first appeared. Even so, there is no denying the impact the disease has on the individual and their family.
It's common for people with cancer to find their life revolves around medical investigations and treatment, to the extent that everything else becomes subsidiary.
Studies have found that after a diagnosis of cancer, issues such as sexual function get little or no attention – either from the individual himself or from the medical and nursing personnel involved with his treatment.
It's just that sex gets overlooked among the detail of everything else that's going on.
Cancer can be a frightening illness until you fully understood what effect it will have on your life. During this initial period of anxiety, there may well be very little desire for sex.
Other people may respond differently though, and find the intimacy of sex a comfort during this difficult time.
It's likely that once all the facts are known and treatment is under way, a desire for sex will return – although this doesn't necessarily mean it will be easy to resume a sexual relationship.
Any serious illness can cause anxiety and uncertainty.
As far as sex is concerned, there could be a fear that:
- sex could cause physical injuries
- sex could cause the illness to break out again
- the cancer could be contagious or sexually transmitted.
These kinds of worries are usually completely without foundation, but they can make a sexual relationship reach a standstill.
It's vital for couples in this situation to talk to each other, and to a doctor, about their concerns.
Usually it will be enough just to be reassured that all is well, but sometimes the couple will benefit from being referred to a doctor or therapist specialising in psychosexual medicine.
Can it sometimes be dangerous to have sex when you have cancer?
Almost never. Unless the cancer affects the genital area, there is usually no reason why the individual shouldn't have sex, and even then it usually won't be a problem.
While it's true that such a general statement needs to be qualified with the caveat to always check with your doctor first, there are very, very few people for whom sex would present any possible difficulties with their health.
Cancer and fertility
It's important people are kept well informed about their illness and its consequences in the short and the long term, including the possible impact it will have on their sex life or fertility.
In recent years some men undergoing cancer treatment have elected to freeze some of their sperm as an insurance against the difficulties with conceiving that might result from cancer treatment.
This is an area that gives rise to much debate, particularly on its ethical aspects, but it is likely to become an increasingly common practice.
There are many excellent support organisations for people with cancer.
Apart from useful practical advice on the many aspects of living with cancer, it can be a great help to share a problem with others who have gone, or are going, through the same experience.
Some of the major support groups include:
- Macmillan Cancer Support: 0808 808 00 00
- Cancer Research UK: 0808 800 4040
- Prostate Cancer UK: 0800 074 8383.
The GP and nurses in primary care and the staff of the palliative care team are all there to help, too.
Although the issue of sexuality can be overlooked in cancer, it may only require an initial word to the doctor or nurse for it to be recognised – and then treated well.