| The Testicular Cancer Resource Center |
When the topic of TC comes up, undoubtedly one of the main
concerns raised by men has to do with one of our favorite topics: SEX.
These are all VERY valid questions and ones that should be raised with your doctor. We have done some research into this matter, and here's what we have found so far.
Many men worry that losing one testicle will affect their ability to have sexual intercourse or will make them sterile or impotent. But a man with one healthy testicle can still have a normal erection, and the remaining testicle will usually produce enough testosterone and sperm for normal sexual function and fertility. Therefore, the operation to remove just one testicle, called an inguinal orchiectomy (IO), does not normally make a patient impotent.
Nevertheless, it still is surgery. It is usually best to wait until the incision has healed and you are comfortable before resuming intercourse. Follow your surgeon's instructions about when you can return to normal physical and sexual activity.
RPLND and Ejaculation
Surgery to remove the retroperitoneal lymph nodes (RPLND) will not alter a man's ability to have an erection or an orgasm, but it can interfere with ejaculation. During ejaculation, sympathetic nerves in the retroperitoneum help move semen into the urethra and close the opening to the bladder so the semen travels out through the penis. Those nerves run through the area where the lymph nodes are removed during an RPLND. If they are damaged, semen may flow backward into the bladder instead of coming out through the penis. This is called retrograde ejaculation. In some men, little or no semen comes out at all.
The important thing to understand is that erection, orgasm, ejaculation, fertility, and sexual pleasure are not the same thing. A man can still have erections, want sex, have an orgasm, and enjoy sex even if little or no semen comes out. Many men say a dry orgasm feels essentially the same, just without the wet spot, although some say it feels different.
In the past, ejaculation problems were very common after RPLND. Today, nerve-sparing techniques have greatly improved the odds of preserving normal forward ejaculation. When nerve sparing is appropriate and a primary RPLND is performed by an experienced testicular cancer surgeon, forward ejaculation can be preserved in more than 90% of men. RPLND after chemotherapy can be more difficult, and the chances may be lower.
Certain medications can sometimes temporarily restore forward ejaculation. And even if normal ejaculation cannot be restored, that does not necessarily mean losing the ability to have biological children. As always, if fertility or forward ejaculation are important to you, make sure your surgeon has extensive experience with nerve-sparing RPLND.
Radiation, Chemotherapy and Sex
If you end up having radiation therapy for testicular cancer, it does not directly interfere with your ability to have an erection or an orgasm. Chemotherapy also does not normally damage the nerves or structures needed for erections or orgasm.
That does not mean treatment has no effect on your sex life. Fatigue, nausea, stress, temporary hormone changes, and simply feeling lousy can reduce your interest in sex for a while. Different men react very differently, and things often improve as treatment ends and you recover.
Both radiation and chemotherapy can also affect sperm production, but that is a fertility issue rather than a sexual-function issue. We cover that in much more detail on the TCRC Fertility page.
Sex During Chemotherapy
If you are receiving chemotherapy, ask your oncology team what sexual precautions they recommend. Small amounts of some chemotherapy drugs can be present in semen for a short time, so using a condom may be recommended during treatment and for a period afterward.
Chemotherapy can also damage sperm, so pregnancy should be avoided during treatment and for the period your oncology team recommends afterward. The exact time depends on the drugs and treatment you received, so there is no single rule that is right for everyone.
Sex Drive
Regarding sex drive, testicular cancer survivors we have spoken with have told us everything from having sex the day after their IO (ouch!) all the way through having very little interest in sex for quite a while. Just as each one of us is different going in, we're going to be just as different coming out, too.
One healthy remaining testicle will usually make enough testosterone, but some testicular cancer survivors do develop low testosterone. Fatigue, stress, depression, medications, and the emotional impact of cancer can also affect sex drive. One big key is to keep the patient-doctor communication lines open, before and after any treatments. If you feel different, or just out of whack, let your doctor know. If low testosterone is a possibility, it can be checked with a blood test.
What About Appearance?
This is often a much bigger worry before the orchiectomy than it turns out to be afterward. Losing one testicle is usually far less noticeable than men expect. The remaining testicle and the scrotum often look normal enough that the guy changing next to you in the locker room is unlikely to notice anything unless he is deliberately looking. Even a sexual partner may not notice unless they know what to look for or get very up close and personal.
Over the years, we have heard from many partners who basically say the same thing: the missing testicle matters much less to them than it does to the man who lost it. That does not mean the concern is silly. Some men, particularly younger or single men who are thinking about future partners, can be very self-conscious about the change.
If the appearance bothers you, a testicular prosthesis is an option. It can be placed during the orchiectomy or later. There are advantages and disadvantages, and it is a very personal decision. The TCRC Testicular Implants page includes information about prostheses as well as comments from men who chose to get one, men who did not, and their partners.
Finally, I would like to stress that testicular cancer is not contagious and it cannot be transmitted via sexual intercourse. There are a lot of reasons to be afraid of cancer, but this is not one of them!
