Managing treatment effects

Treatment effects

Surgery – The removal of one testicle won’t affect erections or orgasms but can affect testosterone levels. RPLND may damage nerves, causing semen to travel backwards into the bladder instead of forwards out of the penis. This still feels like an orgasm, but no semen will come out.

Chemotherapy – Chemotherapy drugs may remain in your system and be present in your semen for a few days. For a few weeks after chemotherapy, you may have some trouble getting and keeping an erection.

Radiation therapy – Treatment to the pelvis may temporarily stop semen production. You will still feel the sensations of an orgasm but will ejaculate little or no semen (dry orgasm). In most cases, semen production returns to normal after a few months.

Managing changes to sexuality and intimacy

• Protect your partner from any drugs in your semen by using barrier contraception, such as condoms, during chemotherapy and radiation therapy and for a number of days afterwards, as advised by your doctor.
• Accept that tiredness and worry may lower your interest in sex and remember that sex drive usually returns when treatment ends.
• Be gentle the first few times you are sexually active after treatment. Start with touching, and tell your partner, if you have one, what feels good.
• Talk openly with your doctor or sexual health counsellor about any challenges. They may be able to help and reassure you.

Download our booklet ‘Sexuality, Intimacy and Cancer’

Treatment effects

Surgery – Most men who have had one testicle removed can go on to have children naturally. Men who have both testicles removed (rarely required) will no longer produce sperm and will be infertile. Men who experience retrograde ejaculation after RPLND will also be infertile.

Chemotherapy and Radiation therapy – Both chemotherapy and radiation therapy can temporarily decrease sperm production and cause unhealthy sperm. It may take one or more years before there are enough healthy sperm to conceive a child. In some cases, infertility may be permanent.

Managing fertility changes

• Use sperm banking to store sperm before cancer treatment for use at a later date. Samples can be stored for many years. Although there is a cost involved, most sperm-banking facilities have various payment plans to make it more affordable. Ask your cancer specialist to refer you to a fertility specialist so you can find out more about your options.
• Avoid pregnancy until sperm are healthy again by using contraception during and after chemotherapy or radiation therapy for about 6 –12 months, as advised by your doctor. You may need a sperm analysis test to determine this.
• If infertility appears to be permanent, talk to a counsellor or family member about how you are feeling. Infertility can be very upsetting for you and your family, and you may have many mixed emotions about the future.

Download our booklet ‘Fertility and Cancer’

Treatment effects

Surgery – If you have had a testicle removed, it may affect how you feel about yourself as a man. You may have less confidence and feel less sexually desirable. Some men adjust quickly to having one testicle, while others find that it takes some time.

Chemotherapy and Radiation therapy – Any type of cancer treatment can change the way you feel about yourself (your self-esteem). You may feel less confident about who you are and what you can do, particularly if your body has changed physically. Some men find that their sense of identity or
masculinity is affected by their cancer experience.

Adjusting to appearance changes

• Give yourself time to get used to any changes to your body. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts of you that have changed.
• Talk to other people who have had a similar experience. You can call Cancer Council 13 11 20 to find out about our peer support programs or visit the Cancer Council Online Community.
• Let your partner, if you have one, know how you are feeling. Show your partner any changes and let them touch your body, if you are both comfortable with this.
• If you continue to be concerned about your appearance, you may wish to speak to your medical team about getting an artificial testicle (prosthesis).
• You may also find it helpful to talk to a psychologist if you are having trouble adjusting to any changes – ask your GP for a referral.