Fertility and sexuality

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Contents and links: Libido & sexuality | Causes of infertility | Erectile dysfunction | Vaginal pain or dryness | Menopause | Sperm storage  | Ovarian tissue  | Search for fertility clinic | Coping with hot flushes | Vaginal care during radiotherapy | Lifestyle and cancer guide |

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Cancer and its treatments can cause a number of problems related to the function of our sexual organs, fertility and sexuality. These concerns can  be broadly divided into three problem with sexuality (loss of libido, vaginal dryness, erectile dysfunction), fertility (lack of sperm, lack of eggs) and premature menopause (lack of female hormone).

In males, trauma to the pelvic region or spinal cord can damage veins and nerves needed for an erection. Surgery of the colon, prostate, bladder, or rectum may also damage these nerves. Radiotherapy to a lesser extent can also have an adverse affect but this depends on the dose and technique of administration. Drugs given for prostate cancer can reduce the male hormone (testosterone) levels, the most common culprit being LHRH modifiers (eg zoladex) but other drugs for depression and high blood pressure can also compromise sexual function.

In women, radiotherapy to the lower pelvis can damage the glands which moisten the vagina and cause some thickening of the tissues. Drugs such as tamoxifen can cause uncomfortable vaginal discharge and other drugs for breast cancer such as the those known as the aromatase inhibitors (arimidex, aromasin, femara) can cause vaginal dryness. Menopause may reduce the libido in some women. Hot flushes can reduce the sleep pattern impairing libido.

For both males and females psychological wellbeing is very important for a healthy sexual function. Depression, lack out esteem, guilt and anxiety all contribute to loss of libido and erectile dysfunction. If a man experiences loss of erection, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to chronic problems during sex. If the cycle is inescapable, it can result in impotence. Treatment related fatigue and poor sleep patterns can impair libido. Other medical conditions can effect libido even something straight forward such as constipation can affect libido.

How can you help? Medical intervention with lubricants and drugs such as viagra are certainly helpful and various your specialist team should help with this. Various lifestyle interventions may also help particularly for erectile dysfunction (ED). The penis is very sensitive to changes in oxygen and blood supply, in fact ED is often the first sign in men of hardened arteries and reports have shown in men, in general, ED precedes angina by two years unless intervention is not taken. Lifestyle intervention is aimed at improving the blood supply to the pelvis and the oxygen in the blood stream.   The most obvious start, if you smoke is to give up this alone will increase the oxygen in the blood stream by 20%.

Regular exercise will generally improve the state of the blood vessels and increase the flow of oxygen to all tissues including the pelvis, it will also help to loose weight which also helps ED (see how to exercise after cancer).

Pelvic floor exercises are particularly useful as this directly stimulates the muscles around the penis but this need to be performed regularly (see pelvic floor exercises). Diet of course not only will reduce weight, if that is an issue but certain foods have specific benefits on sexual function. Psychological factors in impotence are often secondary to physical causes, and they magnify their significance. The advice to generally improve psychological wellbeing, described above, certainly applies to sexual function

Sexuality - Cancer or its treatments can affect sexuality in a number of ways:

  • loss of libido - Any general illness, psychological upset, loss of self esteem or body image problems. Drugs such as Zoladex in men and women.
  • vaginal dryness - Simply becoming post menopausal, radiotherapy to the vagina, drugs such as aromatase inhibitors (arimidex, aromasin & femara)
  • vaginal pain - Infection, radiotherapy, surgery.
  • erectile dysfunction - Age, hormones, surgery.

Fertility - issues after cancer?

  • how is fertility affected
  • fertility preservation

Menopause - brought on earlier by cancer treatments.

Safety - issues after cancer

Fertility can be impaired in both men and women can occur following chemotherapy, surgery or radiotherapy to the ovaries or testis for the following reasons, In women damage to the ovaries not only leads to infertility but early menopause in men removal of the testis will lead to reduced androgens and a type of menopause but surgery elsewhere in the pelvis and drugs will also lead to erectile dysfunction. The main causes of infertility include:

  • Surgery (removal) of the testis or ovaries
  • Radiotherapy to the testis or ovaries
  • Chemotherapy
  • Hormone therapy particularly LHRH modifiers (eg Zoladex)

In men it is possible to store sperm before chemotherapy. In women it is more difficult but recent developments in technology are now allowing measures  which could allow pregnancy after treatments has completed. Eggs can now be retrieved and stored although alternatives include storing fertilized eggs (ovum) but some centres are looking into storing sections of ovary. In the UK this service is not freely available on the NHS and only a few areas have the necessary licences to conduct such complex procedures (search fertility centres).

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