The effect of cancer on sexual function

Despite the decrease in overall cancer incidence and mortality rates in developed countries since the early 1990s, cancer remains a major public health problem. Among men, the most common cancers are cancers of the prostate, lung, colon and rectum. Sexual well‐being may be altered by both the diagnosis and treatment of cancer. This in turn can have a deleterious impact on quality of life. Sexual dysfunction is often unrecognized, underestimated and untreated.

Sexual dysfunction is one of the more common consequences of cancer treatment. Men are less likely than women to seek professional help for mental and physical health problems. Sexual dysfunction in cancer patients may result from biological, psychological and social factors, just as they do in healthy men. Biological factors such as anatomic alterations (rectum amputation, penile amputation), physiological changes (hormonal status) and secondary effect of medical intervention may preclude normal sexual functioning even when sex desire is intact. The patient's physical status is related to both the stage of the disease and the type of medical intervention. Side effects of the treatment such as nausea, vomiting, fatigue, hair loss can result in adverse effects on sexuality together with disfiguring surgery. Negative emotional states such as anxiety, depression, anger may disrupt sexual activity. Disturbances of body image can contribute to the development of sexual dysfunction: orchiectomy is such an example. Other important psychological factors etiologically significant for sexual dysfunction are financial difficulties and occupational changes. Radiotherapy and surgery are the most effective treatments for prostate cancer. Erectile dysfunction (ED) is reported in 6–80% after external‐beam radiotherapy and 2–61% after brachytherapy. ED after surgery is reported in 40–100%. Ejaculation problems and a decrease in libido occur in up to 80%. Testicular cancer affects mostly young men in their fertile and sexually active life. ED, loss of libido, decreased orgasm have been reported in about 20% of these patients.