Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

Abstract

Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED.

Sexual Health After Cancer Therapy

“…What research has now made clear is that the partner plays a crucial role in coping with the impact of cancer treatments on the quality of life of the patient, a perspective that was not mentioned by Voznesensky et al 3 An excellent review that underscores the role of the sexual partner in managing ED of any cause was recently published and is applicable to patients with cancer as well. 4 The review by Voznesensky et al 3 assumes that the goal of treatment of ED is the return of erectile function and ability to have coital sex. However, there is now a strong trend in the field toward a more holistic approach to sexuality that incorporates more than penetrative activities.…”

“…Often, nonsexual intimate activities and/or nonintercourse sexual activities can be most gratifying for the patient and the partner. 5 Other caveats specific to treatments for ED that were not discussed by Voznesensky et al 3 should be mentioned. Almost 75% of patients discontinue use of oral agents after 1 year, commonly because of lack of efficacy despite achieving an erection.…”

“…2 The impact of prostate cancer treatments on erectile dysfunction (ED) is well known. However, the review by Voznesensky et al 3 highlights the fact that treatment of men with other malignancies, including bladder, testicular, colorectal, and those treated with marrow or peripheral stem cell transplant, can also play havoc with erectile function. The authors explain the anatomy and physiology of normal erections and explain how surgery, radiation, chemotherapy, and hormonal therapy can cause ED, dry ejaculation, climacturia (leaking urine during orgasm), or anorgasmia (difficulty reaching orgasm).…”

Managing Erectile Dysfunction After Cancer: More Than Penile Rigidity

“…For Voznesensky et al, 1 the goal of treatment is to restore a man's ability to have hard erections. Libido is mentioned once in the introduction, but the rest of their review focuses narrowly on the penis and its rigidity.…”

Penile prosthesis in the management of erectile dysfunction following cancer therapy

“…ED commonly occurs following local treatment for prostate and other pelvic cancers. The direct and indirect mechanisms by which pelvic surgery and radiation impair erectile function has been extensively reviewed ( 2 ). Furthermore, these malignancies most commonly affect older men, who may suffer from decreased erection quality due to aging and are consequently more vulnerable to further vascular or neurological insult.…”