Sexuality and Reproductive Issues (PDQ®): Supportive care - Patient Information [NCI] - Factors Affecting Sexual Function in People With Cancer
Both physical and psychological factors contribute to the development of sexual dysfunction. Physical factors include loss of function due to the effects of cancer therapies, fatigue, and pain. Surgery, chemotherapy, and radiation therapy may have a direct physical impact on sexual function. Other factors that may contribute to sexual dysfunction include pain medications, depression, feelings of guilt from misbeliefs about the origin of the cancer, changes in body image after surgery, and stresses due to personal relationships. Getting older is often associated with a decrease in sexual desire and performance, however, sex may be important to the older person's quality of life and the loss of sexual function can be distressing.
Surgery can directly affect sexual function. Factors that help predict a patient's sexual function after surgery include age, sexual and bladder function before surgery, tumor location and size, and how much tissue was removed during surgery. Surgeries that affect sexual function include breast cancer, colorectal cancer, prostate cancer, and other pelvic tumors.
Sexual function after breast cancer surgery has been the subject of much research. Surgery to save or reconstruct the breast appears to have little effect on sexual function compared with surgery to remove the whole breast. Women who have surgery to save the breast are more likely to continue to enjoy breast caressing, but there is no difference in areas such as how often women have sex, the ease of reaching orgasm, or overall sexual satisfaction. Having a mastectomy, however, has been linked to a loss of interest in sex. Chemotherapy has been linked to problems with sexual function.
Sexual and bladder dysfunctions are common complications of surgery for rectal cancer. The main cause of problems with erection, ejaculation, and orgasm is injury to nerves in the pelvic cavity. Nerves can be damaged when their blood supply is disrupted or when the nerves are cut.
Newer nerve-sparing techniques for radical prostatectomy are being debated as a more successful approach for preserving erectile function than radiation therapy for prostate cancer. Long-term follow-up is needed to compare the effects of surgery with the effects of radiation therapy. Recovery of erectile function usually occurs within a year after having a radical prostatectomy. The effects of radiation therapy on erectile function are very slow and gradual occurring for two or three years after treatment. The cause of loss of erectile function differs between surgery and radiation therapy. Radical prostatectomy damages nerves that make blood vessels open wider to allow more blood into the penis. Eventually the tissue does not get enough oxygen, cells die, and scar tissue forms that interferes with erectile function. Radiation therapy appears to damage the arteries that bring blood to the penis.