Reproduction and Sexuality
Not all chemotherapy treatment will result in side effects that relate to your reproductive ability or sexuality, but some may. Reproductive problems are a frequent side effect of cancer treatment, especially chemotherapy. Patients may recover their ability to have children or this side effect may be permanent. Hormonal therapy may help some women overcome reproductive problems. For men, storing sperm before undergoing treatment should be considered in case reproductive function is permanently damaged. Sexual dysfunction is also common, but open communication with your partner and doctor as well as taking steps to improve your self-esteem can help.
What reproduction or sexuality side effects may occur?
It is perfectly natural for people who have been diagnosed with cancer to be concerned about the effect of their illness on their sexuality. Especially right after the diagnosis, you may temporarily lose interest in sex as you focus on understanding your cancer and the treatments available. During or after treatment, you may have difficulty accepting the way your body looks or functions and may have fears about your partner’s acceptance of the changes.
Changes in your reproductive abilities or sexuality due to cancer treatment may include:
- Gynecomastia (formation of breast tissue in men)
- Impotence (inability to achieve or sustain an erection)
- Irregular menstrual cycles
- Menopause, and related symptoms
- Reduced sexual desire
- Vaginal dryness
Some of these side effects will resolve after treatment is completed, while others may be more long term.
Which chemotherapy drugs cause reproductive problems?
All chemotherapy drugs can affect reproductive abilities; however, the class that is most commonly associated with reproductive problems are the alkylating agents, see table 1, as well as several other chemotherapy drugs.
Table 1 Chemotherapy drugs that have been reported to cause reproductive problems in 10% or more of patients
- Busulfan (Busulfex®, Myleran®)
- Cyclophosphamide (Cytoxan®, Neosar®)
- Mechlorethamine (Mustargen®)
- Melphalan (Alkeran®)
- Procarbazine (Matulane®)
Other chemotherapy drugs
- Daunorubicin (Cerubidine®)
- Doxorubicin (Adriamycin®, Rubex®)
- Epirubicin (Ellence®)
- Etoposide (VePesid®, Toposar®, Etopophos®)
- Idarubicin (Idamycin®, Idamycin PFS®)
- Lomustine (CeeNU®)
- Methotrexate (Rheumatrex®, Trexall®)
Furthermore, a major cause of damage to the testes in men is treatment with platinum compounds:
- Cisplatin (Platinol®)
- Carboplatin (Paraplatin®)
- Oxaliplatin (Eloxatin®)
How is sexual dysfunction managed?
Coping with sexual dysfunction may be very difficult. Maintaining open communication with your doctor and your partner, as well as taking steps to improve your self-esteem may help.
Communication: Without a doubt, one of the most common problems regarding cancer and sexuality is people’s reluctance to talk about it with their sexual partner and their healthcare team. However, communication is the key to coping with this difficult topic. Cancer care specialists are accustomed to addressing these issues every day.
Perhaps more importantly, sharing your thoughts, feelings, and any fears you may have regarding sexual dysfunction with your partner is essential to maintaining an intimate relationship with that person. Through open communication, you and your partner can work toward finding other ways to express yourselves beyond intercourse, such as gentle touching, holding hands, kissing, hugging and sharing emotional closeness.
Self-esteem and body image: Concerns about the impact of cancer and treatment on sexuality are often closely linked to issues of self-esteem and body image. Cancer treatment often involves surgery; surgery can leave scars and cause physical or neurological damage. Radiation treatment and chemotherapy can produce side effects such as hair loss and extreme fatigue. These effects and others can strongly influence how a person with cancer feels about his or her body and sexuality.
To support a positive self-image, follow these suggestions that have helped many people with cancer:
- It sounds simple, but looking better may actually help you feel better. Try to maintain the same grooming habits—fashion, hairstyle, and so on—as you did before your diagnosis.
- Plan special activities for both the days when you’re feeling well and those when you aren’t. Acknowledge that cancer and treatment can cause shifts in mood.
- Enjoy the days when you’re feeling well. On those days that are difficult, keep a positive outlook—plan all you’d like to do as soon as you feel better.
- If you need help with clothes and hair and other aspects of your appearance, don’t hesitate to ask for it. The “Look Good…Feel Better” program of the American Cancer Society (ACS), for example, can help.
- The ACS publications, “Sexuality for Women and Their Partners” and “Sexuality for Men and Their Partners” may be helpful to you.
What treatments are available for reproductive or sexuality issues?
In recent years, several drugs have been developed for men with erectile dysfunction. These drugs help men maintain an erection by inhibiting an enzyme. Examples include sildafenil (Viagara®), tadalafil (Cialis®) and vardenafil (Levitra®).
There are also medications available to help women deal with the symptoms of menopause. Make sure to tell your doctor what symptoms you are experiencing so that proper steps can be taken to provide some relief.
What else can I do?
If you think you may want to have children after treatment and the cancer treatment is likely to cause sterility, you may wish to bank eggs or sperm. However, you must do this before you receive your treatment. Talk to your doctor about your wish to have children, so that steps can be taken to assure that you have this choice later.