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Male Sexuality and Cancer

Overview of Male Anatomy

This information will help you understand how the male reproductive system works (before treatment) and some of the words your doctor or healthcare provider might use.

A man’s genitals (the penis and scrotum) are outside the body. The scrotum contains the testicles, which make sperm and testosterone. When a man ejaculates, sperm travels through a tube (vas deferens) to the prostate gland. White, milky fluid called semen is added and it travels down the urethra and out the penis.

When a man has a vasectomy, the vas deferens is cut and tied.

What happens during an erection?

  • The prostate gland has a bundle of nerves around it. When a man gets turned on (is aroused) or interested in sex, or the penis is stimulated, a message is sent to these nerves that makes blood flow to the penis. The tissue of the penis is like a sponge, which can absorb blood. When this spongy tissue fills with blood, the penis gets hard.
  • When men have pelvic surgery or pelvic radiation, these nerves are often damaged. After surgery, the nerves might be bruised or inflamed. If this has happened, these nerves can heal, but it’s a slow process, which can take up to 2 years. If nerves are cut, they won’t grow back together and the damage is likely permanent.
  • Men can still enjoy having their penis or genital area stimulated and they can still have an orgasm, even if they don’t get an erection. Cancer treatments don’t damage the nerves that control orgasms or feelings in the pelvic area and penis.

How does an orgasm happen?

  • When some nerves are stimulated, it gives the body a feeling of pleasure. For example, when the penis is touched in a sexual way, a man feels pleasure.
  • Many people think ejaculation and orgasm are the same thing—they aren’t. Sometimes after surgery or pelvic radiation, some of the nerves are damaged and some of the nerves aren’t. Even if nerves are damaged, a man can have an orgasm without having an erection. This is because the nerves that help a man feel pleasure are different than the nerves that cause an erection.
  • If taking part in sexual activities (e.g., stimulating the penis with a hand) and your penis isn’t hard, it’s a good idea to use a lubricant. If you don’t, the friction can be painful and you might not enjoy it as much.
  • If the prostate or both testicles have been removed, a man can still have an orgasm, but he won’t ejaculate. This is called a dry orgasm. Some men say that the quality of the orgasm is different, but many men say it’s just as enjoyable.

What is testosterone?

  • Testosterone is a hormone that affects sex drive and interest. The testicles make sperm and testosterone. Some testosterone is also made by the adrenal glands.
  • Testosterone normally decreases as men get older. Testosterone can also decrease for a short time if a man is depressed, stressed, sick, or gets hurt. Testosterone replacement is a treatment for low testosterone. To find out more, talk to your doctor.
  • If you’ve had testicular cancer and have had one or both testicles removed, ask your doctor about testosterone replacement.

Will cancer treatment affect my testosterone?

  • Some cancer treatments stop the body from making testosterone. For example, androgen deprivation therapy (e.g., Eligard®, Casodex®) or having the testicles removed can do this. If you have questions about testosterone replacement, talk to your doctor or healthcare provider.
  • You don’t need testosterone to have sex, but it does help you get aroused, have an erection, and have an orgasm. Men without testosterone can still have sex, but it can be challenging with low sex drive. When testosterone is decreased, many men aren’t as interested in sex.
  • Sometimes men stop being sexual and sometimes they even stop being affectionate. This can happen because they can’t have sex or because they’ve lost their sexual desire. If this happens to you, remember that your partner might still be interested in sex and/or being affectionate (e.g., hugging, cuddling). Your partner might not say anything about this because he or she doesn’t want to put pressure on you. Some couples aren’t affected if they don’t have sex. It’s important to talk about sex or other ways to be intimate so you know how your partner feels. Your partner might want to talk about ways to be sexual or he or she might be okay with not having sex.
  • There are ways to be intimate and improve your sex life by learning more about improving your sexual desire and erections.​

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