Your sex life and testicular cancer

If you have had one testicle removed, it should not necessarily affect your

• Ability to father children (fertility)
• Sexual performance
• Sexual appetite (libido)

The remaining testicle will usually make more testosterone (the male sex hormone) and sperm to make up for the one that has been removed.

But you may find that you do feel less like having sex, at least for a while. This is perfectly normal. Any treatment can make you feel like this. Other treatment side effects, such as feeling tired or sick, are bound to have an effect on your libido.

Being diagnosed with cancer raises a lot of emotions such as fear, anxiety and anger. All these can affect your libido too. But this is temporary. After you have got over your treatment and are beginning to come to terms with having had cancer, you will find your libido comes back.

Some men are diagnosed with testicular cancer in both testicles. Or it comes back in the other testicle after you have been treated. If this happens to you, you will need to have your other testicle removed. After the operation, you will no longer produce sperm or testosterone. So you will not be able to father a child unless you have sperm banking.

If you have had both testicles removed, you will be given testosterone replacement therapy. This is necessary to give you a normal sex drive and so that you can get an erection. Low levels of testosterone can also cause mood changes and tiredness.

Testosterone replacement can be given by

• Mouth
• Injection
• Skin patches

Tablets are not very well absorbed, so treatment by mouth is not often used these days. Injections work well. They can be given into the muscle of your arm or leg every 2 to 3 weeks. Some research has shown that the levels of the hormone in your blood are more stable if you have injections at least every 2 weeks. If the levels are not stable, you can have mood changes, tiredness and loss of your sex drive between injections.

Skin patches are the newest way to give testosterone replacement. They are like plasters that give a small dose of testosterone through the skin all the time. They have very few side effects (just mild skin irritation in some men) and keep the testosterone levels very stable in your blood.

One operation for testicular cancer that can affect your sex life is a retroperitoneal lymph node dissection. This means taking out the lymph nodes at the back of the abdomen. This operation is not done as often in the UK as it is in some other countries. But you may need to have it done if your lymph nodes are still enlarged after radiotherapy or chemotherapy.

Retrograde ejaculation means ejaculating backwards. Your semen and sperm go back into your bladder instead of coming out of your penis. And your orgasms will feel different because they will be dry. This means you will not be able to have children by natural sexual intercourse. But it may be possible to take sperm directly from your testicles or from your urine after you have had sex. The sperm can be used to fertilise your partner directly or with the "test tube baby" technique (in vitro fertilization or IVF).

Talk to your surgeon about other possible side effects before you have a retroperitoneal lymph node dissection. Nerve damage may make you lose your ability to have erections. There is more information in the CancerHelp UK section on sex and cancer for men.

You may be afraid that you can pass on cancer cells to your partner during sex. This is not true. Cancer is not infectious. But you should use a condom if you are having chemotherapy. Doctors don't know enough about how much of the drugs come through in the semen. But it may cause some irritation to your partner. So wearing a condom makes sure that your partner is as safe as possible.

It is sensible to use a condom or take precautions to prevent pregnancy for a while after radiotherapy or chemotherapy. This is because there may be a chance that your sperm have been affected by the treatment and this could cause abnormal development of a baby you father during this time.

There is no increased risk of you fathering an abnormal baby in the future after testicular cancer treatment has ended.

You may find it difficult to talk about any difficulties you are having related to sex, either with your doctor or your partner. After all, your sex life is very personal. But if you can manage to take a deep breath and talk to your doctor or nurse, you may find they have a specialist counsellor or a sex therapist you can be referred to.

Remember - your doctor is likely to have treated many other men with similar problems. Try not to feel embarrassed.

If you would like to talk to someone outside your own friends and family, look in our coping with cancer section for information about counselling and for details of counselling organisations. 

If you are worried about talking to your partner, it may be because you are afraid they might reject you, or be angry with you in some way. But you are probably more worried about this than you need to be. Your partner is likely to be relieved that you want to talk things over. They may have been trying to find the right time to raise the subject themselves. And you may feel even closer after you have talked any difficulties through.

Look in the testicular cancer reading list for books you may find helpful.

There are organisations that can provide information about your sex life and cancer. Or they can put you in touch with cancer support groups where you can talk to others who have been through similar experiences to your own.

There is more about sex and cancer for men, and for partners in the main coping with cancer section of CancerHelp UK.