|The Testicular Cancer Resource Center|
When the topic of TC comes about, undoubtedly one of the main concerns raised by men has to do with one of our favorite topics: SEX.
These are all VERY valid questions and ones that should be raised with your doctor. We have done some research into this matter, and here's what we have found so far..
Many men worry that losing one testicle will affect their ability to have sexual intercourse or will make them sterile or impotent. But a man with one healthy testicle can still have a normal erection and can still produce sperm. Therefore, the operation to remove just one testicle, called an inguinal orchiectomy (IO), does not make a patient impotent and seldom interferes with fertility. Nevertheless, it still is surgery, and in order to avoid complications like a hernia, we advise that you wait a couple of weeks after the surgery before attempting intercourse.
Surgery to remove the retroperitoneal lymph nodes (RPLND) will not alter a man's ability to have an erection or an orgasm, but the operation can cause infertility because it can interfere with ejaculation. In the past, removing these lymph nodes invariably caused the nerves that control ejaculation to be cut. Without these nerves, the bladder neck does not close during ejaculation, and your sperm end up in the bladder instead of where you would expect them to go. Nowadays most surgeons attempt to perform a nerve-sparing RPLND. The good surgeons are successful almost all of the time, but the regular surgeons with little experience with the operation are not particularly successful. Some men recover the ability to ejaculate without treatment, while others may be helped by medication in an effort to regain their fertility. Most, however, will simply have dry ejaculations. As I understand it, it essentially feels the same, but without the wet spot. Some men claim that it does feel different. As always, if fertility or a forward ejaculation are important to you, make sure that your surgeon has extensive experience with the nerve sparing procedure!
If you end up having radiation therapy it should not change your ability to have sex whatsoever. Radiation therapy can, however, interfere with sperm production. Usually the effect is temporary, and most patients regain their fertility within a matter of months. As for chemotherapy and its effects, men who receive chemotherapy for testicular cancer continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is temporary for most patients, some may become permanently sterile. For more information on TC and fertility, check out the TCRC Fertility page.
In either case, if you are receiving chemotherapy, we strongly recommend that you use some form of barrier contraception during and shortly after treatments. You do not want to pass any of those chemotherapy drugs to your partner via semen! Generally speaking, we think it would be best to use a condom between the time chemotherapy starts and 2-3 days after the last dose of chemo.
Regarding sex drive, testicular cancer survivors we have spoken with have told me everything from having sex the day after their IO (ouch!) all the way through having to go on hormonal therapies to re-establish their desire. Just as each one of us is different going in, we're going to be just as different coming out, too. One big key is to keep the patient-doctor communication lines open, before and after any treatments. If you feel different, or just out of whack, let your doctor know. They cannot read your mind, and they definitely cannot diagnose anything if you do not tell them that something is wrong!
Finally, I would like to stress that testicular cancer is not contagious and it cannot be transmitted via sexual intercourse. There are a lot of reasons to be afraid of cancer, but this is not one of them!