Testicular cancer (TC) often affects young men during their peak reproductive and sexually active years, making concerns about intimacy after treatment deeply personal. While treatment for TC is highly successful, addressing the subsequent physical and emotional changes to sexual health is a significant part of survivorship. The goal is to return to a satisfying, fulfilling intimate life.
Physical Recovery and When to Resume Sex
Resuming sexual activity involves physical healing from the primary surgical treatment, typically an orchiectomy (removal of the affected testicle). Healthcare providers recommend avoiding strenuous activity, including sexual intercourse, for two to four weeks following surgery. This allows the inguinal incision to heal completely, preventing strain on the surgical site and reducing the risk of complications.
General recovery, including the reduction of scrotal swelling, usually takes several weeks. Overall physical stamina may be affected if additional treatments like chemotherapy or radiation were necessary. Treatment-related fatigue can reduce interest in sex, requiring survivors to redefine intimacy during recovery.
Changes to Sexual Function After Treatment
Most men who have a unilateral orchiectomy maintain normal sexual function because the remaining testicle usually produces sufficient testosterone and sperm. However, more intensive treatments can introduce specific changes. Low libido, or diminished sexual desire, can occur temporarily due to chemotherapy or radiation side effects, or if the remaining testicle does not produce enough testosterone.
Hormone replacement therapy may be necessary if blood tests confirm a low testosterone level, which can help restore sexual drive, energy, and mood. Erectile dysfunction (ED) is another possibility, reported in 12% to 40% of survivors, caused by nerve or vascular damage from extensive surgery or chemotherapy. Treatments for ED often include oral medications like PDE5 inhibitors, which increase blood flow to the penis.
A major concern is a change in ejaculation, particularly after a retroperitoneal lymph node dissection (RPLND). This procedure risks damaging the sympathetic nerves responsible for bladder neck closure during ejaculation, leading to retrograde ejaculation. In this condition, semen travels backward into the bladder, resulting in a “dry orgasm,” which does not necessarily affect the sensation of orgasm. Newer, nerve-sparing techniques for RPLND have significantly reduced this risk.
Addressing Body Image and Emotional Health
The psychological effects of a cancer diagnosis and treatment can sometimes pose a greater challenge to intimacy than physical changes. Anxiety, depression, and fear of recurrence are common among survivors and can severely impact sexual desire and performance. The loss of a testicle can also challenge self-esteem and body image, leading to feelings of inadequacy.
Some men choose to have a testicular prosthetic implanted to address body image concerns, helping them feel more confident. Open and honest communication with a partner is a powerful coping strategy, strengthening emotional intimacy and reducing performance anxiety. If emotional difficulties persist, seeking professional help from a therapist or a sex counselor specializing in cancer survivorship is recommended.
Fertility and Future Family Planning
A diagnosis of testicular cancer and its treatment often raises questions about the ability to have children. Both the cancer itself and treatments like chemotherapy or radiation can temporarily or permanently impair sperm production. Therefore, the most important action for survivors interested in future fatherhood is sperm banking (cryopreservation) before starting chemotherapy or radiation.
While fertility can return within two years after chemotherapy for many men, this recovery is not guaranteed. For those who experience permanent infertility, banked sperm can be used later through assisted reproductive technologies, such as in vitro fertilization (IVF). Men receiving active chemotherapy must also use effective contraception, as some drugs can potentially damage a developing fetus. Discussion with a healthcare provider and a fertility specialist is advisable to understand specific risks and create a plan aligned with family goals.