Testicular cancer is a highly treatable malignancy, but diagnosis and subsequent treatment can introduce new health concerns for survivors. Erectile dysfunction (ED)—the consistent inability to attain or maintain an erection—is a common issue men research after a testicular cancer diagnosis. The direct answer is that the cancer itself almost never causes ED; however, the necessary treatments often lead to sexual health changes. Understanding the distinction between the cancer’s effects and the treatment’s side effects is the first step in managing this common survivorship issue.
Is Erectile Dysfunction a Direct Symptom of Testicular Cancer?
Erectile dysfunction is generally not a primary symptom leading to a testicular cancer (TC) diagnosis. The cancer itself rarely interferes directly with the physical mechanisms required for an erection. In extremely rare instances involving advanced tumors, the size or location of a mass might compress nerves or blood vessels, potentially impairing erectile function. For the majority of men, the discovery of a lump or swelling is the first sign, not a change in sexual performance. TC primarily affects men in their prime reproductive years, and the hormonal changes that cause ED are usually a result of therapy, not the disease itself.
How Cancer Treatments Lead to Erectile Dysfunction
The treatments required for testicular cancer are the main contributors to physical changes in sexual function. Initial treatment almost always involves an orchiectomy, the surgical removal of the cancerous testicle. Since testicles are the primary source of testosterone, removing one can potentially reduce hormone levels, though a single healthy testicle is often sufficient to maintain normal function. While orchiectomy is generally not the sole cause of ED, it may introduce a hormonal imbalance.
Subsequent therapies, such as chemotherapy and radiation, can damage the remaining testicular tissue, leading to a long-term reduction in testosterone production. Cisplatin-based chemotherapy, a standard treatment, is known to damage the Leydig cells responsible for testosterone synthesis. This damage results in hypogonadism (clinically low testosterone), which directly impacts libido and the ability to achieve an erection. Certain surgical procedures, like retroperitoneal lymph node dissection (RPLND) for advanced disease, can also cause nerve damage that interferes with ejaculation, though modern nerve-sparing techniques have reduced this risk.
Diagnosing and Treating Low Testosterone After Cancer
A common physical cause of ED in testicular cancer survivors is hypogonadism, a testosterone deficiency resulting from damage to the remaining testicular tissue. This condition can lead to a reduced sex drive, low energy, and difficulty with erections. To diagnose hypogonadism, a physician orders blood tests to measure the total serum testosterone level, typically taken in the morning when levels are highest. Testing should also include luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to determine if the problem originates in the testicles or the pituitary gland.
If blood work confirms low testosterone, Testosterone Replacement Therapy (TRT) is the standard treatment. TRT restores hormone levels, improving sexual desire and erectile function. Delivery methods for TRT include:
- Topical gels
- Patches
- Subcutaneous pellets implanted under the skin
- Intramuscular injections
These methods aim to maintain steady, physiologic hormone levels. For men whose ED is not fully resolved by TRT, or for those with normal testosterone levels, pharmacological treatments like phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil or tadalafil) may be prescribed to help achieve an erection.
The Psychological Impact on Sexual Function
Beyond the physical effects of treatment, the psychological burden of a cancer diagnosis contributes to sexual dysfunction. The fear of recurrence and the emotional stress of treatment can lead to anxiety and depression, which suppress sexual desire and performance. Many survivors experience reduced self-esteem and body image issues following an orchiectomy. This change in physical appearance can create performance anxiety, where the fear of failing to achieve an erection causes difficulty with the physical act. Cancer treatments often result in persistent fatigue, which naturally reduces interest in sexual activity. This exhaustion, combined with emotional distress, can create a cycle where a man avoids intimacy, potentially straining relationships. Open communication with a partner about these feelings is an important step in recovery and helps manage expectations. Seeking professional help from a mental health counselor or joining a support group provides survivors with effective coping strategies to address the emotional components of sexual health recovery.