Fertility and Sexuality Concerns After Childhood Cancer for Men
Fertility (or the ability to have children) after cancer therapy is a very complex topic. It is related to:
- The doses and types of medications given.
- If radiation or surgery to reproductive organs was performed.
- The age at the time of treatment.
With all of these variables, it is hard to predict a survivor's reproductive health.
What therapies cause the most risk?
Certain treatments are thought to have a higher risk of affecting fertility. These include:
- Chemotherapy agents that are most strongly tied to infertility include alkylating agents (like cyclophosphamide and ifosfamide). Risks are higher with higher doses of these medications.
- Bone marrow/stem cell transplants often include treatments that affect fertility.
- Radiation fields that include the testicles and/or brain (which signals the testicles to make sperm and testosterone). Full body (TBI) radiation can affect both the testes and brain.
- Surgery involving the testicles, prostate, or other areas of the pelvis.
- It is not known how newer cancer medications will affect long term fertility.
How can I learn about my fertility?
Survivors who wish to father a child or assess their fertility should see a reproductive specialist who works with cancer survivors. They are often called Oncofertility specialists. They can perform testing to help evaluate fertility, including certain hormone levels and sperm counts.
Your provider may tell you that you can or cannot father a child, but there is no guarantee. You should always use reliable birth control if you do not wish to father a child.
How can cancer treatment affect sexual function?
There may be other concerns about sexual health for male survivors as well. These can include low testosterone levels, low sexual desire, or erectile dysfunction. An important first step is acknowledging the problem and seeking the help of a urologist who specializes in these issues.
What effect does radiation have on a man/boy’s sexual function?
Radiation to the pelvis in a man or boy may affect sexual function. It is not clear if the dose of radiation to the pelvis of a male child makes a difference in sexual function later on. If radiation included the lower part of the pelvis, it may impact the nerves and vessels that allow erections to develop. Sexual function needs to be monitored during and after the onset of puberty – this can include erections, libido (sexual drive), and nocturnal emissions (an orgasm while sleeping).
How can I get help with sexual concerns?
Symptoms of sexual dysfunction can be very distressing for older boys and young men. A urologist can help with the management of sexual issues. Sex or couples therapists can help address intimacy and sexual function issues. You can also talk with your healthcare provider about managing your concerns or finding a therapist.
Questions and concerns about fertility and sexuality are common for men who have been treated for childhood cancers. Discussing your concerns with your healthcare team can help you get help and learn how to manage issues.
Long-Term Follow Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Version 5.0, 2018. Accessed at: http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf