In 2022, health care providers diagnosed an estimated 10.3 million American men with erectile dysfunction, or ED. Erectile dysfunction is any change in erection function that makes it unable to work well enough for sustained intimacy. Erections have several inputs, including your:

• Blood flow
• Nervous system
• Hormones
• Psychological health

If even one of these inputs is off, you may experience erectile dysfunction. 

How cancer affects erectile dysfunction

“Having any type of cancer can cause some sexual dysfunction for patients because during any treatment, or after a diagnosis, it can increase stress and fatigue,” says urologist Christopher Deibert, MD, MPH. “These factors can have patients feeling like they don’t want to be sexually active or intimate.”

Specifically, some chemotherapy patients feel wiped out because of treatment, which can negatively impact sexual function and libido. Additionally, your body may change during cancer treatment, which changes your ability to be intimate with your partner. 

“The main area where cancer therapy can impact sexual dysfunction is radiation or surgery within the pelvis,” says Dr. Deibert. “These treatments can directly affect vessels and nerves that go to the penis and are vital for helping with normal erectile function.”

Location of cancer and its impact on sexual functions

Prostate, bladder, uterine, cervical, ovarian, and colorectal cancers all have a higher chance of negatively affecting ED and both male and female sexual functions. “All of these cancers are particularly high-risk because of where the tumor develops and treatment occurs,” says Dr. Deibert. “Accordingly, injuries can occur to your vessels and/or nerves around your sex organs.” 

Generally, if you have some sexual dysfunction after cancer therapy, you may improve over the subsequent six to 12 months. However, by the time you get to 12 months after treatment, whatever your sexual function is at that point is very likely to be your new, long-term baseline function.

Primary treatments for erectile dysfunction

One of the first treatments for ED is to test your hormones and testosterone. If these levels are lower than typical, your provider can adjust them. “Otherwise, if we’ve established a patient’s cancer treatment was associated with their ED, we’ll usually focus on treatments that improve blood flow to the penis to help with erections,” says Dr. Deibert. 

First, providers address improving blood flow through oral medications like Cialis, Viagra, and Levitra, called phosphodiesterase inhibitors. These medications are common and have been around for 25 years. Approximately 75% of men re-establish or improve their erection quality through such phosphodiesterase inhibitors. 

If these medications don’t work, some men can benefit from a vacuum erection device. “Essentially, this device forces blood into the penis, which you then put a constriction band or ring around the base of your penis to keep the blood there,” says Dr. Deibert. 

There’s also an injectable medication patients can use. “I describe these medications as injecting the exact medication where you need it, instead of taking it orally and hoping it gets to your penis,” says Dr. Deibert. “Through these injectables, we’re able to help approximately 80% of men get a better-quality erection.”

If none of these treatments work, your health care provider will discuss surgery with you – specifically surgery for a penile prosthesis. “This surgery is typically a final therapy option, and it does a fantastic job giving men penile rigidity,” says Dr. Deibert.

While your penis will look and feel a bit different than your previous natural erection, it’s an excellent way for couples to re-establish intimacy when they couldn’t before. According to Dr. Deibert, manufacturers of these devices cite approximately 90% or higher patient and partner satisfaction. 

“So, highly motivated patients should expect very positive outcomes with this kind of device,” says Dr. Deibert. Although some risks are associated with the device – like a malfunction or break – they won't hurt the patient, but will require another surgery to replace it. 

Note, these treatments apply to all men with ED, regardless of why they have it, but are particularly pertinent to cancer survivors.

Psychological factors of erectile dysfunction

Your psychological or mental health can be a significant piece of erectile dysfunction. Surgery or cancer therapy of any sort can impact your self- or body image. Your skin or musculature may look different, or you may lose your hair or eyebrows through chemotherapy. “These things can affect self-perception, body image and self-worth, which then transfers into their sexual intimacy with their partner,” says Dr. Deibert. 

Treating erectile dysfunction

“Many people think of ED as a man’s problem,” says Dr. Deibert. “But, especially in patients who are cancer survivors, I see it as a couple’s intimacy issue.” Both partners can feel a sense of loss when they’re no longer sexually intimate in the way they’re accustomed to. “That’s why, from my standpoint, it’s always valuable when a patient’s partner or spouse comes to appointments, too, so we can talk through all these issues together.”

Additionally, patients who have tried all the nonsurgical therapies but haven't succeeded shouldn't be discouraged. "The surgical prosthesis is a great option in patients for whom nothing else is working anymore," says Dr. Deibert. 

“We perceive ED treatment as part of the cancer survivorship paradigm. After treating your cancer, and you're feeling as well as you can, ready to be intimate, and looking to restore all other aspects of your life before cancer, we're here to help," says Dr. Deibert.