Colorectal Cancer and Sexual Health for Men

While sexual problems after treatment for colon cancer are common, there are resources and support available to help regain your overall sexual well-being and function. Erection problems are most common in men with rectal cancer, because the surgery and radiation take place near crucial nerves and blood vessels. Even when cancer occurs higher in the colon, however, many men notice loss of desire, erection problems, changes in ejaculation, and reduced sexual satisfaction. Having poor control over bowel movements or living with an ostomy can also affect a man’s sex life.  

 Surgery for Colon Cancer 

When the tumor is located in a part of the colon above the level of the rectum, surgery usually removes a section of the colon and the lymph nodes next to it. Nerves and blood vessels involved in erection are not likely to be damaged in this type of surgery. If the tumor involves the sigmoid colon, however, which is just above the rectum, nerve damage can affect ejaculation of semen. Sympathetic nerves, which are part of the involuntary nervous system, may be damaged. These are the nerves that cause the prostate and seminal vesicles to contract during emission, the first phase of a man’s orgasm when the ingredients of semen gather. The nerves also signal the valve between the bladder and prostate to close. If they are damaged, a man can still have a pleasurable feeling of orgasm, but he will have a dry orgasm--no semen will come out of his penis. With severe damage, the prostate and seminal vesicles will be paralyzed and semen will not gather in the urethra. Milder damage can cause retrograde ejaculation. The semen gathers but spurts backwards into the bladder because the internal valve stays open. Some men with dry orgasms feel their pleasure is weaker than before cancer treatment, but others do not notice a change. Dry orgasms can be a problem if a man is trying to father a child. Different types of infertility treatment can be used to recover sperm, but if a man wants to have children in the future, he should consider banking sperm before surgery on the sigmoid colon. 

Surgery for Rectal Cancer 

After operations that reconnect the colon and rectum or anus, men may have looser stools, more frequency, and more urgency, along with occasional incontinence. Sometimes leakage can occur, and a man may need to wear a pad or an adult diaper. Men may also leak during sexual activity. Worry about odor and accidents can interfere with sex. Learning to manage diet and bowel habits can help. A nutritionist who works with cancer patients may have some good suggestions. The largest surgery for cancer in the lower rectum is abdominoperineal resection (APR), especially if cancer has spread to the sphincter muscle. Dry orgasm and erection problems are more common after APR than other operations. The nerves that direct blood flow to the penis are more likely to be damaged when the whole rectum must be removed. The nerves responsible for erection are located between the prostate and rectum. These nerves direct extra blood to flow into the penis, causing an erection.  

Sexual Considerations with an Ostomy 

  • Avoid eating high-fiber foods that create gas or odor in the hours before anticipated sexual activity  

  • Do not insert vibrators or sexual toys into your stoma  

  • Determine if you have enough bowel control to irrigate and use a stoma cap during sex. 

  • If you have questions or think you might benefit from additional support around caring for your ostomy, be sure to talk with your medical team. 

Radiation Therapy 

Men who have radiation therapy before or after rectal surgery have a higher risk of developing urinary and bowel incontinence, erectile dysfunction, and dry orgasm. The radiation causes further scarring in the tissue, adding to damage to nerves and small blood vessels from surgery. 

Total Pelvic Exenteration 

Total Pelvic Exenteration is the biggest and most radical surgery for colorectal cancer. It includes removing the bladder, prostate, colon, and rectum. It may allow long-term survival for a man with a large rectal cancer that has spread to the bladder and prostate, or to men with pelvic sarcomas, a rare type of tumor. After total exenteration, most men have two stomas: a colostomy and an ileal conduit for urine. Sometimes, however, the surgeon can build a new internal bladder pouch (neobladder) and/or an internal pouch to connect the small bowel with the anus. Because of the need to have clean margins (removing all tissue that could contain cancer cells) the nerves involved in erection may not be spared. However, the nerves involved in skin sensation and the pleasure of orgasm run close to the walls of the pelvis and are not in the surgeon’s working area. Sensation on the skin in the genital area and penis remains normal, as does a man’s ability to feel pleasure at orgasm. Men who want to have erections after recovering can consider penile injection therapy, a vacuum device, or a penile prosthesis.