Sexual Dysfunction

Reviewed by: HU Medical Review Board | Last review date: September 2017.

Because the bladder is located in the pelvic region, many patients with bladder cancer may experience sexual dysfunction.1,2 This may be caused by the cancer itself or by treatments for the bladder cancer.

Different treatments for bladder cancer are linked to different possible types of sexual effects. When considering your treatment options for bladder cancer, it is important to speak with the healthcare providers on your cancer care team about your questions or concerns about the sexual effects of different treatment options.

However, there are many ways that these sexual effects can be addressed. Some patients with bladder cancer are able to manage these effects and experience an enjoyable sex life again after treatment. Your healthcare providers can talk with you about any sexual effects that you experience, and about the ways that they can be addressed and managed.

How does sexual dysfunction impact men and women?

Bladder cancer and its treatments can cause a range of physical and emotional changes that can affect a patient’s sexuality.2,3 Both male and female patients with bladder cancer may experience a decrease in their level of sexual desire. This can be caused by physical effects of cancer or its treatment, but it can also be caused by emotional changes, including:

  • Lower energy levels
  • Mood changes, such as stress, depression, and anxiety
  • Feelings of sadness, fear, and frustration
  • Feeling insecure or self-conscious about the physical effects of surgical treatments
  • Worries about fertility (the ability to have children)

Men with bladder cancer may experience sexual effects caused by the physical effects of treatment. These symptoms are more common among men who are older, as well as among men who were already experiencing sexual issues before they were diagnosed and treated for bladder cancer. Some men may experience pain during sex and/or have problems achieving or maintaining an erection (erectile dysfunction). They may also experience issues related to ejaculation, such as:

  • Premature ejaculation
  • Urination during ejaculation
  • “Dry” ejaculation that does not produce semen

Women with bladder cancer can also experience sexual effects due to the physical effects of bladder cancer and its treatments. These include pain during sex, for example, due to vaginal dryness or to other effects of treatment.

Impact of non-muscle-invasive bladder cancer treatments

Around three-quarters of patients diagnosed with bladder cancer each year have non-muscle-invasive bladder cancer.4 This type of bladder cancer involves bladder cancer cells that are located in the thin layer of cells that line the inside of the bladder, but have not grown into the muscle in the wall of the bladder.

A study investigated the sexual effects experienced by men and women who were diagnosed and treated for non-muscle-invasive bladder cancer. About half of the patients said that they had experienced sexual effects. The most common sexual effects were:

  • Sexual inactivity (38.8%), reported by both men and women
  • Erectile difficulties (60.0%) among men
  • Vaginal dryness (62.5%) among women

Many patients said that they were concerned that treatments they were receiving for bladder cancer would somehow affect their partner in a negative way. Around half of the patients in the study said that they found it helpful to talk with their partners about the sexual effects they were experiencing.

Possible effects of surgery

Patients with advanced bladder cancer that has grown into the muscle of the bladder wall may need to have surgery called a radical cystectomy.2,5 This surgery causes sexual effects in both men and women.

In men who have a radical cystectomy, the surgeon removes the bladder and usually the prostate gland and the seminal vesicles as well. Men who have this surgery can still ejaculate (have an orgasm), but it does not produce semen. After this type of surgery, men may have trouble getting and maintaining an erection. However, some men are able to recover their ability to have an erection, for example, through pelvic floor exercises and/or drugs to treat erectile dysfunction.

In women who have a radical cystectomy, the surgeon removes the patient’s bladder and may also remove the uterus, ovaries, fallopian tubes, cervix, and sometimes part of the vagina. Some women may choose to have vaginal reconstruction surgery to rebuild the vagina to improve their ability to have sex more comfortably. The radical cystectomy can also affect a woman’s ability to become sexually aroused and to have an orgasm. It is important to talk with your surgeon about the possible sexual effects of your surgery, because there are ways that the surgeon may potentially be able to prevent some of these effects, depending upon the situation.

Possible effects of radiation therapy

Radiation therapy is commonly used to treat bladder cancer in both men and women.2,3 It can cause sexual effects during the treatment period, but in some cases, these will lessen or go away in the weeks or months after treatment is completed, but could potentially take longer. Common side effects of treatment with radiation therapy include fatigue, nausea, vomiting, and diarrhea. These can reduce sexual desire.

Men can experience erectile dysfunction as a result of radiation therapy. In women who receive radiation therapy in the pelvic area to treat bladder cancer, common symptoms include:

  • Reduced sexual desire
  • Vaginal dryness
  • Vaginal itching, irritation, and discomfort

Possible effects of chemotherapy

Systemic chemotherapy is commonly used to treat advanced bladder cancer.2,3 In men and women, this treatment can cause side effects that can reduce sexual desire, such as:

  • Weight gain or weight loss
  • Nausea
  • Vomiting
  • Diarrhea

Many patients with non-muscle-invasive bladder cancer may be treated with a special type of chemotherapy delivered directly into the bladder. This can cause pain and irritation that can make it uncomfortable to have sex. However, these side effects often go away after treatment is completed.

How to manage sexual dysfunction

After you have recovered from your bladder cancer treatments, there are many options for helping to restore your ability to have and enjoy sex again.2,3 Your healthcare provider will discuss the available options with you.

For men, options for managing erectile dysfunction due to bladder cancer may include:

  • Medications taken by mouth
  • Medications injected into the penis
  • Vacuum constriction devices (a small pump placed over the penis)
  • Implants placed inside the penis by a surgeon

For women, options for relieving and managing the sexual effects of bladder cancer may include:

  • Pelvic floor exercises and physical therapy
  • Vaginal moisturizers and lubricants
  • Low-dose vaginal estrogen
  • Vaginal lidocaine
  • Vaginal dilators to reduce vaginal tightness

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