{"entity":{"id":"sexual-function-after-cancer","kind":"technology","name":"Sexual function and intimacy after cancer, for both sexes","aka":[],"tldr":"Sexual difficulty is among the losses people report most after cancer treatment and among the least often asked about. The guideline says a member of the care team should raise it, and that counselling should be offered to everyone. The treatments are real but modest, and the clearest finding is that a tablet taken only when needed does not restore erections after prostate surgery.","summary":"ASCO's 2018 guideline, adapted from Cancer Care Ontario, begins with the part that costs nothing: \"It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first.\" For women it recommends lubricants and moisturisers first, with \"low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone\" considered in some cases. For men it names phosphodiesterase type 5 inhibitors and surgery for those refractory to medical management. For both sexes it recommends treating vasomotor symptoms, including with cognitive behavioural therapy, slow breathing, hypnosis, venlafaxine and gabapentin. No newer ASCO or European equivalent is indexed, so this remains the reference.\n\nAfter prostatectomy, the detail matters. The REACTT trial randomised 423 men after bilateral nerve-sparing surgery to daily tadalafil, on-demand tadalafil or placebo. Unassisted erectile function after a drug-free washout was no better in either tadalafil arm than placebo, at 20.9, 16.9 and 19.1 per cent reaching the recovery threshold. While the drug was being taken, daily dosing improved function and reduced loss of penile length. A network meta-analysis of 22 randomised trials in 2,711 patients found that only pelvic floor muscle training and regular daily sildenafil 100 mg were associated with a higher likelihood of recovery, and concluded that \"the on-demand dose of phosphodiesterase-5 inhibitors should not be considered as a penile rehabilitation strategy\". Pelvic floor training is in the corpus already and costs nothing.\n\nCouple-based work has short-lived benefit in the best trial: 120 couples randomised to an intimacy-enhancement programme against an active control showed better sexual function and satisfaction immediately afterwards, with effects at three and six months described by the authors as \"minimal\". A different couples intervention unexpectedly worsened relationship quality, which is a reminder that these are interventions with effects in both directions rather than universally safe extras.\n\nWhat comes back, and when: partial, and the timescale differs by cause. Erectile function after nerve-sparing prostatectomy recovers over one to two years where the nerves were spared, and daily rather than on-demand treatment plus pelvic floor training is what the evidence supports during that window. Libido follows testosterone where testosterone is the problem. Pain from vaginal atrophy does not improve with time and needs treating. Body image, confidence and the conversation with a partner are the parts that counselling addresses, and the guideline says to offer that to everyone rather than to the few who ask.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Sexual_dysfunction","links":[{"label":"Interventions to Address Sexual Problems in People With Cancer: ASCO guideline adaptation (JCO 2018)","url":"https://doi.org/10.1200/JCO.2017.75.8995"},{"label":"REACTT: tadalafil and erectile function recovery after bilateral nerve-sparing radical prostatectomy (Eur Urol 2014)","url":"https://doi.org/10.1016/j.eururo.2013.09.051"},{"label":"Penile rehabilitation after nerve-sparing radical prostatectomy: systematic review and network meta-analysis (J Urol 2021)","url":"https://doi.org/10.1097/JU.0000000000001584"},{"label":"Efficacy of a couple-based intervention addressing sexual concerns for breast cancer survivors (Cancer 2025)","url":"https://doi.org/10.1002/cncr.35685"}],"tags":["rejuvenation","survivorship","evidence:moderate"],"related":["idea-moon-sexual-health-as-toxicity-domain"],"cancers":["prostate","breast-hr-positive","colorectal","cervical","endometrial","testicular","urothelial"],"sections":["rejuvenation","supportive-care"],"technologies":["vaginal-oestrogen-after-breast-cancer","menopause-after-cancer-treatment","testosterone-after-cancer-treatment","survivorship-care-plan","cbt-fatigue-distress"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["erectile-dysfunction-after-prostate-cancer","pelvic-floor-muscle-exercises","sex-fertility-after-bowel-cancer","late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Sexual function after cancer has separate mechanical, hormonal and psychological components, and treating only one of them usually fails. Nerve-sparing surgery leaves cavernous nerves that recover over months, during which regular oxygenation of the erectile tissue is the rationale for daily rather than on-demand dosing. Oestrogen and testosterone deficiency act on tissue and on desire respectively, and body image and relationship change act independently of both.","strengths":["A clear guideline instruction that the clinician raises it, not the patient","Daily dosing and pelvic floor training have network meta-analytic support after prostatectomy","Several of the contributing causes, such as pain and hormone deficiency, are directly treatable"],"limitations":["On-demand tablets do not restore unassisted erections after prostatectomy","Couples interventions have short-lived benefit and one trial found harm on a relationship measure","The reference guideline dates from 2018 with no update indexed"]},"route":"/technologies/sexual-function-after-cancer/","neighbours":{"idea":[{"id":"idea-moon-sexual-health-as-toxicity-domain","kind":"idea","name":"Sexual health assessed and treated as a standard toxicity domain","route":"/ideas/idea-moon-sexual-health-as-toxicity-domain/"}],"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-mind-body-image-after-cancer","kind":"technology","name":"Body image after cancer treatment: how it is measured, what drives it, and what helps","route":"/technologies/rejuv-mind-body-image-after-cancer/"},{"id":"gvhd-organ-by-organ","kind":"technology","name":"Chronic GvHD organ by organ: skin, mouth, eyes, gut, liver, joints and genital tract","route":"/technologies/gvhd-organ-by-organ/"},{"id":"cbt-fatigue-distress","kind":"technology","name":"Cognitive behavioural therapy for fatigue and distress","route":"/technologies/cbt-fatigue-distress/"},{"id":"rejuv-tx-fertility-and-growth","kind":"technology","name":"Fertility, growth and what total body irradiation costs","route":"/technologies/rejuv-tx-fertility-and-growth/"},{"id":"rejuv-mind-body-after-stoma-and-limb-loss","kind":"technology","name":"Living with a stoma, and living after an amputation","route":"/technologies/rejuv-mind-body-after-stoma-and-limb-loss/"},{"id":"menopause-after-cancer-treatment","kind":"technology","name":"Menopause brought on by cancer treatment, and the options for it","route":"/technologies/menopause-after-cancer-treatment/"},{"id":"rejuv-life-partners-and-intimacy","kind":"technology","name":"Partners and relationships after cancer: what the divorce data actually show","route":"/technologies/rejuv-life-partners-and-intimacy/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"testosterone-after-cancer-treatment","kind":"technology","name":"Testosterone after cancer treatment in men","route":"/technologies/testosterone-after-cancer-treatment/"},{"id":"vaginal-oestrogen-after-breast-cancer","kind":"technology","name":"Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees","route":"/technologies/vaginal-oestrogen-after-breast-cancer/"}],"term":[{"id":"erectile-dysfunction-after-prostate-cancer","kind":"term","name":"Erectile dysfunction after prostate cancer treatment","route":"/terms/erectile-dysfunction-after-prostate-cancer/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"pelvic-floor-muscle-exercises","kind":"term","name":"Pelvic floor muscle exercises","route":"/terms/pelvic-floor-muscle-exercises/"},{"id":"sex-fertility-after-bowel-cancer","kind":"term","name":"Sexual function, fertility and body image after bowel cancer","route":"/terms/sex-fertility-after-bowel-cancer/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}