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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.
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.
After 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.
Couple-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.
What 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.
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.
Query for this technology: (TITLE:"Sexual function and intimacy after cancer, for both sexes" OR ABSTRACT:"Sexual function and intimacy after cancer, for both sexes") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Sexual function and intimacy after cancer, for both sexes, not a curated reading list.
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Shares Testicular germ cell tumours, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Menopause brought on by cancer treatment, and the options for it, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Testicular germ cell tumours, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.