So, often when patients present with testicular cancer, because the testicles are involved, patients are often concerned about their ability to have sexual performance either during treatments or after treatments. Now, there can be several potential impacts on sexual function as a result of some of the therapies that we have for testicular cancer.
Certainly, we discuss the possibility of infertility due to some of the treatments we have, because that can affect the sperm. For that reason, we recommend that patients bank their sperm ahead of time. Patients are sometimes concerned about their ability to have erections or sexual activity.
Now, treatments for testicular cancer, whether it's chemotherapy or radiation therapy, generally will not affect the ability for a man to have an erection. Now, if in rare cases where testicular cancer occurs in one testicle and may then reoccur in another testicle, then both testicles sometimes have to be removed in very rare cases.
In those cases, then, the patient loses the ability to produce testosterone. Testosterone is normally produced by the testicles and provides what's called the libido or the desire for sexual activity. Even though there may be removal of the testicles, we can actually supplement the patient's testosterone by administering testosterone. What we call exogenous testosterone or testosterone replacement therapy.
So we can then, give the patient testosterone to give that patient the benefits of the testosterone including getting their desire and libido back to normal. But certainly, effects on testosterone can affect your libido.
Another way that sexual activity may be affected, is through something called retrograde ejaculation. In some cases where testicular cancer has spread to the abdominal lymph nodes or where a procedure is done to remove the lymph nodes in the abdominal area, there can be damage or injury to some of the nerves that go through that area.
These nerves are called sympathetic nerves. And they go down to the pelvic area and allow a man to be able to ejaculate properly. Which means that, during the course of ejaculation, semen is expelled through the urethra. With retrograde ejaculation, what occurs is that ejaculation still occurs, but rather than coming out the front it actually goes backwards into the bladder.
So when there is injury to the sympathetic nerves, during this procedure called the retroperitoneal lymph node dissection, then that can in some cases cause retrograde ejaculation. So that can be something that changes during sexual activity. So, yes, testes cancer can affect sexual activity in some way or shape or form. But in most cases the ability to have erections will be sustained and none of our treatments generally affect the ability to have erections.