Does chemotherapy cause erectile dysfunction? This is a common concern for men undergoing cancer treatment, yet it often goes undiscussed. Chemotherapy can contribute to erectile dysfunction through multiple pathways—including vascular damage, hormonal changes, nerve injury, and psychological factors—though not all patients will experience these effects. The relationship between chemotherapy and sexual function is complex, influenced by the specific drugs used, cumulative dose, cancer type, other treatments such as radiotherapy or hormone therapy, and individual health factors. Understanding these connections empowers patients and healthcare professionals to address sexual health proactively as an integral part of cancer survivorship care.

Does Chemotherapy Cause Erectile Dysfunction?

Chemotherapy can contribute to erectile dysfunction (ED), though the relationship is complex and multifactorial. Whilst there is no single, direct mechanism by which all chemotherapy agents cause ED, the treatment can affect sexual function through several pathways. It is important to recognise that erectile dysfunction in cancer survivors is frequently related to multiple factors, including the cancer itself, other treatments (such as pelvic surgery, radiotherapy, or hormone therapy), and pre-existing health conditions. Understanding these connections helps patients and healthcare professionals address this often under-discussed aspect of cancer care.

The impact of chemotherapy on erectile function occurs through both direct and indirect mechanisms. Direct effects include damage to the vascular endothelium (the inner lining of blood vessels), which is essential for achieving and maintaining erections. Some cytotoxic agents can also affect testosterone production by damaging Leydig cells in the testes, leading to hypogonadism. Additionally, chemotherapy may cause peripheral neuropathy, affecting the nerve signals required for normal erectile function.

Indirect factors play an equally significant role. The physical burden of cancer treatment—including fatigue, nausea, and general malaise—naturally reduces libido and sexual interest. Psychological factors such as anxiety, depression, altered body image, and fear of cancer recurrence profoundly affect sexual confidence and performance. Many patients also experience relationship strain during treatment, which can compound difficulties with intimacy.

It is important to note that not all patients receiving chemotherapy will develop erectile dysfunction, and the severity varies considerably between individuals. Factors influencing risk include the specific chemotherapy regimen used, cumulative dose, patient age, pre-existing vascular or metabolic conditions (such as diabetes or cardiovascular disease), and baseline sexual function. The cancer itself, particularly pelvic malignancies, may also directly affect erectile function independent of treatment effects. In some cancers, non-chemotherapy treatments—such as pelvic radiotherapy, surgery, or androgen deprivation therapy—often make a larger contribution to erectile dysfunction than chemotherapy itself. Recovery of sexual function after chemotherapy is possible for many patients, though timelines vary and some may experience persistent changes requiring ongoing management.

Erectile dysfunction should be distinguished from fertility impairment, which may also result from chemotherapy. Whilst both can occur, they are separate issues requiring different counselling and management approaches. Robust UK prevalence data for chemotherapy-related erectile dysfunction are limited, but sexual health concerns are recognised as an important aspect of cancer survivorship care.

For further information, see the NHS pages on erectile dysfunction and sexual problems after cancer.

Which Chemotherapy Drugs Are Most Likely to Cause Erectile Problems?

Whilst comprehensive data linking specific chemotherapy agents to erectile dysfunction remain limited, certain drug classes and regimens appear to carry higher risk. The evidence base is evolving, and it is important to recognise that individual responses vary significantly. Robust comparative incidence data for erectile dysfunction across different chemotherapy regimens are sparse, and many reports do not distinguish between chemotherapy-related effects and those caused by other cancer treatments, such as hormone therapy or radiotherapy.

Alkylating agents, including cyclophosphamide and ifosfamide, are among the drugs most commonly implicated in gonadal toxicity. These agents can directly damage testicular tissue and reduce testosterone production. The gonadotoxic effects are often dose-dependent, with higher cumulative doses increasing the risk of persistent hypogonadism.

Platinum-based compounds—including cisplatin, carboplatin, and oxaliplatin—may also affect sexual function. Cisplatin-based regimens, frequently used in testicular and other genitourinary cancers, have been associated with both acute and long-term effects on sexual function, including gonadal toxicity and potential vascular effects. The mechanisms and incidence for carboplatin and oxaliplatin are less well characterised. It is important to note that platinum-based agents are chemically distinct from classical alkylating agents, though they share some alkylating-like properties.

Vinca alkaloids (such as vincristine and vinblastine) can cause peripheral neuropathy, which may affect the autonomic nerves involved in erectile function. Similarly, taxanes (paclitaxel and docetaxel) are known to cause sensory and autonomic neuropathy, potentially impacting sexual response. The neuropathic effects may improve after treatment cessation but can occasionally persist.

Combination chemotherapy regimens may carry cumulative risks due to multiple mechanisms of action. However, specific claims about the erectile dysfunction risk of particular regimens should be interpreted cautiously in the absence of robust comparative data.

It is crucial to emphasise that there is no definitive list ranking chemotherapy drugs by their likelihood of causing erectile dysfunction. The MHRA Summary of Product Characteristics (SmPC) and EMA product information for individual agents may list sexual dysfunction as a potential adverse effect, but incidence rates are often poorly quantified. Healthcare professionals should discuss potential sexual side effects when counselling patients about treatment options, recognising that individual risk factors, cancer type, and other treatments (particularly androgen deprivation therapy, which commonly causes erectile dysfunction and reduced libido) also significantly influence outcomes.

For detailed safety information on individual chemotherapy agents, consult the relevant MHRA/EMC SmPCs and EMA European Public Assessment Reports (EPARs) where available. General information on chemotherapy side effects is available on the NHS website.

Managing Erectile Dysfunction During and After Chemotherapy

Effective management of chemotherapy-related erectile dysfunction requires a holistic, multidisciplinary approach addressing both physical and psychological factors. Early discussion and intervention can significantly improve outcomes and quality of life.

Initial assessment should include a thorough sexual health history, evaluation of contributing factors such as cardiovascular disease, diabetes, depression, and relationship difficulties, and appropriate hormonal investigations. According to NICE Clinical Knowledge Summaries (CKS) on erectile dysfunction, men presenting with ED should have a comprehensive assessment. For patients with suspected hypogonadism, hormonal work-up should include two separate early morning serum total testosterone measurements (taken before 11 am), along with sex hormone-binding globulin (SHBG), luteinising hormone (LH), follicle-stimulating hormone (FSH), and, where indicated, prolactin. UK guidance suggests that total testosterone below 8 nmol/L typically indicates hypogonadism, whilst levels between 8 and 12 nmol/L represent a borderline zone requiring clinical correlation and repeat testing. The underlying cause of hypogonadism should be investigated, and management coordinated with the patient's oncology and, where appropriate, endocrinology teams.

For patients with confirmed hypogonadism, testosterone replacement therapy (TRT) may be appropriate once contraindications are excluded. TRT is contraindicated in men with active prostate cancer or male breast cancer. Before initiating TRT, baseline prostate-specific antigen (PSA) and haematocrit should be measured, and ongoing monitoring is required according to UK guidance from the Society for Endocrinology or British Society for Sexual Medicine. Testosterone replacement should be prescribed and monitored by specialists experienced in male hypogonadism.

Phosphodiesterase type 5 (PDE5) inhibitors—including sildenafil, tadalafil, and vardenafil—represent first-line pharmacological treatment for erectile dysfunction in cancer survivors, as recommended by NICE CKS. These medications enhance the natural erectile response by increasing blood flow to the penis. They are generally well-tolerated, though important contraindications and cautions apply. PDE5 inhibitors are contraindicated in men taking nitrates (including nicorandil) or riociguat, due to the risk of severe hypotension. Caution is required in men taking alpha-blockers, and clinical advice should be sought before use in men with severe cardiovascular disease or recent myocardial infarction or stroke. Patients should be counselled that these medications require sexual stimulation to be effective and may need several attempts before optimal results are achieved. Some evidence suggests early use of PDE5 inhibitors during or shortly after treatment may help preserve erectile tissue health, though this remains an area of ongoing research. For detailed safety information, consult the MHRA/EMC SmPCs for sildenafil, tadalafil, and vardenafil.

Psychological support is essential and should not be overlooked. Referral to psychosexual counselling or relationship therapy can address anxiety, depression, body image concerns, and communication difficulties with partners. Many cancer centres offer specialist psychosexual services as part of holistic survivorship care. Lifestyle modifications—including regular exercise, smoking cessation, limiting alcohol intake, and maintaining a healthy weight—support both general cardiovascular health and erectile function.

For patients who do not respond adequately to oral medications, second-line treatments include vacuum erection devices, intracavernosal injections (alprostadil), intraurethral alprostadil, or topical alprostadil cream (available in the UK). These options require specialist assessment and training. In selected cases, penile prosthesis surgery may be considered for refractory cases, though this is typically reserved for patients who have completed cancer treatment and have stable disease.

If you experience side effects from any medication, you should report them via the MHRA Yellow Card scheme at https://yellowcard.mhra.gov.uk or by searching for MHRA Yellow Card in the Google Play or Apple App Store.

When to Seek Medical Advice About Sexual Health During Cancer Treatment

Patients should feel empowered to discuss sexual health concerns at any point during their cancer journey, and healthcare professionals should proactively create opportunities for these conversations. Sexual function is an important component of quality of life and overall wellbeing, and concerns should never be dismissed as trivial or inevitable.

Key times to seek medical advice include:

• Before starting chemotherapy: Discussing potential sexual side effects and fertility preservation options allows for informed decision-making and early planning. This is particularly important for younger patients or those wishing to father children in the future. According to NICE guidance on fertility problems (CG156), sperm banking should be offered and arranged before gonadotoxic treatment commences.

• During active treatment: If erectile difficulties, loss of libido, or relationship strain develop during chemotherapy, early discussion enables timely intervention. Patients should not wait until treatment is complete to raise concerns, as some strategies can be implemented concurrently with cancer therapy.

• After treatment completion: Sexual function may take time to recover after chemotherapy ends. If difficulties persist or worsen, medical review is warranted. NICE CKS recommends assessment and, where appropriate, referral for specialist input.

• If experiencing additional symptoms: Patients should seek prompt medical attention if erectile dysfunction is accompanied by reduced morning erections, loss of body hair, breast enlargement, fatigue, mood changes, or reduced muscle mass—these may indicate significant hypogonadism requiring hormone assessment and possible replacement therapy.

Referral pathways vary by region, but patients can typically access support through their GP as the first point of contact. According to NICE CKS, men with erectile dysfunction and underlying cancer should have their care coordinated with their oncology team. Onward referral to urology, andrology, endocrinology, or psychosexual services may be arranged when indicated. Many cancer centres now have dedicated survivorship clinics addressing long-term effects of treatment, including sexual dysfunction.

Patients should contact their GP or oncology team urgently if they experience a painful erection lasting more than four hours (priapism), which is a medical emergency requiring immediate treatment. Further information is available on the NHS priapism page. Patients should also seek advice if they develop new symptoms suggesting disease progression.

Open communication with healthcare providers and partners remains fundamental to addressing sexual health concerns effectively, and patients should be reassured that these discussions are a routine and important part of comprehensive cancer care. For further support and information, see the NHS pages on erectile dysfunction and sexual problems after cancer.

Frequently Asked Questions