Testicular cancer is the most common cancer in men aged 15 to 49 in the UK, with over 2,400 new cases annually. Whilst survival rates exceed 95%, many men worry whether testicular cancer causes erectile dysfunction and how treatment might affect their sexual health. Understanding the relationship between testicular cancer and erectile function is essential for informed decision-making and managing expectations. This article examines whether the cancer itself directly causes erectile difficulties, explores the impact of various treatments, and outlines practical management strategies to help men maintain sexual wellbeing during and after testicular cancer treatment.
Summary: Testicular cancer itself rarely causes erectile dysfunction directly, as the tumour does not typically damage the nerves or blood vessels required for erections.
- One functioning testis usually maintains normal testosterone levels and erectile function after orchidectomy.
- Psychological factors such as anxiety, depression, and body image concerns often affect sexual function more than the cancer itself.
- Chemotherapy may cause temporary erectile difficulties, with most men recovering normal function within months of treatment completion.
- PDE5 inhibitors (such as sildenafil) are first-line treatments for erectile dysfunction in testicular cancer survivors where clinically appropriate.
- Retroperitoneal lymph node dissection may affect ejaculation but typically preserves erectile function, especially with nerve-sparing techniques.
- Men experiencing persistent erectile difficulties should seek medical advice, as effective treatments and specialist support are available through the NHS.
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Understanding Testicular Cancer and Sexual Function
Testicular cancer is the most common malignancy in men aged 15 to 49 years in the UK, with approximately 2,400 new cases diagnosed annually according to Cancer Research UK. Despite its prevalence in younger men, overall five-year survival rates exceed 95%, and for stage I disease survival approaches 99%, making testicular cancer one of the most treatable cancers. However, the diagnosis and subsequent treatment can raise concerns about sexual function, fertility, and overall quality of life.
Sexual function encompasses several interconnected processes, including libido (sexual desire), erectile function, ejaculation, and orgasm. Erectile dysfunction (ED) specifically refers to the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The physiological mechanisms underlying erections involve complex interactions between neurological, vascular, hormonal, and psychological factors.
Testosterone, primarily produced in the testes, plays a crucial role in maintaining sexual desire and erectile function. The testes also produce sperm and other hormones essential for male reproductive health. When testicular cancer develops, patients naturally worry about how the disease and its treatment might affect these functions. Understanding the relationship between testicular cancer and sexual health requires examining both the direct effects of the cancer itself and the potential impact of various treatment modalities.
It is important to recognise that sexual health concerns following a testicular cancer diagnosis are common and legitimate. Healthcare professionals increasingly acknowledge that addressing these concerns is an integral part of comprehensive cancer care, not merely a secondary consideration. Resources such as NHS England, Macmillan Cancer Support, and Cancer Research UK provide patient-facing information on sexual health and fertility after testicular cancer.
Does Testicular Cancer Cause Erectile Dysfunction?
Testicular cancer itself rarely causes erectile dysfunction through direct damage to the nerves or blood vessels required for erections. The tumour is localised to the testis and does not typically affect the neurovascular mechanisms underlying erectile function. Most men maintain normal erectile function immediately following diagnosis and before treatment commences.
However, several indirect factors related to testicular cancer may influence sexual function:
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Hormonal considerations: Whilst the remaining healthy testis usually compensates adequately for testosterone production, some men may have reduced testosterone levels (hypogonadism) at diagnosis due to Leydig cell dysfunction. Low testosterone can reduce libido and contribute to erectile difficulties. In most cases, one functioning testis maintains normal hormone levels. Bilateral testicular cancer (affecting both testes) is extremely rare, occurring in only 1–2% of cases.
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Tumour burden and systemic illness: In advanced cases with significant metastatic disease, general ill health, fatigue, pain, and systemic symptoms may temporarily reduce sexual desire and function, though this is not ED in the classical sense.
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Pre-existing conditions: Some men may have undiagnosed erectile dysfunction unrelated to their cancer diagnosis.
The distinction between testicular cancer causing ED and treatment-related ED is crucial. Research indicates that baseline erectile function in men with newly diagnosed testicular cancer is generally comparable to age-matched controls. However, the psychological impact of receiving a cancer diagnosis can affect sexual function even before treatment begins. Anxiety, fear about the future, and concerns about masculinity and fertility can all contribute to temporary difficulties with sexual performance. Whilst the primary tumour is unlikely to cause organic erectile dysfunction directly, hormonal changes and the emotional burden of diagnosis should not be underestimated.
Psychological Impact on Sexual Function After Diagnosis
The psychological consequences of a testicular cancer diagnosis can significantly affect sexual function, often more profoundly than the physical aspects of the disease. Young men facing cancer may experience a range of emotional responses that directly impact their sexual health and intimate relationships.
Common psychological factors include:
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Anxiety and depression: Studies indicate that a substantial proportion of testicular cancer patients experience clinically significant anxiety or depression during and after treatment. These conditions are well-established risk factors for erectile dysfunction, as they can reduce libido and interfere with the physiological processes necessary for erections.
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Body image concerns: Surgical removal of a testis (orchidectomy) may lead to feelings of altered masculinity or physical incompleteness. Some men report self-consciousness about their appearance, which can inhibit sexual confidence and intimacy.
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Fear of recurrence: Ongoing worry about cancer returning can create persistent stress that diminishes sexual desire and performance.
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Relationship strain: The diagnosis may place stress on partnerships, affecting communication and intimacy between couples.
Performance anxiety represents a particularly common issue. Once a man experiences difficulty achieving or maintaining an erection—whether due to stress, fatigue, or other factors—he may develop anticipatory anxiety about future sexual encounters. This creates a self-perpetuating cycle where anxiety itself becomes the primary cause of erectile difficulties.
Research demonstrates that psychological distress correlates strongly with sexual dysfunction in testicular cancer survivors, sometimes more so than physical treatment effects. This underscores the importance of addressing mental health as an integral component of sexual health management. Psychological support is available through NHS Talking Therapies (formerly IAPT), Macmillan Cancer Support, and specialist psychosexual therapy services. Counselling, cognitive behavioural therapy, or support groups can prove invaluable in managing these concerns and restoring sexual confidence. Patients are encouraged to discuss psychological concerns with their care team early.
Managing Erectile Dysfunction During and After Treatment
Treatment for testicular cancer may include surgery (orchidectomy), chemotherapy, radiotherapy, or a combination of these modalities. Each treatment approach carries different implications for sexual function, and management strategies should be tailored accordingly.
Surgical considerations: Radical inguinal orchidectomy—the standard surgical treatment—removes the affected testis but preserves erectile function in the vast majority of cases. The nerves and blood vessels responsible for erections are not affected by this procedure. Retroperitoneal lymph node dissection (RPLND), sometimes required for advanced disease, carries a risk of damaging nerves involved in ejaculation, which can cause retrograde ejaculation (where semen enters the bladder) or anejaculation. Nerve-sparing surgical techniques, performed in specialist UK centres, have significantly reduced these complications. RPLND does not typically affect erectile function directly.
Chemotherapy effects: Platinum-based chemotherapy regimens (such as BEP: bleomycin, etoposide, and cisplatin) may cause temporary fatigue, nausea, and reduced libido during treatment. Some men experience temporary erectile difficulties during chemotherapy cycles. Whilst many men recover normal erectile function within months of treatment completion, a subset may experience longer-term sexual dysfunction or persistent low testosterone (hypogonadism). Follow-up testosterone testing is advisable if symptoms such as persistent fatigue, reduced libido, or erectile difficulties occur.
Radiotherapy impact: When radiotherapy is used (less common in modern practice), it is typically directed at para-aortic lymph nodes. Whilst radiotherapy does not directly injure the neurovascular pathways responsible for erections, it can impair Leydig cell function and spermatogenesis, with potential downstream effects on testosterone levels and fertility.
Fertility preservation: Before starting chemotherapy, radiotherapy, or RPLND, men should be offered the opportunity to discuss sperm cryopreservation (sperm banking). Post-treatment semen analysis and referral to fertility services may be appropriate if conception is desired.
Management approaches for erectile dysfunction include:
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Phosphodiesterase-5 (PDE5) inhibitors: Medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are first-line treatments for erectile dysfunction. These drugs enhance the natural erectile response and are generally safe and effective for testicular cancer survivors. Generic sildenafil can usually be prescribed on the NHS where clinically appropriate; availability of other agents may depend on local formulary arrangements. Important safety note: PDE5 inhibitors are contraindicated in men taking nitrates (e.g., glyceryl trinitrate for angina) or riociguat, and caution is required with alpha-blockers. A cardiovascular risk assessment should be undertaken before prescribing, as erectile dysfunction can be an early marker of cardiovascular disease. Detailed prescribing information is available in the British National Formulary (BNF) and individual Summary of Product Characteristics (SmPC) documents via the electronic Medicines Compendium (eMC).
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Investigations: Assessment typically includes measurement of morning total testosterone on two separate occasions, along with luteinising hormone (LH) and follicle-stimulating hormone (FSH). Prolactin and thyroid function tests may also be considered. Screening for cardiovascular risk factors (blood pressure, lipids, HbA1c) is recommended, as erectile dysfunction may signal underlying diabetes, dyslipidaemia, or hypertension.
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Psychological support: Counselling or psychosexual therapy can address anxiety, depression, and relationship concerns that contribute to sexual difficulties. NHS Talking Therapies and Macmillan support services offer accessible pathways.
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Testosterone replacement: In cases where both testes are affected or testosterone levels remain persistently low despite adequate time for recovery, testosterone replacement therapy may be appropriate under specialist (endocrinology or urology) supervision.
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Alternative treatments: For men who cannot use or do not respond to oral medications, alternatives include alprostadil (intraurethral or intracavernosal), vacuum erection devices, and penile prosthesis. Referral to urology or andrology services can facilitate access to these options.
NICE guidance (Clinical Knowledge Summaries on Erectile Dysfunction) emphasises the importance of discussing sexual health concerns with patients throughout their cancer journey. Healthcare professionals should proactively raise these topics, as many patients feel uncomfortable initiating such conversations.
Reporting side effects: If you experience a suspected side effect from any medication, you can report it via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store.
When to Seek Medical Advice About Sexual Health Concerns
Men experiencing sexual health concerns during or after testicular cancer treatment should not hesitate to seek medical advice. Sexual function is an important aspect of quality of life and overall wellbeing, and healthcare professionals are equipped to provide appropriate support and treatment.
You should contact your GP or specialist if:
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Erectile difficulties persist for more than a few weeks or cause significant distress
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You experience complete loss of erectile function
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Sexual problems are affecting your relationship or mental health
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You have concerns about testosterone levels (symptoms may include persistent fatigue, reduced muscle mass, mood changes, or decreased libido)
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You notice any new lumps, swelling, or changes in the remaining testis
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You experience pain during sexual activity
Important: urgent referral for suspected testicular cancer: According to NICE guideline NG12 (Suspected cancer: recognition and referral), men with non-painful enlargement or change in shape or texture of the testis should be offered direct-access ultrasound within two weeks. If the ultrasound is abnormal and suggests cancer, an urgent referral (within two weeks) to urology is indicated. Emergency advice: Sudden severe testicular pain or swelling may indicate testicular torsion or other acute conditions and requires urgent same-day assessment, typically via Accident & Emergency.
Preparing for your appointment: It can be helpful to note when sexual difficulties began, whether they are consistent or intermittent, and any other symptoms you have noticed. Be prepared to discuss your treatment history and any medications you are taking, as some drugs can affect sexual function.
Your GP can perform an initial assessment, which may include:
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Discussion of symptoms and their impact on your life
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Physical examination if appropriate
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Blood tests to check testosterone (ideally two morning samples), luteinising hormone (LH), follicle-stimulating hormone (FSH), and possibly prolactin and thyroid function
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Screening for cardiovascular risk factors (blood pressure, lipids, HbA1c), as erectile dysfunction can be an early sign of diabetes or cardiovascular disease
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Review of current medications
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Assessment of psychological factors
Depending on the findings, your GP may prescribe treatment directly or refer you to a specialist service. Urology or andrology departments, oncology follow-up clinics, NHS sexual health services, and specialist psychosexual therapy services can all provide expert assessment and management.
Remember: Sexual health concerns are a normal and expected part of cancer survivorship. Healthcare professionals routinely address these issues and can offer effective treatments. Early intervention often leads to better outcomes, so seeking help promptly is advisable. Most sexual difficulties following testicular cancer treatment are treatable, and the majority of men go on to enjoy satisfying sexual relationships. Further information and support are available from NHS England, Cancer Research UK, Macmillan Cancer Support, and the Orchid cancer charity.
Frequently Asked Questions
Can testicular cancer itself directly cause erectile dysfunction?
Testicular cancer itself rarely causes erectile dysfunction through direct physical damage, as the tumour does not typically affect the nerves or blood vessels required for erections. However, hormonal changes, psychological stress from diagnosis, and advanced disease with systemic symptoms may indirectly influence sexual function.
Will I still be able to get an erection after having a testicle removed?
Yes, the vast majority of men maintain normal erectile function after orchidectomy (surgical removal of one testis). The procedure does not affect the nerves or blood vessels responsible for erections, and one remaining testis typically produces sufficient testosterone to maintain sexual function.
How does chemotherapy for testicular cancer affect erectile function?
Chemotherapy may cause temporary erectile difficulties during treatment cycles due to fatigue, nausea, and reduced libido. Most men recover normal erectile function within months of completing chemotherapy, though a subset may experience longer-term sexual dysfunction or persistent low testosterone requiring medical assessment.
What's the difference between erectile dysfunction from testicular cancer and psychological erectile problems?
Organic erectile dysfunction results from physical damage to nerves, blood vessels, or hormonal systems, whilst psychological erectile dysfunction stems from anxiety, depression, or stress. In testicular cancer patients, psychological factors such as diagnosis-related anxiety and body image concerns often contribute more significantly to erectile difficulties than the cancer itself.
Can I get Viagra or similar medication on the NHS after testicular cancer treatment?
Yes, PDE5 inhibitors such as sildenafil (Viagra) can usually be prescribed on the NHS where clinically appropriate for erectile dysfunction following testicular cancer treatment. Your GP will assess your suitability, check for contraindications (such as nitrate medications), and may perform cardiovascular screening before prescribing.
When should I see a doctor about erection problems after testicular cancer?
You should contact your GP or specialist if erectile difficulties persist for more than a few weeks, cause significant distress, or affect your relationship or mental health. Early intervention often leads to better outcomes, and most sexual difficulties following testicular cancer treatment are treatable with appropriate medical support.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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