Hitting a Nerve: Nerve Damage From Cancer Treatment Can Impair Sexual Function

Nerve and other damage from cancer treatments can impair men’s sexual function, and adjusting can be a challenge.
A cancer diagnosis is a life-changing event for anyone, but for men with prostate cancer and other pelvic malignancies, the long-term effects of the disease and its treatments can be particularly challenging. In the aftermath of treatment, men not only can experience distressing physical and psychological effects, but many also have their first experiences with sexual dysfunction.

This distressing side effect can result from treatments for bladder, colon, rectal or penile cancer, but men treated for prostate cancer have especially high rates of sexual dysfunction, as high as 75 to 85 percent, depending on the situation. Causes across this spectrum of cancers can include low testosterone levels due to hormone therapy, chemotherapy or radiation; damage to nerves near the prostate as a result of surgery or chemotherapy; compromised blood flow to the penis due to surgery or radiation; and surgical damage to nerves that control semen outflow.

Unfortunately, the topic’s sensitive nature and a lack of accurate information can keep men from getting the help they need.


Until the ‘80s, permanent impotence was considered an unfortunate but inevitable byproduct of prostatectomy. But in 1977, after studying ways to lessen the bleeding that often accompanied the procedure, Johns Hopkins Urologist in Chief Patrick C. Walsh, M.D., was stunned to learn that one of his surgical patients had regained sexual function. Walsh subsequently developed what have become standard nerve-sparing techniques for the operation, performing the first one himself in 1982. Nerve-sparing techniques can also be used in radical cystectomies and in lymph node removal for testicular cancer.

The complicating factor in nerve-sparing prostatectomy is that the nerves are microscopic, which presents a significant challenge to the surgeon, says Andrew Matthew, Ph.D., C.Psych., a psychologist at the Prostate Cancer Rehabilitation Clinic at the University of Toronto’s Princess Margaret Cancer Centre. In addition, the nerve bundles are extremely delicate, and any manipulation inevitably results in some damage. “Removing the nerves from the sides of the prostate traumatizes them so they’re no longer functional for a period of time,” he notes. “It’s quite difficult to determine how much damage has been done to either or both bundles after the procedure.” Further complicating matters: Prostatic nerves can also be disturbed during other procedures, such as surgery for bladder or rectal cancer.

The amount of inflammation and nerve injury directly translates to how long it will take for the nerves to recover, and until they do, men will experience erectile problems. To say that this is distressing for most men is an understatement, especially for younger men. “With the advent of PSA (prostate-specific antigen) tests (of the blood to screen for the disease), we’ve seen more and more young guys diagnosed with prostate cancer in the last decade,” notes Jeffrey Albaugh, Ph.D., APRN, CUCNS, director of sexual health at NorthShore Medical Group in Evanston, Illinois. “They generally do better in terms of recovery, even those in their 40s and 50s, but we still can’t predict how each patient will do.”

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