Testicular cancer as a cause of erectile dysfunction

Testicular cancer is a relatively rare cancer representing only 1% of male cancers and affecting up to 8,000 males and killing 400 males each year in the United States alone. While men of all ages are at risk of developing testicular cancer, it is most commonly diagnosed within the age population of 15 to 39 years. There are two main forms of testicular cancers: seminomas, a slow growing and radiation sensitive cancer and nonseminomas, generally rapid growing cancers. Types of seminomas include: classic, anaplastic and spermatocytic cancers, whereas types of nonseminomas include: choriocarcinomas, embryonal carcinomas, teratomas and yolk sac tumors. Certain factors influence the risk of developing testicular cancer. These include:

• Undescended testicle – Males that suffer from cryptorchidism have been shown to have an elevated risk of testicular cancer.
• Congenital abnormalities – Men born with abnormalities of the testis, penis and/or kidneys have been shown to be at an increased risk of testicular cancer.
• History of testicular cancer – Men who have had a diagnosis of testicular cancer are at risk of developing cancer in the other testicle.
• Family history of testicular cancer – Men who have a first degree family member (i.e. brother or father) that has or had testicular cancer are at an increased risk.

It is important to note that there are other causes of testicular cancer such as exposure to certain chemicals and HIV infection. The good news, testicular cancer is highly curable when detected early. In fact, approximately 95% of patients with testicular cancer are still alive five years later. The bad news, only half of men seek medical attention before the cancer has become aggressive and spread to other parts of the body. Moreover, the treatment of testicular cancer is associated with a variety of complications. Of which, studies have demonstrated a link between erectile dysfunction and testicular cancer.

What are the symptoms of testicular cancer?

Testicular cancer can often go undetected. In fact, many men with testicular cancer do not complain of any form of illness and do not report any symptoms. The first signs of testicular cancer are usually the presence of small or large lumps within the testicles or changes in the feel of the testicles. Patients with testicular cancer may also complain of pain or swelling of the testicles, enlargement of the testicles, pain in the lower abdomen, back or groin areas and swelling of the scrotum.

While all of these symptoms can be explained by other benign conditions, it is important that anyone suffering from the above symptoms seeks medical attention. It is important to note that symptoms in other parts of the body such as the lungs, abdomen, pelvis, back or brain may be present in testicular cancer patients in which the cancer has spread to other parts of the body.

What is erectile dysfunction?

Erectile dysfunction is defined by the inability to obtain or maintain an erection during sexual activity. It is a fairly common condition with 6.2% of all males and approximately half of males over the age of 75 years suffer from erectile dysfunction. Moreover, approximately 30 million men in the United States alone suffer from erectile dysfunction and erectile dysfunction accounts for over 1.5 million doctor-office visits each year.

There are both physical and psychological causes of erectile dysfunction. However, it is most commonly caused by physical conditions such as: heart disease, atherosclerosis (clogged blood vessels), high blood pressure, diabetes, obesity, Parkinson’s disease, multiple sclerosis, low levels to testosterone, Peyronie’s disease, certain medications such as antidepressants, antihistamines and medications used to treat high blood pressure, pain and prostate cancer, smoking, alcoholism or drug abuse and treatments and surgeries for prostate cancer.

It is important that psychological factors such as depression, anxiety, stress and other mental health conditions are also considered as a possible cause of erectile dysfunction.

How is testicular cancer linked to erectile dysfunction?

Many studies have shown a direct link between erectile dysfunction and testicular cancer. In fact, both the disease state of testicular cancer, as well as the treatment of testicular cancer can potentiate erectile dysfunction in patients. A significant risk of erectile dysfunction, ejaculatory dysfunction and inhibition of orgasm has been demonstrated in men diagnosed with testicular cancer. In fact, in the analysis of over 100 males with testicular cancer, 25 percent showed a reduced sexual desire, 7% had erectile dysfunction, 24 percent had orgasmic dysfunction, 16 percent had ejaculatory dysfunction and 11 percent displayed a reduced sexual activity. It is important to note that patients demonstrated these sexual dysfunctions for period of up to 2 years following diagnosis.

In another analysis of over 400 patients receiving radiation therapy as a modality of testicular cancer therapy, 14 percent of patients had reduced sexual desire, 23 percent had orgasmic dysfunction, 25 percent had erectile dysfunction, 40 percent had ejaculatory dysfunction and 29% had reduced sexual activity.

A third analysis of 160 patients receiving chemotherapy as a testicular cancer therapeutic modality demonstrated that: 25 percent of patients had reduced sexual desire, 28 percent had orgasmic dysfunction, 11 percent had erectile dysfunction, 28 percent had ejaculatory dysfunction and 34% had reduced sexual activity.

A final analysis observed sexual dysfunction of testicular cancer patients that underwent the surgical resection of the affected testicle showed that: 13 percent of patients had reduced sexual desire, 22 percent had orgasmic dysfunction, 11 percent had erectile dysfunction, 62 percent had ejaculatory dysfunction and 29% had reduced sexual activity.

These analyses concluded that there is a link between erectile dysfunction and testicular cancer, as well as there being an influence of treatment modality on erectile dysfunction.

References

MedicineNet - https://www.medicinenet.com/script/main/art.asp?articlekey=76863

National Cancer Institute - https://www.cancer.gov/cancertopics/types/testicular

National Institute of Health - https://www.nlm.nih.gov/medlineplus/erectiledysfunction.html

Nazareth I, Lewin J, King M. Sexual dysfunction after treatment for testicular cancer: a systematic review. J Psychosom Res. 2001;51:735-43.

Fosså SD, Dahl AA, Haaland CF. Health-related quality of life in patients treated for testicular cancer. Curr Opin Urol 1999;9:425-9.

Huddart RA et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer 2005;93:200-7.