Chemotherapy and Erectile Dysfunction: Causes and Coping Strategies

Chemotherapy can be associated with erectile dysfunction (ED) in some people, often through effects on hormones, nerves, blood vessels, and overall wellbeing. ^[1] Several cancer treatments, including certain chemotherapy regimens and transplants, may lower testosterone, which can reduce libido and contribute to ED. ^[2] ED can also be influenced by fatigue, stress, and depression during and after treatment. ^[3]

How Chemotherapy Can Lead to ED

• Hormonal changes: Some treatments can lower testosterone (hypogonadism), which can reduce sexual desire and make erections harder to achieve. ^[4] Stem cell or bone marrow transplants have been linked with decreased testosterone and loss of libido. ^[2]

• Nerve and blood vessel effects: Cancer treatments may affect the nerves and blood vessels that control erection, which can lead to difficulty getting or keeping an erection. ^[5]

• General side effects and emotions: Fatigue, stress, and mood changes during chemotherapy can reduce sex drive and contribute to sexual dysfunction. ^[3] Emotional support and understanding from partners can help manage these issues. ^[6]

• Treatment-specific factors: The type of drugs, total dosage, and duration of chemotherapy, along with individual health factors, all influence the chance and severity of sexual side effects. ^[7]

Is ED Temporary or Long‑Term?

ED during chemotherapy is often temporary and may improve as recovery progresses, but the course varies by age, baseline function, and whether key nerves or hormones were affected. ^[8] In many people, changes in sperm and sexual function can begin within a few months of treatment and may recover over time, though this depends on the regimen and individual health. ^[9]

First-Line Ways to Cope

• Address modifiable risks: Managing blood pressure, cholesterol, diabetes, smoking, and body weight can improve erectile function. ^[10]

• Psychosocial support: Relationship factors, stress, and mood can significantly impact sexual health; open communication and counseling may help. ^[10]

• Medications (PDE5 inhibitors): First-line medicines like sildenafil, vardenafil, and tadalafil can be effective for many people with ED after cancer treatment. ^[10]

• Specialist referral: A urologist who specializes in ED can discuss medications, injections, devices, and tailored plans to restore erectile function. ^[11]

Additional Treatment Options

• Injections and devices: Penile injections and vacuum erection devices can help achieve erections when pills are not effective or suitable. ^[11]

• Implants: For persistent ED, penile implants may be considered after evaluation by a specialist. ^[12]

• Hormone evaluation: If low testosterone is suspected, testing and appropriate management may be discussed with your care team. ^[4]

Practical Tips During Treatment

• Protect partners: During chemotherapy, using condoms is advised to avoid exposing partners to chemotherapy drugs. ^[9]

• Plan intimacy: Fatigue is common choose times when energy is better, use lubrication, and focus on comfort and connection. ^[13] Partner communication about preferences and concerns can reduce anxiety and improve sexual experiences. ^[12]

• Fertility and family planning: Chemotherapy can affect sperm count and motility temporarily or, in some cases, longer term; discuss sperm banking before treatment when possible. ^[9] If building a family is a goal, ask your team about fertility options and timing after treatment. ^[5]

When to Seek Help

• If ED persists: If difficulty with erections continues, talk with your oncology team for a referral to sexual health or urology specialists who work with cancer survivors. ^[1]

• If there are new symptoms: Report genital discharge, burning, odor, or itching after sex, as these need evaluation and may be manageable with simple treatments. ^[13]

Key Takeaways

• Chemotherapy and related cancer treatments can contribute to ED through hormonal, neurologic, vascular, and emotional pathways. ^{[5] [4]}
• Effective help exists: lifestyle changes, counseling, PDE5 inhibitors, injections, devices, and implants can restore sexual function for many people. ^{[10] [11]}
• Open communication and specialist support make a real difference in recovery and quality of life. ^{[12] [1]}