Can radiation therapy cause low libido, and how can you cope?

Radiation therapy can be linked to low libido (reduced sexual desire), especially when treatment involves the pelvis or is combined with hormonal therapy for cancers like prostate cancer. Sexual changes after pelvic radiation commonly include erection difficulties, altered orgasm sensation, and changes in semen, all of which can reduce desire. ^[1] Some people notice burning with ejaculation during treatment, which usually resolves within 1–2 months after finishing radiation, but other sexual changes can appear months to years later and may be persistent. ^[1] When hormonal therapy is added to radiation (common in prostate cancer care), decreased sexual desire is a recognized side effect that can last months after hormone therapy ends. ^[2] These impacts vary widely by treatment field, dose, and individual factors, and support services are available to help you manage sexual health during and after therapy. ^[3]

Why libido can drop

• Direct pelvic effects: Radiation to the pelvis can lead to erectile dysfunction (difficulty getting or keeping an erection), changes in orgasm, and semen changes; these functional issues often lower desire. ^[1] Such changes can emerge months to years after therapy and, in some cases, be long-lasting. ^[1]
• Hormonal therapy combination: When radiation is given with androgen-deprivation therapy (ADT) for prostate cancer, patients commonly experience lower sexual desire, fatigue, hot flashes, mood changes, and erectile dysfunction, all of which can dampen libido. ^[2] Some side effects improve over time after hormone therapy stops, but others may persist for months. ^[2]
• Fatigue and general side effects: Radiation can cause fatigue and appetite loss, which reduce energy and interest in sex. ^[4]

How common and how long does it last?

There is meaningful variability, but many people receiving pelvic radiation report sexual changes, with some effects starting during treatment and others appearing later. ^[1] Burning with ejaculation during therapy typically improves within 1–2 months after radiation ends, while erectile and orgasm changes can arise months to years later and may be lasting. ^[1] With concurrent hormonal therapy, reduced sexual desire is a well-known side effect that may ease gradually after hormones are discontinued, though timing differs from person to person. ^[2]

Practical coping strategies

• Medical evaluation and treatment options

  • Discuss erection changes or low desire with your care team; referral to sexual medicine specialists is available and can provide tailored therapies. ^[3]
  • For erectile difficulties, options may include medications, devices, or rehabilitation strategies; care teams can guide you and coordinate support. ^[3]
  • If you received hormonal therapy, track symptoms like hot flashes, mood changes, and fatigue; some will lessen after therapy ends, and targeted treatments can help. ^[2]

• During treatment

  • You can be sexually active during external-beam radiation unless your radiation oncologist advises otherwise, and you are not radioactive to others. ^[5]
  • Use contraception if pregnancy is possible, as cancer treatments can affect fertility. ^[5]
  • Consider lubricants and gentle approaches to reduce discomfort and maintain intimacy. ^[5]

• Psychological and relationship support

  • Stress, anxiety, and depression commonly affect sexual health after cancer; professional support and open communication with partners improve outcomes. ^[6]
  • Education and building a support system including mental health and sexual health professionals are key to recovery of sexual well-being. ^[7]
  • Exploring new ways of intimacy, relearning body sensations, and patience with yourself and your partner can help restore sexual confidence and desire over time. ^[8]

When to seek specialized help

If low libido or sexual function changes persist or cause distress, ask for referral to a sexual medicine program; these teams can help before, during, and after radiation, including addressing fertility concerns. ^[3] Specialized programs for male sexual and reproductive health can assist with issues like erectile dysfunction and reduced desire and coordinate with your oncology team. ^[3]