Is low libido a common side effect of Colon Cancer treatment? How can it be managed?

Low libido (reduced sexual desire) is common after colon and rectal cancer treatment and can stem from physical, hormonal, nerve, and emotional factors related to surgery, chemotherapy, and radiation. Cancer and its treatments can affect sexual life in both physical and emotional ways, and specialized sexual health programs can help address these changes. ^[1] Cancer care teams for colorectal conditions acknowledge that sex and intimacy may be affected, and dedicated services exist to support recovery. ^[2] These concerns are also part of survivorship care planning as people transition after treatment. ^[3]

Why it happens

• Surgery-related nerve effects: Pelvic surgery for rectal cancer can injure autonomic nerves, leading to erectile problems in men and arousal/orgasm difficulties in women, which can lower desire. This risk is well-recognized, and nerve-preserving techniques have improved outcomes, but dysfunction can still occur. [PM15] Sexual disorders in rectal cancer can arise from the disease itself and treatments including surgery, chemotherapy, and radiotherapy. [PM13]

• Radiation and chemotherapy effects: Pelvic radiation and systemic chemotherapy may contribute to hormonal changes, vaginal dryness, erectile dysfunction, and fatigue, all of which reduce libido. Women may report more sexual problems after radiotherapy compared with surgery alone at long-term follow-up. [PM14] Cancer treatments can also lead to hypogonadism (low testosterone) in men, which lowers desire. [PM18]

• Emotional and body-image factors: Stress, changes in body image (including stoma), and relationship worries commonly reduce sexual interest after treatment. Sexual health programs acknowledge both physical symptoms and emotional challenges impacting intimacy. ^[1] Survivorship resources highlight that life after treatment often involves addressing fertility and sexual concerns. ^[3]

How common is it?

Sexual dysfunction after cancer is widespread: estimates across cancers suggest low libido and other sexual health issues affect a large proportion of survivors, with notable prevalence in colorectal populations due to multimodality therapy. [PM18] Rectal cancer care frequently reports bowel, sexual, and urinary dysfunction after combined surgery, radiation, and chemotherapy, underscoring the impact on quality of life. [PM16]

First steps you can take

• Talk to your care team: It’s reasonable to discuss sex and intimacy with your doctor or nurse; many centers have sexual health services for colorectal cancer survivors. These programs have experts trained in female sexual health, fertility, and male sexual function, and can discuss physical changes and strategies to improve intimacy. ^[4] Comprehensive survivorship support is available to guide life after treatment, including sexual concerns. ^[3]

• Review medications and hormones: Fatigue, pain medicines, antidepressants, and hormonal shifts can all lower desire; a medical review can identify reversible contributors. Cancer treatment can produce hypogonadism in men, which may be addressed when appropriate. [PM18]

Evidence-based management options

Medical and hormonal care

• Men: If low testosterone (hypogonadism) is confirmed and not contraindicated, testosterone therapy may be considered to improve libido and energy; erectile dysfunction can be treated with phosphodiesterase type 5 inhibitors (like sildenafil), with second-line options including vacuum devices, urethral suppositories, injections, or implants when needed. [PM18]
• Women: For genitourinary syndrome of menopause (dryness, pain), start with nonhormonal moisturizers and lubricants; when appropriate, low-dose local vaginal estrogen can help with comfort and arousal. Pelvic radiation or chemotherapy may also contribute to early menopause, making these options particularly relevant. [PM18]

Rehabilitation and physical therapies

• Pelvic floor physical therapy: Helpful for pelvic pain, vaginal tightness (stenosis), and post-surgical dysfunction; structured therapy and vaginal dilators can restore comfort and confidence, supporting desire. [PM18]
• Nerve-sparing surgical follow-up: If surgery contributed to dysfunction, urology/gynecology consults can assess nerve-related issues and targeted treatments. Advances in nerve-preservation during rectal surgery aim to reduce sexual complications. [PM15]

Psychosexual and relationship support

• Counseling and sex therapy: A biopsychosocial approach addressing mind and body improves outcomes; group or individual psychosexual interventions can increase sexual desire and relationship satisfaction in cancer survivors. [PM18] Structured psychosexual programs have demonstrated significant improvements in desire symptoms compared with usual care. [PM21]
• Education and communication: Guided discussion about expectations, body image, and practical tips for intimacy can lower anxiety and rekindle desire; oncology programs often provide such resources for colorectal survivors. ^[1] Centers dedicated to colorectal cancer offer integrative and supportive services that include sexual health support. ^[5]

Practical tips you can try

• Manage dryness and pain: Use water-based or silicone lubricants; add vaginal moisturizers regularly for comfort, which can help desire return when sex becomes less painful. [PM18]
• Plan for energy: Choose times of day when fatigue and nausea are lowest; gentle activity and sleep hygiene can improve overall vitality, supporting libido. ^[5]
• Gradual intimacy: Start with non-sexual touch and expand slowly; reducing performance pressure often helps desire grow. Sexual health teams can coach on paced return to intimacy. ^[1]
• Address stoma concerns: Practical strategies (discreet pouch covers, emptying before intimacy) and counseling reduce self-consciousness and help couples reconnect. Programs for colorectal survivors routinely discuss these concerns. ^[2]

When to seek specialist care

• Persistent symptoms: If low libido or sexual pain lasts more than a few months after treatment or significantly affects quality of life, ask for referral to oncology sexual health services, urology, gynecology, or pelvic floor therapy. Centers with colorectal cancer expertise offer multidisciplinary sexual health programs. ^[4] Survivorship clinics are designed to address these issues after treatment ends. ^[3]

Outlook

With tailored medical, rehabilitative, and psychosocial care, most people can improve sexual comfort and desire over time. A comprehensive, patient-centered approach screening for hormonal issues, treating physical symptoms, and supporting emotional wellbeing has been shown to help cancer survivors regain satisfying sexual lives. [PM18] Integrating sexual health into follow-up care is increasingly emphasized in colorectal cancer survivorship to enhance overall quality of life. [PM16]