Elephants and Tea - March 2023 - 16

Sexuality INTIMATE ISSUES WITH MARLOE
erections are most often related to the
disruption of hormone levels in the body.
Chemotherapies that are gonadotoxic can
negatively affect testicular function and
reduce testosterone production. Healthy
levels of testosterone promote erections
by helping maintain nitric oxide levels,
one of the main chemical players that
gets synthesized and released during the
erection process. 7
Nitric oxide in the penis
acts to relax the tissues and promote
vasodilation.7,11
Without adequate levels,
erectile function is compromised.
Testicular damage and low levels of
testosterone (called hypogonadism) may
be temporary or permanent. Although
a full discussion on hypogonadism is
beyond the scope of this article, it's
important to talk with your provider
about this possibility. There are also some
non-chemotherapy medications that can
impact hormone levels.11
Your provider or
pharmacist can help determine if you are
on any meds that might be contributing
to erection problems.
THE BRAIN-BODY CONNECTION
Although we have been reviewing a lot of
ways that cancer treatments physiologically
impact erectile function, we cannot forget
the brain-body connection when it comes to
erections. As noted earlier, sexual erections
are triggered by the brain sending signals
down to the genitals, leading to a cascade
of events that results in an erection. These
signals are the brain's response to some sort
of stimulation that it perceived as sexually
relevant. You might recall that the brain
tends to ignore these types of signals when
it's overwhelmed or otherwise occupied with
other (more pressing) matters. For instance,
thoughts related to cancer.
Cancer sucks! It's stressful, scary, anxietyprovoking,
and exhausting. Unsurprisingly,
these negative thoughts and feelings tend
to display themselves front-and-center in
people's emotional landscapes, leaving
little room for anything else. This hijacks
the brain's attention, preventing it from
" seeing " stuff as sexy and telling your body
to respond accordingly. It's no secret that
the distress related to the diagnosis and
day-to-day living with cancer can impact
your mental health, and it's been found
that depression and anxiety are associated
with erection problems in young men.13
Further, some of the medications that are
used for treatment of these mood disorders
(especially a group called selective serotonin
reuptake inhibitors, or SSRIs) are known to
negatively affect sexual response for many
people taking them.8,13
Experiencing distress and anxiety about
your illness is a totally legit and logical
(not to mention, normal) reason for difficulty
with erections. Giving yourself a
little grace can go a long way. Over time,
you may find that your focus can once
again turn toward the sexier aspects of
life. In Part II, we will take a closer look
at the importance of curating a healthy
headspace when it comes to navigating
some of the mental roadblocks that cancer
creates, and we will identify some of the
psychosocial strategies for successfully
adjusting to erection changes.
THE BOTTOM LINE
Having trouble with erections after cancer
is a real thing, and it's often related to a
complicated combo of altered erection
hardware and negative emotional overload.
But that doesn't mean that you will
never enjoy sex again. Knowing a little bit
more about how your body works might
make it easier for your brain to get on
board with some of the options for overcoming
sexual challenges related to erections.
Coming up, we will dive into the
medications, mechanical aids, and mental
approaches available to help maximize the
erectile equipment you are working with.
Stay tuned! l
MARLOE ESCH, RN, BSN, ONCOLOGY CERTIFIED NURSE (OCN), AND YOUNG ADULT CANCER SURVIVOR,
GRADUATED FROM THE UNIVERSITY OF WISCONSIN - MADISON SCHOOL OF NURSING (GO BADGERS!) IN 2008.
SHE ENJOYS EDUCATING BOTH SURVIVORS AND HEALTHCARE PROFESSIONALS ON THE TOPIC OF CANCER
AND SEXUALITY, AND HAS PRESENTED FOR THE YOUNG SURVIVAL COALITION, THE ONCOLOGY NURSING
SOCIETY, AND PLANNED PARENTHOOD OF WISCONSIN, AMONG OTHERS. SHE HOLDS A CERTIFICATE
FROM THE SEXUAL HEALTH CERTIFICATE PROGRAM THROUGH THE UNIVERSITY OF MICHIGAN AND IS
CURRENTLY PURSUING HER DOCTOR OF NURSING PRACTICE (DNP) AT THE UNIVERSITY OF WISCONSIN -
MILWAUKEE. AN ENTHUSIASTIC SUPPORTER OF SEXUAL HEALTH AND WELLNESS, MARLOE IS MAKING IT HER
MISSION TO BRING SEX INTO THE SURVIVORSHIP SPOTLIGHT.
REFERENCES AND BIBLIOGRAPHY:
1. Alvarez, S. D., " Why Men Wake Up with Erections, " Hippocampus. (October 22, 2022).
https://www.newcastle.edu.au/hippocampus/story/2020/male-erections. [Accessed
December 26, 2022.]
2. American Cancer Society, " Cancer, Sex, and the Male Body, " (2020). https://www.
cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-andsexual-side-effects/sexuality-for-men-with-cancer/how-male-body-works-sexually.html.
[Accessed
November 26, 2022.]
3. American Cancer Society. " How Cancer Can Affect Erections, " (2020). https://www.
cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-andsexual-side-effects/sexuality-for-men-with-cancer/erections-and-treatment.html.
[Accessed
November 26, 2022.]
4. A Woman's Touch, " Erectile Function, " (2013). https://sexualityresources.com/wpcontent/uploads/ErectileFunction13.pdf.
[Accessed on November 26, 2022.]
5. Carter, J., et al., " Interventions to Address Sexual Problems in People with Cancer:
American Cancer Society of Clinical Oncology Clinical Practice Guideline Adaptation of
Cancer Care Ontario Guideline, " Journal of Clinical Oncology, 36(5), 492-511 (2018).
https://doi.org/10.1200/JCO.2017.75.8995. [Accessed December 26, 2022.]
6. Dizon, D. S., & Katz, A., " Overview of Sexual Dysfunction in Male Cancer Survivors, "
UpToDate (2022). https://www.uptodate.com/contents/overview-of-sexual-dysfunctionin-male-cancer-survivors.
[Accessed November 26, 2022.]
7. Dlugasch, L., & Story, L., Applied Pathophysiology for the Advanced Practice Nurse.
Jones & Bartlett Learning; 1st edition (December 11, 2019).
8. Khera, M., " Treatment of Male Sexual Dysfunction, " UpToDate (2022). https://www.
uptodate.com/contents/treatment-of-male-sexual-dysfunction. [Accessed November 26,
2022.]
9. Mitchell, L., Lewin, J., Dirks, J., Wang, K., Tam, S., Katz, A., McCann, B., Lo, K.,
Laurence, V., Rousset-Jablonski, C., & Gupta, A. A., " Sexual Health Issues for the
Young Adult with Cancer: An International Symposium Held during the First Global
Adolescents and Young Adults Cancer Congress (Edinburgh, United Kingdom). " Journal
of Adolescent and Young Adult Oncology, 7(2), 153-163 (2018). https://doi.org/10.1089/
jayao.2017.0067. [Accessed December 26, 2022.]
10. National Comprehensive Cancer Network. NCCN guidelines: Survivorship [Version
1.2022], https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf.
[Accessed November 16, 2022].
11. Rosen, R. C., & Khera, M., " Epidemiology and Etiologies of Male Sexual Dysfunction, "
UpToDate. (2022). https://www.uptodate.com/contents/epidemiology-and-etiologies-ofmale-sexual-dysfunction.
[Accessed December 12, 2022.]
12. Stanton, A. M., Handy, A. B., & Meston, C. M., " Sexual Function in Adolescents and
Young Adults Diagnosed with Cancer: A Systematic Review. " Journal of Cancer
Survivorship: Research and Practice, 12(1), 47-63 (2018). https://doi.org/10.1007/
s11764-017-0643-y. [Accessed December 26, 2022.]
13. Sukhu, T., Ross, S., & Coward, R. M., " Urological Survivorship Issues Among Adolescent
Boys and Young Men Who Are Cancer Survivors, " Sexual Medicine Reviews, 6(3),
396-409 (2018). https://doi.org/10.1016/j.sxmr.2017.12.007. [Accessed December 26,
2022.]
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Elephants and Tea - March 2023

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