It is normal to worry about the possible effects of testicular cancer and its treatment on your sex life and fertility. This section explains how treatment may affect your sex life and fertility. There is also information on contraception during treatment, having children in the future, testosterone replacement and storing sperm (sperm banking).

Orchidectomy

Removing a testicle will not affect your ability to get an erection or make someone pregnant. The healthy testicle will usually produce enough testosterone and sperm, unless it is very small.

Removing the retroperitoneal lymph nodes (RPLND)

Surgery to remove the retroperitoneal lymph nodes may damage the nerves involved in ejaculation. This can cause sperm to go backwards into the bladder instead of coming out through the penis when you orgasm. The sperm then passes out harmlessly when you next pass urine (pee). This is called retrograde ejaculation.

The operation does not stop you getting an erection, but your orgasm will feel different because it is dry (dry climax). Surgeons can use newer surgical techniques, such as keyhole and robotic surgery, to try and protect the nerves and reduce the risk of this. But your doctor may still advise you to think about storing sperm if you need this operation.

Urinary sperm retrieval

If you are unable to store sperm before your operation and you have retrograde ejaculation, sometimes specialists can collect the sperm from your pee. They will give you a drink that makes your urine less harmful to your sperm. You will be asked to pee and then masturbate. After you ejaculate, you will have to pee again. The sperm is quickly collected from the urine, prepared and stored.

Radiotherapy

Radiotherapy to the lymph nodes in the tummy (abdomen) does not affect your ability to have sex. It does not usually cause infertility. But your doctor might still suggest you store sperm.

Chemotherapy

Chemotherapy does not affect your ability to have sex. But side effects might lower your sex drive for a while. Chemotherapy for testicular cancer usually causes infertility but it is usually temporary. Your doctor will talk to you about storing sperm before your treatment. High-dose chemotherapy with stem cell support has a much higher risk of causing infertility, which may be permanent.

If you need to start chemotherapy straight away, there may be no time to give and store sperm samples. But you may be able to store sperm within the first few days of starting chemotherapy.

How quickly the sperm count recovers after chemotherapy can vary. It can depend on:

• your sperm count before having chemotherapy
• the type and amount of chemotherapy you have.

Your sperm count usually starts to return to normal about 18 months to 2 years after treatment. But it can take longer for some people. You can ask to have your sperm count checked.

Sex life and sex drive

Treatments for testicular cancer do not usually affect your ability to have sex. But a diagnosis of testicular cancer can cause a lot of feelings. This may affect your sex drive (libido) for a time. Treatment side effects may also mean you have a lower sex drive. If you have a partner, let them know how you feel. It can take time to recover physically and emotionally.

If you find you have a low sex drive, this will usually improve as your feelings get easier to cope with and you recover from treatment. If you are having sexual difficulties, there is support available.

Testosterone replacement therapy

Removing one testicle does not usually affect your sex drive. The remaining testicle should make enough testosterone on its own. Sometimes the remaining testicle does not produce enough testosterone. Or, rarely, both testicles have to be removed because of cancer.

A lack of testosterone can:

• affect your ability to get an erection
• reduce your sex drive
• cause tiredness, low mood and problems such as thinning of the bones (osteoporosis).

Tell your doctor if you are having these or any other symptoms. They can measure your testosterone level with a blood test. If it is low, your doctor may be able to prescribe testosterone replacement therapy to improve your symptoms. You can have it as a gel, an injection into a muscle, an implant, or a patch that you stick to the skin. Your doctor can give you more information about testosterone replacement therapy.

Sex and testicular cancer

Sexual difficulties are very personal. A common worry is that you can pass cancer cells on during sex. Cancer is not infectious, so it is safe for you to have sex. Whatever feelings or concerns you have, it can help to talk to someone.

• Talking to a partner – if you have a partner, it can help to talk openly to them about any problems you are having. You might find that you understand each other better by having an honest conversation.
• Talking to a potential partner – if you are single, you may have some concerns about starting a new relationship or having sex with someone new. If you meet someone new, you may want to give yourself some time to feel comfortable in the relationship before talking about any concerns you may have.
• Support from your healthcare team – talk to your doctor or nurse about any sexual difficulties you have. You may feel embarrassed, but they have experience of speaking to others who have had similar problems. Many hospitals also have specialist nurses who can offer support. Some hospitals have counsellors who have had special training to help people who are having sexual difficulties. They are called sex and relationship therapists.
• Talk to others in a similar situation – sometimes it helps to talk to someone who is going through the same thing. You can find support by visiting the testicular cancer forum.
• Support organisations – ask your team about support groups. You can also contact support organisations such as Orchid and the College of Sexual and Relationship Therapists.

If you identify as gay, bisexual or transgender

Many sexual difficulties caused by testicular cancer are similar whatever your sexual orientation or gender identity. But you may have some specific questions. Having your sexual or gender identity acknowledged may help you feel better supported. It also means your healthcare team can give you the right information and advice.

If you feel unable to talk to your healthcare team about your sexuality, the LGBT Foundation has a helpline that can give you confidential advice and support.