Sexual Health


Aug 04, 2019

Mention a penile implant to a man with erectile dysfunction (ED), and you might get a squeamish look. The idea of having surgery on his private parts is likely to make any man squirm. And, naturally, there are questions. Will the implant work? Will there be complications? Will sex feel the same? What do partners think?

These are all valid concerns. However, research over the years has found that implants have high satisfaction rates from men and their partners.

What is a penile implant?

A penile implant (sometimes called a penile prosthesis), is a device that allows a man to get an erection whenever he chooses. The implant is placed inside the body. No part of the implant is visible. Sexual sensations, ejaculation, and orgasm remain the same for most men.

In basic terms, implant surgeons remove the corpora cavernosa – two spongy chambers in the penis. Typically, these chambers fill with blood to form an erection. The tissue is replaced with implant materials, which form erections differently, depending on the type:

  • Malleable (semi-rigid, bendable) implants are rods placed in the shaft of the penis. When a man wants to have an erection, he simply lifts the penis into position. When he is done with sexual activity, he places it downward again.
  • Inflatable penile implants are a bit more complex. Instead of bendable rods, surgeons place two cylinders inside the penis shaft. These cylinders are connected to a pump that is surgically placed in the scrotum. To have an erection, the man activates the pump, which fills the cylinders with fluid, making the penis erect. After sex, he deactivates the pump, and the penis returns to its flaccid (not erect) state. Inflatable implants come in two varieties. Three-piece units include the pair of cylinders, the pump, and a fluid-containing reservoir. With two-piece units, the pump and reservoir are in the same unit.

Why get an implant?

 While less-invasive treatments for ED, such as pills, injections, and suppositories, help lots of men, they aren’t appropriate for everyone. Some men just don’t have success with these options. And others can’t use them. For example, men who take medications containing nitrates cannot take ED pills because drug interactions could cause a dangerous drop in blood pressure.

Are men satisfied?

Experts say yes, for the most part. Here is a brief summary of research conducted over the last two years:

  • In June 2018, BJU International published a study of 142 Italian men with implants. Men tended to be satisfied with their implants one year after surgery. More experienced surgeons were more likely to have satisfied patients.
  • A July 2018 Journal of Sexual Medicine study of 902 men with implants reported that 93% were highly satisfied six months after implantation. Those who experienced major complications were less satisfied.
  •  A November 2018 paper in Sexual Medicine Reviews reported that patient and partner satisfaction rates were over 85%.
  • Research published in the Journal of Sexual Medicine in May 2019 analyzed couples’ satisfaction with implants in a group of 883 men and their partners. About 90% of those with malleable implants said they were “somewhat” or “very” satisfied. Rates for these categories were 96% for men with two-piece inflatable implants and 99% for men with three-piece inflatable devices.Most of the couples said the implant met their expectations and that the device was easy to use. In addition, most said they felt confidence in their ability to engage in sexual activity. 

Implant advantages

Many men enjoy the spontaneity that implants offer. Instead of waiting for other treatments to take effect, they can create their erection in the moment. Some feel more masculine having their erectile function restored and more confident being able to please their partner.

Implant disadvantages

On the other hand, implants can have some drawbacks. As with any surgical procedure, there is a risk for infection. Device malfunctions are rare, but possible. There could be some shortening of the penis (although some men don’t notice). And some men don’t like the “artificial” aspect of a prosthesis.

A big decision

While most men and their partners are satisfied with their implants, only you and your partner can decide what is best for your personal situation. It’s important to be prepared and have realistic expectations. Also, keep in mind that implant procedures are not reversable. Once the corpora cavernosa are replaced, they cannot be restored.

Be sure to let your urologist know if you or your partner have any questions or concerns.

Resources

BJU International

Capogrosso, Paolo, et al.

“Satisfaction rate at 1year followup in patients treated with penile implants: data from the multicentre prospective registry INSISTED

(Abstract. First published: June 29, 2018)

https://onlinelibrary.wiley.com/doi/abs/10.1111/bju.14462

International Society for Sexual Medicine

“What if I don’t like the implant? Can the operation be reversed?”

https://www.issm.info/sexual-health-qa/what-if-i-dont-like-the-implant-can-the-operation-be-reversed/?ref_condition=penile-prosthesis

“Will sex still feel the same with a prosthesis?”

https://www.issm.info/sexual-health-qa/will-sex-still-feel-the-same-with-a-prosthesis/?ref_condition=penile-prosthesis

Journal of Sexual Medicine

Carvalheira, Ana, PhD, et al.

“Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation”

(Full-text. December 2015)

http://www.jsm.jsexmed.org/article/S1743-6095(16)30020-0/fulltext

Çayan, Selahittin, MD, FECSM, et al.

“Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation”

(Full-text. Published: May 30, 2019)

https://www.jsm.jsexmed.org/article/S1743-6095(19)31140-3/fulltext

Habous, Mohamad, MD, FEBU, FECSM, et al.

“Predictors of Satisfaction in Men After Penile Implant Surgery”

(Full-text. Published online: July 15, 2018)

https://www.jsm.jsexmed.org/article/S1743-6095(18)31002-6/fulltext

Mayo Clinic

“Two-piece penile implant”

https://www.mayoclinic.org/tests-procedures/penile-implants/multimedia/two-piece-penile-implant/img-20008851

Sexual Medicine Reviews

Barton, Gregory J., et al.

“Sexual Quality of Life and Satisfaction With Penile Prostheses”

(Full-text. Published online: November 29, 2018)

https://www.smr.jsexmed.org/article/S2050-0521(18)30113-6/fulltext

Urology Care Foundation

“What is Erectile Dysfunction?”

(Updated: June 2018)

https://www.urologyhealth.org/urologic-conditions/erectile-dysfunction#Treatment



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Jul 03, 2019

Marijuana (cannabis) use laws have been changing rapidly in North America. Last week, Illinois became the 11th U.S. state to legalize recreational marijuana, and such use became legal across Canada last October. Mexico might legalize recreational marijuana later this year.

With marijuana more freely available, people do have health concerns. In regard to sexual and reproductive health, both men and women should know the possible short-term and long-term effects of marijuana on their sexual performance and fertility.

In today’s post, we’ll discuss some recent research of interest to men and to couples who are interested in having children.

Past Research

Before we get started, let’s take a moment to consider past research on marijuana and male fertility. Back in 2011, we reported on ways marijuana might affect sperm cells:

When healthy sperm cells are released, they don’t start swimming toward the egg right away. Instead, they go with the flow of the semen until they are closer to the egg. Then the swimming starts in a process called hyperactivation.

But sperm under the influence of marijuana start swimming immediately. The result? Many tire themselves out and don’t reach the egg at all.

Those that do reach the egg are less likely to fertilize it. This is because THC [tetrahydrocannabinol – marijuana’s active ingredient) hinders their ability to release enzymes needed to pass through the egg cell’s wall.

What do scientists think of marijuana’s effects on sperm now? The answers are mixed.

Increased Sperm Concentrations

In February 2019, researchers reported that men who had smoked marijuana in the past had “significantly higher concentrations of sperm” than men who had never smoked it.

Between 2000 and 2017, researchers collected and analyzed 1,143 semen samples from 662 men who were patients at a fertility clinic. The men also answered questions about their marijuana use.

Over half the men said they’d smoked marijuana at some point in the past. Forty-four percent said their smoking days were behind them, but 11% said they still smoked. About 45% of the men said they had never smoked marijuana.

Semen sample analyses showed that men with a history of smoking marijuana had an average of 62.7 million sperm cells per milliliter of semen. For men who had never smoked, the average count was 45.4 million sperm per milliliter.

The researchers also looked at how many men had sperm concentrations below 15 million per milliliter, the “normal” benchmark set forth by the World Health Organization. Five percent of marijuana smokers fell into this category, but over twice as many – 12% - of the nonsmokers did.

Does this mean that marijuana leads to higher sperm concentrations? Not necessarily. The authors pointed out that the men may have mis-stated their marijuana use, since the drug was illegal for most of the study period.

Also, the results run counter to previous studies that have shown negative effects on sperm. So more research is needed.

“These unexpected findings highlight how little we know about the reproductive health effects of marijuana, and in fact of the health effects of marijuana in general,” said study co-author Jorge Chavarro of the Harvard Chan School of Public Health in a press release.

“Our results need to be interpreted with caution and they highlight the need to further study the health effects of marijuana use,” he added.

Negative Effects on Sperm

Another study, published in April 2019, had some discouraging news for hopeful fathers.

At the annual meeting of the American Urological Association, researchers reported that sperm quality declined in men who used marijuana.

Their study involved 622 men between the ages of 18 and 59. One hundred twenty-five of the participants were infertile, 144 men used tobacco, and 74 men used marijuana. Another 279 fertile men who did not use tobacco or marijuana served as a comparison group.

After analyzing the men’s semen samples, the researchers found poorer semen parameters among marijuana users compared to the men who used tobacco. The marijuana users had fewer sperm cells per milliliter. Their sperm also had worse motility (ability to swim to an egg cell for fertilization) and poorer morphology (defects in size and shape).

The Takeaway

We still have a lot to learn about the marijuana’s effects on our general health, as well as our sexual health. In the meantime, couples who hope to become parents should be open about their marijuana use when talking to their doctors. They should also be up front about the use of any other substances that could reduce their chances of conceiving.

Even if you’re not thinking about having children, take a moment to consider your own marijuana use. Do you think it’s impacting your health, even in subtle ways? If so, don’t hesitate to bring this up with your doctor and take steps to get your use under control.

Resources

CNN.com

Simon, Darran and Nicole Chavez

“Canada just legalized recreational pot. Here's what you need to know”

(Updated: October 17, 2018)

https://www.cnn.com/2018/10/17/health/canada-legalizes-recreational-marijuana/index.html

Stracqualursi, Veronica

“Illinois becomes the 11th state to legalize recreational marijuana”

(June 25, 2019)

https://www.cnn.com/2019/06/25/politics/illinois-legal-marijuana/index.html

Harvard T.H. Chan School of Public Health

“Marijuana smoking linked with higher sperm concentrations”

(Press release. February 5, 2019)

https://www.hsph.harvard.edu/news/press-releases/marijuana-smoking-sperm-counts/

Human Reproduction

Nassan, Feiby L., et al.

“Marijuana smoking and markers of testicular function among men from a fertility centre”

(Full-text. February 5, 2019)

https://academic.oup.com/DocumentLibrary/humrep/PR_Papers/dez002.pdf

Journal of Urology

Hallak, Jorge, et al.

“MP75-09 Marijuana Consumption Has a Direct Deleterious Effect on Spermatozoa by Increasing Intracellular Reactive Oxygen Species Levels 20 Times More Than Tobacco Smoking: Reasons For Concern On Widespread Use”

(Abstract. Published: April 1, 2019)

https://www.auajournals.org/doi/10.1097/01.JU.0000557221.22634.47

Medical News Today

Nall, Rachel, MSN, CRNA

“Normal sperm count: Everything you need to know”

(Last reviewed: March 28, 2019)

https://www.medicalnewstoday.com/articles/324821.php

MedPageToday.com

Bankhead, Charles

“Studies: Weed Degrades Sperm, Spurs LUTS”

(May 5, 2019)

https://www.medpagetoday.com/meetingcoverage/aua/79630

The Motley Fool

Williams, Sean

“Mexico Aims to Legalize Recreational Marijuana Before October”

(April 28, 2019)

https://www.fool.com/investing/2019/04/28/mexico-aims-to-legalize-recreational-marijuana-bef.aspx

The Science Times

Inocando, Aileen

“Marijuana Use Found to Cause Infertility Among Men”

(May 6, 2019)

https://www.sciencetimes.com/articles/21304/20190506/marijuana-use-found-to-cause-infertility-among-men.htm

SexHealthMatters.org

“Marijuana and Male Sex Health”

(May 31, 2011)

https://www.sexhealthmatters.org/sex-health-blog/marijuana-and-male-sex-health



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May 28, 2019

Last year, scientists reported that almost two-thirds of people with multiple sclerosis (MS) experience sexual challenges, with the most common problems being loss of libido, orgasm difficulties, and trouble with arousal (vaginal lubrication and erections).

While this rate is high, it doesn’t mean that people with MS can’t enjoy intimacy. But understanding the challenges, staying patient, and making adjustments will go a long way in keeping sexual relationships strong.

Mechanisms

How does MS cause sexual problems? Here are some of the mechanisms:

  • Poor message transmission. MS is a central nervous system disorder that attacks the myelin sheath, the coating that protects nerve cells. The result is a disconnect between the brain and other body parts, including organs involved with sexual function. For example, a man with MS might receive sexual stimulation (such as an erotic image or touch), but his brain might not “get the message” to start an erection. Similarly, a woman’s vagina might not lubricate because it doesn’t “know” about sexual stimuli. For some people, MS leads to decreased – or increased – genital sensation. In some cases, touch might become painful.
  • Depression and anxiety. An illness like MS takes a toll on one’s mental health as well. It can be hard to plan for the future, and people may miss doing things they used to do. They might also worry about their partner’s feelings and reaction to the situation. Communication between partners can break down. Together, these factors can diminish libido and make it more difficult to become aroused.
  • Incontinence. Some people with MS feel nervous about having urinary accidents, especially during sex.
  • Fatigue. With MS, it’s not unusual to feel too tired for sex.
  • Spasticity and muscle weakness. Trouble controlling muscle movements or feeling weak in the muscles may make some sexual activities difficult.

Problems for Women

In November 2018, a study in the Journal of Sexual Medicine provided some insight on how extensive sexual dysfunction is among women with MS. Researchers looked at data from nine other studies on MS and female sexuality. Overall, almost 1,500 women – roughly half with MS – were involved.

In the analysis, women with MS were almost twice as likely to have sexual problems than women who didn’t have MS. Trouble with arousal, lubrication, desire, orgasm, and pain were more common in women with MS. They also tended to have lower sexual satisfaction.

Problems for Men

Erectile dysfunction (ED) is a common problem for men with MS. Erections might not be firm enough for sex, or they might not occur at all.

Fortunately, men with ED have a number of treatment options:

Men might also experience trouble with ejaculation.

Next Steps

If you or your partner is struggling with MS and intimacy, consider these options:

  • See your doctor. As about treatments for sexual issues. For example, the solution for poor vaginal lubrication might be an over-the-counter product. And as noted above, there are several ways to treat erectile dysfunction. Many people feel awkward discussing their sex life with their doctor. But remember, your doctor is there to help you.
  • Seek other professional help. Seeing a counselor or sex therapist, especially one who works with people with MS, can give you some new ideas to try in the bedroom. He or she can also help you cope with any depression, anxiety, or relationship conflict you might be experiencing. (Learn more about sex therapy here.)
  • Talk to your partner. Have an honest, open conversation with your partner about any changes in your sexual relationship and how you’re feeling about them. He or she might be feeling the same way but be hesitant to bring it up. Work as a team to keep your relationship on track, emotionally and sexually.
  • Plan for sex. For people with MS, it isn’t always possible to have sex at the spur of the moment. But you can plan for romance and intimacy. Figure out when you and your partner can have time to yourselves to relax and enjoy being together. It might not be as spontaneous, but having that time to look forward to can be just as exciting.
  • Take your time. If it takes you longer to become fully aroused or to climax, that’s okay. Just enjoy the journey and don’t worry about timetables.
  • Experiment. You might need to try other types of sexual stimulation because what worked for years might not be as effective. Now is a great time to try something new. That “something new” could be a new type of touch, different sexual positions, oral sex, the use of sex toys like vibrators, sex at a different time of day, or sex in a new location. Be open to new ideas.

Resources

EverydayHealth.com

Vann, Madeline R., MPH

“How to Have a Healthy Sex Life When You Have Multiple Sclerosis”

(Last updated: December 21, 2016)

https://www.everydayhealth.com/multiple-sclerosis/living-with/maintaining-a-healthy-sex-life-when-you-have-ms/

International Society for Sexual Medicine

“How might multiple sclerosis affect a person sexually?”

https://www.issm.info/sexual-health-qa/how-might-multiple-sclerosis-affect-a-person-sexually/

The Journal of Sexual Medicine

Zhao, Shankun MD, et al.

“Association Between Multiple Sclerosis and Risk of Female Sexual Dysfunction: A Systematic Review and Meta-Analysis”

(Full-text. Published online: November 1, 2018)

https://www.jsm.jsexmed.org/article/S1743-6095(18)31215-3/fulltext

National Multiple Sclerosis Society

“Sexual Problems”

https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Sexual-Dysfunction

SexHealthMatters.org

“About Two-Third of MS Patients Have Sexual Problems”

https://www.sexhealthmatters.org/did-you-know/about-two-third-of-ms-patients-have-sexual-problems

WebMD

“Maintaining Intimacy With Multiple Sclerosis”

(Reviewed: April 24, 2016)

https://www.webmd.com/g00/multiple-sclerosis/multiple-sclerosis-maintaining-intimacy



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May 01, 2019

How do healthcare professionals make decisions when diagnosing and treating illnesses? Certainly, their continuing medical education helps, and most attend conferences and keep up with research in their field’s peer-reviewed journals.

But professionals also consult guidelines issued by medical societies, such as the International Society for Sexual Medicine (ISSM) or the American Urological Association (AUA). Society panels take a close look at the latest clinical trials and other studies and use that evidence to develop recommendations.

Over the last few years, testosterone replacement therapy has been a hot topic for medical societies. Back in August of last year, we covered new guidelines from the American Urological Society. Today, we’ll discuss a set of guidelines that were updated by the Endocrine Society, a professional group of over 18,000 hormone specialists.

Since testosterone is an important hormone for men, the list of guidelines can be an essential tool for sexual health specialists and primary care physicians who treat men with hypogonadism (low testosterone).

The Endocrine Society guidelines were originally issued in 2010 and updated in 2018.

(Note: For a primer on hypogonadism, please see the links at the bottom of this post.)

Why were the guidelines updated?

Scientists have conducted a great deal of research on testosterone therapy in recent years. The updated guidelines reflect new findings and address concerns.

In addition, more men are seeking help for issues related to testosterone deficiency nowadays, and “low t” gets a lot of media coverage. As a result, men are asking their doctors whether testosterone therapy could help them. It’s critical that prescribers fully understand the benefits and risks.

What do the updated guidelines say?

Highlights of the Endocrine Society’s updated guidelines on hypogonadism include the following points:

Diagnosis

  • In general, men shouldn’t be routinely screened for hypogonadism. However, a diagnosis of hypogonadism is recommended if a man has symptoms (such as low libido or fatigue), and a blood test reveals lower-than-normal testosterone levels.
  • Based on other hormonal measurements, men can be diagnosed with primary hypogonadism (caused by problems in the testes) or secondary hypogonadism (caused by problems in parts of the brain that trigger testosterone production).

Treatment

  • The recommended goals of testosterone therapy are to “induce and maintain” secondary sex characteristics that are driven by testosterone (such as facial hair and muscle mass) and to alleviate symptoms like low sex drive.
  • Testosterone therapy is not recommended for men who would like to father a child in the near future. Men with certain health problems (such as prostate cancer, breast cancer, untreated severe obstructive sleep apnea, and recent heart attack or stroke) should not take testosterone.
  • Testosterone therapy might not be appropriate for men between the ages of 55 and 69 who are expected to live at least another ten years. Doctors should discuss the benefits and risks with these patients.
  • Men over age 65 shouldn’t be prescribed testosterone routinely. Instead, doctors should consider each individual’s situation.
  • Men with HIV, low testosterone, and weight loss might undergo testosterone therapy to gain and maintain weight.
  • Men with diabetes and low testosterone should not use testosterone as a way to control their blood sugar.

Monitoring

  • Once testosterone therapy has begun, men should have regular checkups to make sure it is working well and there are no side effects.
  • During the first year of therapy, men with abnormal prostate cancer screening results should see a urologist.

What does this mean for patients?

While these guidelines are intended for healthcare professionals, they can be useful for men, too.

Understanding the guidelines for any treatment you receive helps you weigh the pros and cons of therapy as you make health decisions.

“The [updated Endocrine Society] guideline emphasizes the importance of patient engagement in a shared decision-making process, especially with respect to the choice of treatment regimens and prostate monitoring,” said Dr. Shalender Bhasin, head of the guideline development task force, in an interview with Endocrine News.

Learn more

For more information on hypogonadism and testosterone, please see these links:

Low Testosterone

Unpacking the Latest Testosterone Therapy Guidelines

What Should Men Know About Topical Testosterone?

Self-Injectable Testosterone Now Available

FDA Approves Testosterone in Pill Form

Resources

Endocrine News

“Q&A: Shalender Bhasin, MD”

(May 2018)

https://endocrinenews.endocrine.org/qa-shalendar-bhasin-md/

The Endocrine Society

“About the Endocrine Society”

https://www.endocrine.org/about-us

“Testosterone Therapy for Hypogonadism Guideline Resources”

https://www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/testosterone-therapy

The Journal of Clinical Endocrinology and Metabolism

Bhasin, Shalender, et al.

“Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline”

(Full-text. Published: March 17, 2018)

https://academic.oup.com/jcem/article/103/5/1715/4939465



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Apr 02, 2019

Justin was 24 years old and in his sexual prime. Or at least, he thought he should be. The last few times he wanted to have intercourse, his erection was rather…lackluster. It wasn’t firm at all, and while his partner didn’t say anything, he was sure his performance disappointed them both.

“I’m too young for this,” he thought. He had seen commercials for erectile dysfunction drugs on television, but the guys always seemed so much older. This type of stuff didn’t happen to younger guys, did it?

He didn’t go to the doctor often, and he couldn’t imagine calling for an appointment for this specific problem. But as time went on, his erections became less predictable. He knew he had to do something.

While surfing online, he found some websites that offered erectile dysfunction (ED) drugs that could be discreetly delivered to his home. He could talk to a doctor through video chat and get a prescription easily. Was this the route to take?

In this post, we’ll consider Justin’s question.

What is telehealth?

Technology has brought people closer together in ways we might not have imagined thirty years ago. And this includes doctors and patients, who can now use the internet to communicate through telehealth (sometimes called telemedicine). Patients can email their doctor, send relevant pictures, and have videoconference discussions of symptoms and treatment options without actually getting together in an office or exam room. These communications can take place on desktop and laptop computers, tablets, and smartphones. In some cases, patients can receive prescriptions through telehealth services.

Why might men with ED consider telehealth?

“Seeing” a doctor online is convenient. Patients can do so in the comfort of their own homes, without the hassle of traveling there, finding parking, or taking time off of work. In addition, many men feel awkward or embarrassed about sexual health problems. Telehealth might offer a degree of privacy, as long as the connection is secure.

Why should men with ED see a doctor in person?

While telehealth has its advantages, it is not a substitute for seeing a doctor in person. For men with ED, this is especially important.

ED is often a sign of more serious health conditions, like diabetes and heart disease. Sometimes, the links are complicated. For example, erections might be impaired by hardening of the arteries (atherosclerosis), low testosterone levels, or autonomic neuropathy (a form of nerve damage). To learn more about these issues, a physical exam is essential. Lab tests may also be ordered, and these can only be done during a traditional office visit.

In fact, ED diagnosis guidelines issued by the American Urological Association (AUA) stress the importance of a physical exam:

Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing.

In other words, a telehealth doctor may be able to prescribe an ED medication, but he or she will not have all the information necessary to determine exactly why a man has ED.

A comprehensive physical exam can reveal any underlying medical conditions, and treatment can begin immediately. Erections can improve, and the risk of any further complications can be reduced.

Dr. Hossein Sadeghi-Nejad, President of the Sexual Medicine Society of North America (the organization behind SexHealthMatters.org) contributed to the AUA guidelines on ED. In an interview with Business Insider, he pointed out that while not all men with ED are at risk for more serious health conditions, “but some are.”

“To lose that window of opportunity to address the bigger problem would be a pity," Dr. Sadeghi-Nejad added.

Next steps?

Some men might find it difficult to work up the nerve and mention ED to the doctor. But it’s worth making the call. It can lead to more satisfying, more confident sex. And it can help you and your doctor address any bigger health concerns that need attention.

Check out these links to learn more:

Erectile Dysfunction (overview of ED, including causes and treatments)

Young Men and Erectile Dysfunction

Possible Causes of Early Onset Erectile Dysfunction (ED)

How Do Certain Diseases Lead to Erectile Dysfunction?

Resources

American Urological Association

“Erectile Dysfunction: AUA Guideline (2018)”

(Published: 2018)

https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline

Business Insider

Court, Emma

“Hot startups like Hims and Roman are marketing Viagra to young men online, but their approach raises 2 big questions”

(February 25, 2019)

https://www.businessinsider.com/hims-and-roman-target-erectile-dysfunction-which-can-signal-health-issues-2019-2

DiversityNursing.com

Bettencourt, Erica

“TeleHealth Pros and Cons”

(January 11, 2019)

http://blog.diversitynursing.com/blog/telehealth-pros-and-cons

SexHealthMatters

“How Do Certain Diseases Lead to Erectile Dysfunction?”

(January 12, 2016)

https://www.sexhealthmatters.org/sex-health-blog/how-do-certain-diseases-lead-to-erectile-dysfunction



Source link


Mar 10, 2019

Is it true that men with a smaller penis are more likely to be infertile?

The simple answer is no. A number of factors can contribute to infertility. A man can have a low sperm count, or his sperm might not be fully developed. He could have retrograde ejaculation, which causes semen (including sperm) to travel backward into the bladder instead of forward out of the penis when he ejaculates. Medications could affect his sperm production. But penis size is not a factor.

Last fall, however, some media outlets reported that men with small penises had lower odds of fathering children. Where did this notion come from? The news stemmed from a poster presentation at the 2018 Scientific Congress of the American Society for Reproductive Medicine in Denver.

Unfortunately, not all the facts were reported accruately. What happened? Let’s take a closer look.

The Study

Eight hundred fifteen men between the ages of 18 and 59 participated in the study, conducted by a research team from the University of Utah. Two hundred nineteen men were infertile; the remaining 596 men were not.

The researchers measured each man’s stretched penile length (SPL) – the distance from the pubic symphysis (a joint near the pubic bone, just above the penis) to the meatus (the urinary opening).

The infertile men’s average SPL was 12.5 centimeters (4.92 inches). The average SPL for the other men was 13.4 centimeters (5.28 inches).

The authors wrote the following conclusions:

This is the first study to demonstrate an association between a shorter SPL and infertility. It is unknown if reduced length is a result of genetic or congenital factors associated with infertility such as testicular dysgenesis syndrome or the result of underlying hormonal differences between the two groups. Further investigation is needed to better understand the association of shorter stretched penile length with male infertility.

The Media Coverage

Not long after the presentation, news outlets started sharing the news, sometimes with misleading headlines linking smaller penises directly to infertility.

But that’s not what the study found, lead author Dr. Austen Slade told Medscape Medical News, noting that he had not spoken to any of the reporters who wrote the misleading articles. (His contact information was included on the poster.)

“Headlines such as 'men with short penises can't father children' are just plain wrong," Dr. Slade said. "What we are saying here, and it would have been obvious if any of these reporters had contacted me, is that a shorter length may be an indication of something else going on."

"Fertility depends on many factors, but not on the size of a man's penis," he added.

As the abstract conclusion explains, penis size could be connected to hormonal, genetic, or congenital (present at birth) factors associated with infertility. The authors called for more research to better understand the study’s results.

Why were readers misled?

It’s possible that the news outlets saw the association between penis size and infertility but didn’t look beyond that for further explanation. Dr. Emily Barrett of Rutgers School of Public Health in New Jersey told Medscape, “anything with the word ‘penis’ is like a magnet for reporters.”

How can you know that health information is accurate?

Whether it’s a news piece or health information in general, there are steps you can take to make sure you’re getting accurate reporting.

  • Consider the source. Is it an outlet you’ve never heard of? Is it an organization you trust?
  • Check the date. How current is the information?
  • Look at how the information was gathered. Does it come from a respected medical journal? From scientists or healthcare providers? From patients?
  • Talk to your doctor. Don’t hesitate to show the article to a professional and ask questions.

See more tips for assessing health information (especially on the internet) here.

Resources

American Academy of Family Physicians

“Health Information on the Web: Finding Reliable Information”

(Last updated: January 4, 2018)

https://familydoctor.org/health-information-on-the-web-finding-reliable-information/

Fertility and Sterility

Slade, A., et al.

“Stretched penile length and infertility, a new association”

(Abstract presented at the 2018 Scientific Congress and Expo of the American Society for Reproductive Medicine. October 9, 2018)

https://www.fertstert.org/article/S0015-0282(18)31064-1/abstract

Healthline

“Pubic symphysis”

(Reviewed: March 19, 2015)

https://www.healthline.com/human-body-maps/pubic-symphysis#1

Medscape Medical News

Lowry, Fran

“Media Sensationalizes Small Penis Study, Upsetting Patients”

(October 16, 2018)

https://www.medscape.com/viewarticle/903512

SexHealthMatters.org

“The Internet and Sex Health Info”

https://www.sexhealthmatters.org/did-you-know/the-internet-and-sex-health-info

Time.com

Oaklander, Mandy

“Can You Really Trust the Health News You Read Online?”

(December 9, 2014)

http://time.com/3625626/health-news-accuracy/

Urology Care Foundation

“What is male infertility?”

https://www.urologyhealth.org/urologic-conditions/male-infertility



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Feb 05, 2019

Back in December, we brought you a blog post on men and masturbation, discussing the benefits, risks, and ways to enhance the experience.  

This month, it’s the women’s turn.

Do women masturbate as much as men do?

Female masturbation is sometimes considered taboo, an activity that isn’t meant for “nice girls” who aren’t supposed to enjoy sexuality. But times are changing.

Female masturbation has become more common over the last few decades. In 2017, a study of 913 French women found that 74% of survey respondents had masturbated at least once in their lives. In 2006, a rate of 60% was reported, and in 1970 the rate was just 19%.

Still, men masturbate more than women do, the study authors explained, noting that 95% of men said they had masturbated compared to 74% of women. Half of the men said they masturbated at least once a week, but only 14% of women maintained this frequency.

Why masturbate?

Masturbation, pleasuring oneself sexually, is a natural, healthy way to achieve sexual release. It can have health benefits, too:

  • It’s a stress reliever and mood booster. Simply taking time for yourself for an enjoyable activity can take your mind off stress and help you focus instead on pleasure. And if masturbation leads to orgasm, the body releases endorphins – powerful neurotransmitters associated with feeling good. (Note: Orgasm shouldn’t necessarily be the end goal of masturbation. If it doesn’t happen for you, don’t worry. It’s fine to just relax and enjoy the experience.)
  • It teaches you about your body. When you’re exploring your body privately, you can try new things that you might not try with a partner. You might find that touching areas like the nipples or ears can be just as exciting as touching the genitals. You might share these discoveries with your partner.
  • It helps keep your genitals healthy. This is especially true for older women. Estrogen is an important hormone for keeping the vagina moist and flexible. When estrogen levels drop at menopause, the vagina can become dry and brittle, making sex uncomfortable. However, masturbation improves blood flow to the area, which might help with lubrication. (Learn more about genital changes at menopause here.)
  • It is (generally) safe. Masturbation is a low-risk sexual activity, and women don’t need to worry about pregnancy or sexually transmitted infections. That said, it’s important to stay safe. Women should wash their hands before masturbating to avoid transmitting any bacteria to the genitals. Sex toys, if used, should be clean and appropriately sized to avoid injury. (Learn more about the sizing of dildos and vibrators here.) Also, if you find that masturbation is interfering with your day-to-day life, be sure to talk to your doctor.

How do women masturbate?

There is no right or wrong way to masturbate, as long as the practice does not hurt anyone. This is a time to treat yourself to new experiences along with the tried-and-true routines.

Here are some ideas to consider:

  • Lie on your back (or stomach) and rub your genitals and other erogenous areas. If you aren’t sure exactly where those areas are, let your hands wander and explore.
  • Squeeze your thighs together.
  • Use your imagination. Fantasize about a particular person or locale.
  • Watch an erotic movie or read a sexually-explicit book while masturbating.
  • Insert a finger or dildo into your vagina.
  • Try using a vibrator.
  • Let water from the shower massage your genitals. (You can also use a hand-held shower head.)
  • Take it slow. You don’t have to rush to orgasm. You don’t even have to orgasm at all. Just enjoy the journey.

Resources

EverydayHealth.com

McCoy, Krisha

“Health Benefits of Solo Female Sexuality”

(Last updated: October 15, 2014)

https://www.everydayhealth.com/sexual-health/female-masturbation-health-benefits.aspx

Healthline

Scaccia, Annamarya

“How to Masturbate with a Vagina: 28 Tips and Tricks for Solo Play”

(Reviewed: March 13, 2018)

https://www.healthline.com/health/womens-health/how-to-masturbate-for-women

Psychology Today

Mintz, Laurie, PhD

“Masturbation 102: How Women Pleasure Themselves”

(June 25, 2018)

https://www.psychologytoday.com/us/blog/stress-and-sex/201806/masturbation-102-how-women-pleasure-themselves

Self.com

Zoldan, Rachel Jacoby

“14 Benefits of Female Masturbation and Why Every Woman Should Do It”

(December 31, 2018)

https://www.self.com/story/13-reasons-every-woman-should-masturbate-besides-the-obvious

Sexologies via Science Direct

Kraus, F.

“The practice of masturbation for women: The end of a taboo?”

(Full-text. October-December 2017)

https://www.sciencedirect.com/science/article/pii/S1158136017300774

WebMD

Pagán, Camille Noe

“Female Masturbation: 5 Things You May Not Know”

(March 11, 2014)

https://www.webmd.com/women/features/female-masturbation-5-things-know#1



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Dec 31, 2018

If you’re a woman going through cancer treatment, you’ve probably had to adapt to a lot of changes in your life. You might have seen some dramatic changes in your sex life, too – changes you might not have been prepared for.

Maybe you’re not able to have sex the way you used to. Perhaps you’re experiencing hormonal changes that affect your level of desire. Maybe you’re feeling confused about your partner or your relationship. Or you might be feeling anxious about starting a new relationship after cancer treatment.

No matter what you’re experiencing, it’s normal to be concerned about your sex life. Your sexuality is a part of who you are. Today we’ll look at some of the issues female cancer survivors face and some strategies to cope with them.

Physical challenges

  • Hormonal changes.  For some women, cancer treatment causes menopause, the time when a woman’s ovaries stop producing eggs and her menstrual periods stop. Along with menopause come lower levels of two hormones, estrogen and androgen. Estrogen helps ready your vagina for sex by making it longer, wider, and lubricated. Androgen affects your sex drive. After menopause, these hormonal changes can cause vaginal dryness and tightness or a loss of desire. Talk to your doctor if you have any problems. For dryness, you may try water-based lubricants, a vaginal moisturizer, or vaginal hormones. For loss of desire, your doctor may prescribe small doses of androgens.
     
  • Pain.  Pain during sex is common for many women. Vaginal dryness and tightness or changes in the genitals from cancer treatment are common causes. Be sure to discuss any sexual pain with your doctor. He or she can give advice tailored to you. Talk to your partner about what does and doesn’t work for you. You may need to discover new ways of touching each other or try new positions and techniques to make the experience pleasurable for you. Try to be patient and open-minded.
  • Fatigue. Breast cancer and its treatment can be exhausting. You might just feel too tired for sex. Try planning intimacy for times when you have more energy, such as the early morning or afternoon.

Emotional challenges

Lots of women feel anxious about changes that result from cancer treatment and how they’ll be perceived by others.

  • Body image. Your body might look different from cancer treatment. Losing a breast or your hair, having scars from surgery, changes in weight – these can all make you feel less attractive. You may worry that these changes will turn off your partner. Some women feel better when they accentuate the positive. You might try a new style of clothes or makeup to give you a boost. Some women wear a breast form or try different skin treatments. Don’t forget that healthy eating and exercise can also make you feel better! Remember, too, that you are still you, beautiful inside and out. As the National Cancer Institute says, “Try to recognize that you are more than your cancer. Know that you have worth – no matter how you look or what happens to you in life.”
  • Dating.  Starting new relationships can be fun and exciting, but women in cancer treatment may feel anxious about it. When should you tell your partner about your cancer? How will he or she react? You can start by just enjoying time with your friends and family. Take part in activities you enjoy or try new ones. You might not meet a new partner, but it’ll boost your spirits and confidence to be out and about. When you do meet someone new, enjoy the experience. When the relationship becomes more serious, and when you feel that you trust the person, you can introduce the topic of cancer. Try practicing what you’ll say with a good friend and ask for feedback. Also think about the many ways that person may react and how you’ll handle them. Don’t assume that the person will reject you. If the relationship has a solid base with caring and trust, the person will likely want to be with you, cancer or not.

Other concerns

  • Is it okay to have sex? Many women wonder whether it’s safe to have sex during or immediately after cancer treatment. Your doctor can best answer this question. If you’ve just had surgery, sex could pull at the stitches, so it might be best to wait awhile. Unusual bleeding is another concern. Some cancer treatments, such as radiation and chemotherapy, can interfere with your immune system and make you more susceptible to infections. Ask your doctor about any precautions you need to take.
  • Radiation. Some women who have radiation therapy worry that they can pass along radiation to their partner. Again, this is a concern best addressed by your doctor. Generally, if the radiation comes from a machine outside your body, no radiation remains in your body. So in this case, you wouldn’t be passing radiation along to your partner. However, radiation from a radioactive implant placed in your uterus or vagina can be passed along to your partner, so it’s best to ask your doctor when you can have sex again.

Talk to your doctor.

Your doctor might not bring up sexual issues, but that doesn’t mean you can’t. Don’t hesitate to speak up! He or she may know the remedy. And even if your doctor doesn’t have all the answers, he or she can refer you to someone who does, such as a sex therapist or counselor. And there’s nothing wrong with seeing a specialist.

Talk to your partner.

If changes in your sex life are troubling you, be sure to talk to your partner as well. Together, you and your partner can brainstorm ways to adjust your sexual repertoire. For example, if vaginal intercourse is uncomfortable, try oral sex or kissing and cuddling. (Read more about sexual pain here.) 

You might also need more time to become fully aroused. If so, tell your partner what you need. Take advantage of that time to experiment and just enjoy each other.  

Your partner might be nervous about sex, too, afraid of hurting you or doing something “wrong.”  If an activity hurts, by all means say so. But if you miss an old activity or touch, let your partner know.

Consider therapy.

Know that you are not alone. Depression and anxiety, common in breast cancer patients and survivors, can take a toll on your sex life as well. If you think you need help, consider therapy or a support group. Couples counseling and sex therapy may also help you work out changes in your relationship.

Moving forward

Remember, your sex life was likely important to you before cancer. There’s no reason it shouldn’t be important now. Cancer and its treatment shouldn’t prevent you from having healthy, fulfilling sex.

To learn more about breast cancer and sexuality, see these links:

Breast Cancer Survivors Face Sexual Concerns

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

Special Therapy Addresses Body Image in Breast Cancer Survivors

Breast Cancer Treatment Could Preserve Ovarian Function

Breast Cancer Has Sexual Impact on Both Survivors and Partners

For Breast Cancer Survivors, Sexual Concerns May Last Years

 

Additional Resources

BreastCancer.org

“Changes in Your Sex Life”

(Last modified: June 13, 2017)

https://www.breastcancer.org/tips/intimacy/changes

Schwartz, Dr. Pepper via PRNewswire

“Breast Cancer and Intimacy: Advice for Survivors to Address Sexual Dysfunction and Regain Confidence”

(October 16, 2018)

https://www.prnewswire.com/news-releases/breast-cancer-and-intimacy-advice-for-survivors-to-address-sexual-dysfunction-and-regain-confidence-300731981.html

Updated: January 2, 2019



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Dec 04, 2018

You might recall a 1992 Seinfeld episode called “The Contest.”

At the beginning, friends Jerry, Kramer, and Elaine are sitting in their favorite coffee shop when fellow friend George walks in, looking upset. He reveals that his mother caught him masturbating and swears he will never do it again – anywhere.

His friends are not convinced, and George proposes a contest. Which friend can go the longest without masturbating? Bets are made, and then Elaine says she wants to join in too.

George and Jerry protest. “It’s easier for a woman not to do it than a man,” Jerry explains, adding, “We have to do it. It’s part of our lifestyle. It’s like, uh . . . shaving.”

Whether masturbating is part of the male lifestyle might be debatable, but research suggests that men masturbate more than women do. A 2010 study from the Kinsey Institute of Indiana University found that 1 in 4 men between the ages of 18 and 59 masturbated a few times a month to weekly. About 20% said they masturbated two to three times a week. In contrast, women masturbated once a week or less.

Masturbation is a healthy activity, for the most part. But there are things men should be aware of, and we’ll go over some of those today, along with ways to make the self-stimulation even better.

What are the benefits of masturbation?

We’ve come a long way from the old wives’ tale telling us that masturbation makes people go blind or gives them hairy palms. In truth, masturbation is natural, normal, and healthy.

Here are some of the benefits:

  • It’s (usually) a safe sexual outlet. You can relieve sexual tension without worries of an unplanned pregnancy or sexually-transmitted infection (STI). You can also get some sexual release if you’re single or if your partner is far away or unable to have sex.
  • It offers an opportunity to explore your own body and figure out where and how you like to be touched.
  • It can relieve tension and stress and might help you sleep better.

Could masturbation become a problem?

Some men masturbate more than others, and as long as it doesn’t interfere with your day-to-day life or your relationships, you probably don’t need to worry about the frequency.

However, men should be aware of some concerns:

  • Skin irritation. Masturbating too vigorously can cause the skin on the penis to become irritated.
  • Penile fracture. Excessive force or bending the penis during masturbation can lead to penile fracture, which is an emergency. If you hear cracking or popping sound, or experience bleeding or bruising, seek immediate medical care.
  • Premature ejaculation. Some men who bring themselves to climax quickly might find that their bodies adjust to this timing.
  • Needing more stimulation. If you masturbate more rigorously, or do so while viewing pornography, you might need more stimulation from your partner to become fully aroused and reach orgasm. Porn may also lead to unrealistic expectations for sex, as it does not depict what usually happens with everyday couples.
  • Addiction. Many men masturbate while watching pornographic videos or looking at adult magazines. This can become problematic if the time spent masturbating takes away from daily responsibilities or interferes with work, school, or relationships. Men who think they are addicted to pornography are encouraged to see their doctor or therapist. (Learn more about porn addiction here.)

Are there other ways to masturbate?

The process may seem pretty straightforward. But men can enhance their experiences by mixing things up. Here are some ideas to try:

  • Visualize other scenarios. While masturbating, close your eyes and imagine an erotic scenario that is different from what you usually experience. See where your mind takes you.
  • Use toys or props. Some men find that vibrators and artificial vaginas enhance their masturbation.
  • Use other media. Try listening to soft music or a suggestive audiobook or podcast.
  • Touch other areas of the body. The penis plays an important role in sexual excitement, but it’s not the only location. Try rubbing your chest, testicles, or perineum (the area between your penis and anus).
  • Try other locations or positions. If you typically masturbate in bed, try it in the shower. If you stroke with your right hand, try doing so with your left.

Ultimately, as long as your technique and practice doesn’t hurt you or others, just do what feels right and enjoy the pleasure.

Resources

Between Us Clinic

Sher, Daniel

“How to Masturbate Correctly – A Guide for Healthy Male Masturbation”

(November 6, 2018)

https://www.betweenusclinic.com/mental-impotence/how-to-masturbate-correctly/

International Society for Sexual Medicine

“Does masturbation cause erectile dysfunction (ED)?”

https://www.issm.info/sexual-health-qa/does-masturbation-cause-erectile-dysfunction-ed/

“What are some effects of sustained pornography use?”

https://www.issm.info/sexual-health-qa/what-are-some-effects-of-sustained-pornography-use/

“What can be done to help someone who has a problem with pornography?”

https://www.issm.info/sexual-health-qa/what-can-be-done-to-help-someone-who-has-a-problem-with-pornography/?ref_condition=sexual-dysfunction

“What is the “normal” frequency of masturbation?”

https://www.issm.info/sexual-health-qa/what-is-the-normal-frequency-of-masturbation/

Medical News Today

Nichols, Hannah

“Are there side effects to masturbation?”

(Last reviewed: December 7, 2017)

https://www.medicalnewstoday.com/articles/320265.php

SeinfeldScripts.com

David, Larry

“The Contest”

(First broadcast: November 18, 1992)

http://www.seinfeldscripts.com/TheContest.htm

VeryWellMind.com

Stritof, Sheri

“What are Some of the Myths About Masturbation?”

(Updated: May 23, 2018)

https://www.verywellmind.com/myths-about-masturbation-2300804

WebMD

Griffin, R. Morgan

“Male Masturbation: 5 Things You Didn't Know”

(Reviewed: January 28, 2017)

https://www.webmd.com/men/guide/male-masturbation-5-things-you-didnt-know#1



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Nov 07, 2018

After a cancer diagnosis, it’s not unusual to have questions swirling through your mind. How far has the cancer progressed? What is the prognosis? What will treatment be like? How will my family and I cope?

Often, questions about sexuality go on the back burner. It’s easy to understand why, when so many other issues may take priority. But keep in mind that sex is an important part of life. There’s no reason for your sexual relationships to stop just because of cancer.

Cancer and its treatment can have a huge impact on sexual function, even if the reproductive organs aren’t targeted. So it’s best to ask about your situation before your treatment begins.

Below, we’ve listed some questions you might consider asking your cancer care team. While not all of them will apply to you, they might trigger other questions you haven’t thought of. Be sure to bring a pen and some paper to jot down the answers. You might also have your partner or a trusted friend or relative go with you to your appointment. It can help to have a second set of ears, just in case you miss something.

Finally, don’t hesitate to ask questions, especially if your healthcare provider doesn’t bring up sexual health. Some people feel awkward discussing sex, but it’s entirely reasonable to wonder how treatment will affect your sex life.

We suggest that you print out these questions and put a mark next to the ones that apply to you. We’ve also included space for you to write down your own questions and answers at the end.

General

  • What are the sexual side effects of this treatment?
  • Will I be able to have sex the way I used to?
  • What should I do if my orgasms change?
  • What should I do if I lose interest in sex or have difficulty becoming aroused?
  • How might this treatment affect my sex hormones (e.g., testosterone and estrogen)?
  • Will I have to stop having sex for a period of time? (If so, when can I resume sexual activity?)
  • Are certain sexual activities or positions recommended over others?
  • Will sex feel different?
  • Will it hurt?  
  • Can you recommend some books or websites, so I can learn more?

For Men

  • Will my erections change?
  • Will I have erectile dysfunction (ED)? If so, will it be permanent?
  • What ED treatments would be best for me?
  • Will I need penile rehabilitation? What does that entail?
  • Will my testosterone levels decrease?
  • How does prostate cancer treatment affect gay and bisexual men?

For Women

  • What is surgical menopause?
  • Will I experience vaginal dryness?
  • If I have trouble with lubrication, should I try a lubricant or moisturizer?
  • Would hormone replacement therapy be an option for me?
  • Will surgery or radiation change the shape of my vagina?
  • Can vaginal dilators help stretch my vagina?

Body Image

  • How will cancer treatment change my appearance?
  • Where might I find items like wigs and breast forms?
  • Can plastic surgery help me? oHow wi
  • Should I consider prosthetics (such as prosthetic testicles)?
  • What can I do about surgical scars?

Partners

  • What should my partner know about sex and cancer?
  • Can my partner “catch” anything through sexual contact?
  • Is it safe for me to have sex if I’m having chemotherapy or radiation therapy?
  • Is help available for partners?
  • Should my partner come with me to therapy?
  • I’m single. When should I tell a new partner about my cancer treatment?
  • Will this treatment affect the way I speak, eat, or socialize?
  • Will this treatment make it more difficult to kiss my partner?

Contraception

  • If pregnancy is no longer a concern, do I still have to practice safe sex?
  • What type of contraception is best for me?
  • Can I use hormonal contraceptives?

Pregnancy and Fertility

  • Is it safe for me (or my partner) to become pregnant during my cancer treatment?
  • Will I still be able to have children?
  • Can I freeze sperm or egg cells for future in vitro fertilization?
  • Where can I find reliable information about surrogacy?
  • Where can I find reliable information about adoption?
  • How can my partner and I cope with infertility?

Emotional Health

  • I’m feeling very anxious about the future. Should I talk to a counselor?
  • Can you refer me to a counselor in my area?
  • Can you put me in touch with a support group or other patients who have had this type of cancer?

Your Questions

My Question

My Doctor’s Answer

 

 

 

 

 

 

 

 

 

 

Learn More

To learn more about cancer and sexuality, these links can help:

Sex After Cancer

Cancer and Sexual Problems

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

How Does Cancer Affect Men’s Sexual Health?

Fertility Options for Men with Cancer

How Does Prostate Cancer Treatment Affect Gay and Bisexual Men?

You can also find information by searching for a specific term on our site.



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