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Sex and Fertility
1. Is loss of desire for sex normal for brain tumor
patients? How long will it last?
A reduction in libido is very normal in patients
with brain tumors. It can have several causes. Because of its
impact on brain structures, the brain tumor itself could affect sexual
desire. No one has been able to isolate an area of the brain responsible
for libido, so the location of your tumor alone cannot tell you how libido
will be affected. Moreover, so many factors are involved in libido
that you should not just accept that the brain tumor causes lack of libido
without investigating other causes.
Treatments for brain tumors can have marked affects
on libido. These affects can be direct or indirect. Direct
affects of treatments may include hormonal changes induced by radiation
or chemotherapy. For example, the anti-nausea medicine compazine may
increase the hormone prolactin, which can reduce sexual desire; newer anti-nausea
medication such as zofran or kytril should not have this problem.
Your doctor should be able to tell you if any of your treatments has been
known to affect libido and how long this libido will last. Even treatments
that do not directly affect libido can indirectly affect it, and these
indirect effects may be stronger than any direct affects. Whether
it is fatigue from radiation or chemotherapy, nausea or diarrhea from chemotherapy,
or weakness, swelling, or pain from steroids, treatments for brain tumors
make you feel lousy. Feeling ill makes most people not want to have
sex. Although the libido should return soon after the treatment is
over, you may not want to wait that long. Treating the side effect
may help. For example, if you have pain, taking a pain killer before
you want to have sex might help. Your doctor should be able to help
you manage side effects.
Loss of libido may be a symptom of depression.
Depression is not uncommon when someone has a brain tumor. It is
also treatable in many cases. Although any doctor can prescribe antidepressants,
talking to a psychiatrist or psychologist, particularly one with experience
with cancer, can help you determine whether therapy would be helpful.
Moreover, some antidepressants, such as the selective serotonin reuptake
inhibitors paxil, prozac, and zoloft, can interfere with sexual desire
themselves. If this is the case for you, speak with your doctor about
switching antidepressants. There may also be other drugs that can bring back
sexual desire or function that is lost due to antidpressants.
Finally, other psychosocial factors beside actual
depression can affect libido. A person with a brain tumor may not
feel attractive, either because of societal views of illness or because
of physical changes such as weight gain from steroids or hair loss from
chemotherapy. Familial roles may be changing so that someone who
once was a breadwinner is now more dependent. In addition, affects
of the tumor or treatments, such as partial paralysis, may require changes
in when or how sex is performed. A reluctance to discuss these changes
may manifest itself as lack of desire. These factors can be identified
and may be resolved in individual or family therapy. However, the
most important thing in dealing with these issues is good communication.
According to Leslie Schover, Ph.D., author of Sexuality and Fertility
After Cancer, "being able to talk about sex with your partner is a
crucial step in recovering a satisfying sex life after cancer treatment."
2. How will medications affect sexual
desire and performance?
The following description may not be complete.
Check with your doctor or pharmacist about any medications you are taking.
Moreover, combinations of medications may have different effects than the
same medications taken alone. Make sure that your doctor and pharmacist
knows all the medications you are taking and any side effects you are having.
Depending on the location of the tumor, radiation
can effect the hormonal balance in the body. For example, radiation
to the pituitary gland can affect sex hormones such as prolactin, which
can affect both desire and performance. Moreover, radiation will
almost always cause temporary fatigue, which may inhibit sexual desire.
Although radiation somnolence can last a couple of months after radiation,
it will resolve and energy should return to normal.
According to the Physician's Desk Reference, the
following medications sometimes prescribed to brain tumor patients may
reduce sexual desire: compazine, tagamet, ativan, valium, xanax, paxil,
prozac, and zoloft. Some of these may only have effects at doses
higher than those prescribed for patients with brain tumors. According
to the PDR, the chemotherapy VP-16 may cause testicular atrophy in rats,
which can affect male sexuality.
3. Can loss of desire be treated?
Depending on the cause, loss of desire may be treatable.
The treatment may involve medications or therapy or both. Speak with
your doctor or therapist about your particular case. Be aware that
not all doctors are not comfortable talking about sex. Even the best
brain tumor doctors may not be able to give you more than a cursory answer
to your questions, so you may need to speak to several people before finding
help. Social workers and therapists may be best able to refer you
to good resources. Also, remember that regardless of the cause of
desire, good communication with your partner is essential to recovering
your sex life.
4. Do medications for brain tumors interact
with birth control?
As with any medication, you need to let your doctor
know if you are on birth control, as there is always the potential for
interaction. You may also want to speak to the ob/gyn or other doctor
who prescribed the birth control. Some chemotherapies, such as vincristine,
can cause a temporary end to menstruation and thus, may interact with birth
control or make it unnecessary. Some antiseizure medications, such
as dilantin or tegretol, will interact with birth control, but others,
such as neurontin, probably will not. Be sure both your brain tumor
doctor and the doctor who prescribed your birth control knows all the medications
you are on.
5. How long after radiation or surgery should
I wait before having sex?
Every case is individual, so this is a good question
for your doctor. In general, sex should be treated like other strenuous
exercise, and as such may be proscribed by your doctor for a specified
time after surgery. Both radiation and surgery can cause fatigue,
so it may be a little while until you have the energy for sex. Otherwise,
there is generally nothing about sex to make it particularly dangerous
after radiation or surgery, so when you have the energy there is no reason
not to have sex unless your doctor recommends against it in your particular
case.
6. Can I have sex while on chemotherapy?
Unless your doctor specifically tells you not to,
you can have sex while on chemotherapy. However, there are several
things to keep in mind and to ask your doctor about. For men on chemotherapy,
some chemotherapies can go into the semen. Moreover, there may be
a small chance that chemotherapy could damage sperm and harm a resulting
fetus. Therefore, you should always use a condom for sex, even oral sex,
during chemotherapy. Note that sperm can last up to three months
in a man's body, so continue to use a condom during that time. Another
possible effect of chemotherapy is lack of ejaculation during orgasm.
As men age, "dry" orgasms can happen naturally, so a single occurrence
may not be caused by chemotherapy. Regardless, dry orgasms are not
harmful and are reported to be as pleasurable to both parties as other
orgasms.
For women on chemotherapy, it is essential that
you not become pregnant. Most chemotherapies for brain tumors are
teratogenic, i.e., they cause birth defects in developing fetuses.
Your doctor should advise you of this without you asking. If you
take birth control it is important to make sure your doctor knows this
and to make sure that your chemotherapy will not interfere with the effectiveness
of contraception.
Many chemotherapies dry out mucous membranes.
You will likely be warned about dry mouth and nose. You may not be
warned that the mucous membrane in the vagina can be temporarily irritated
by some chemotherapies. A dry vagina can make sex painful or uncomfortable.
The proper use of non-petroleum-based lubricants should solve this problem.
7. What do I do about vaginal dryness caused
by brain tumor treatment?
Commercially available lubricants, such as K-Y Jelly,
should help. It is important not use petroleum-based lubricants,
like vasoline, because they can irritate the vagina further and will weaken
condoms.
8. How do I find out about ways to make
sex more comfortable?
Because individual people have individual needs based
on levels and sites of pain, levels and sites of paralysis, and levels
of fatigue there is no one answer to this question. As with anything,
good communication with your partner is essential. You may need to
try different positions or modalities until you find one that is pleasurable
for both you and your partner.
There are many resources in books and on the web
that suggest positions that can be helpful for people who have trouble
having sex due to pain or lack of mobility. You may need to look
for resources for the disabled/handicapped rather than for brain tumor
or cancer patients. Some good resources are:
Sexuality and Fertility After Cancer by Leslie Schover, Ph.D.
New York: John Riley and Sons, 1997. ISBN: 0-471-18194-3
Enabling Romance: A Guide to Love, Sex, and Relationships for the
Disabled (and People Who Care about Them). by Ken Kroll and Erica Levy
Klein. New York: Harmony books, 1992. ISBN:0-517-57532-9
Sexual Function in People with Disability and Chronic Illness: A
Health Professional's Guide by Marca L. Sipski and Craig J. Alexander.
Gaithersburg: Aspen Publication, 1997. ISBN:0-8342-0886-5
Oncolink
9. Will treatments affect fertility?
Most treatments for brain tumors, including surgery, dexamethasone,
antiseizure medication, antidepressants, etc., should not affect fertility.
Radiation aimed at the head is unlikely to affect the sexual organs given
the distance. If you are concerned, or if the radiation is aimed lower,
such as at the spinal cord, speak to your radiation oncologist about fertility before
treatment starts. Your radiation center should be able to provide
a lead shield that you can place over your lower body to block any straying
radiation.
Many chemotherapies can affect fertility.
You should ask your doctor about the affects on fertility before starting
any chemotherapy. In particular, alkylating agents, such as BCNU
(carmustine), CCNU (lomustine), carboplatin, procarbazine, and temozolomide,
will
reduce or eliminate sperm production in men. This is usually reversible,
but it may take several years for sperm counts to return to normal.
VP-16 (etoposide) may also reduce sperm count. In women, vincristine and
tamoxifen can temporarily end menstruation, but menstruation should return
after the end of chemotherapy. Alkylating agents also can affect
female egg production, and the effects worsen for older women.
10. How do I preserve fertility if I am
undergoing chemotherapy?
The most important thing is to speak to your doctor
before starting chemotherapy. Many brain tumor specialists
focus on issues of immediate survival. They may not consider fertility
important and may not bring it up. You need to be assertive in expressing
your concerns and priorities so that you and your doctor can make decisions
that are appropriate for you before your treatment starts.
Men who are concerned about fertility can preserve
sperm in a sperm bank. The sperm is frozen and can be unfrozen later
for in vitro fertilization. There is an annual fee for preservation.
For normal sperm banking there is a minimum recommended sperm count.
Do not necessarily rule out sperm banking if your sperm count is below
this minimum, but consult with your doctors and the sperm bank about chances
of success so you can make an informed decision. A small chance may
be better than no chance. A call or appointment with a fertility
doctor may also be appropriate to discuss options other than sperm banking
which may become available.
Women who are concerned about fertility have other
options. The field of female fertility and egg and ovary banking
is changing rapidly even as this is being written. Talk to a fertility
expert to find out all the options that are currently available to you.
For example, you may be able to have one or more eggs fertilized in vitro
with your husbands sperm and frozen for later implantation, although currently
this is an expensive procedure with uncertain results.
11. Will brain tumor treatments cause
impotence? Are there treatments?
No brain tumor treatments are listed as causing impotence.
This does not mean it can't happen, just that it rarely does. Impotence
can also be caused by other factors, such as depression, which should be
investigated. It is also important to remember that occasional impotence
is normal as men age. If you have repeated impotence, speak to your
doctor. There are several treatments, from implants to vacuum chambers
to Viagra. Only your doctor can tell you whether they will be effective
for you.
12. If I do not have feeling in my genital
area, can I still achieve orgasm?
Yes. According to most sources about people
with disabilities, many people without feeling in or control over their
genital area still achieve orgasm. Other areas of the body may become
erogenous zones to replace those that are lost. Moreover, much of
sex is psychological and comes from the giving and receiving of pleasure.
It may take some trial and error and good communication with your partner
to find what works for you.
13. How do I find a fertility expert or
a therapist for sexual problems?
You can find lists of physicians
from the American
Medical Association or the American Society
for Reproductive Medicine, and you can find a list of some therapists
from the American
Association of Sex Educators, Counselors, and Therapists. Your
doctor or the social worker at your hospital should also be able to refer
you to someone in your area.
Last Updated: 6/5/00
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