Sexual Health​

Icon of the male gender symbol

Comprehensive care for sexual health

Why is sexual health important in ADT management?

ADT can impact sexual health. Patients on ADT can experience sexual side effects, including a decrease in penis and testicular size, decreased sensitivity to sexual stimulation, and erectile dysfunction.1
Up to 90% of patients being treated with ADT experience reduced libido2

Recommendations for healthcare providers managing sexual health during ADT3

  1. Assess sexual health and explain the importance of maintaining sexual function
  • Perform a baseline sexual health assessment, including:
    • ability to achieve an erection
    • sexual impacts such as orgasm and sexual desire
    • sexual practices, including frequency and types of sexual activity
    • patient satisfaction with sexual activity
    • gender(s) of sexual and/or romantic partner(s)
    • satisfaction of partner(s) with sexual activity
    • fertility plans if relevant
  1. Educate patients and partners on sexual effects of ADT
  • Counsel patients on erectile dysfunction and reduced sexual desire and potential decrease in penile and testicular size
  1. Provide interventions to maintain sexual activity during ADT
  • Encourage patients to continue sexual activity and explain the importance of continued sexual and/or romantic touch with partner(s), erectile dysfunction treatment options (including risks and likelihood of success), and options for maintaining sexual activity
There are ways to address the effects of ADT on sexual function and intimacy. The table below gives examples of common problems with approaches and recommendations to make4:

Problem

Approach and recommendations

Sexual changes​

Erectile dysfunction

  • Standard pharmacological and physical erectile dysfunction treatments
  • Redefinition or reframing of sexual activities (eg, nonpenetrative sexual activity)
Loss of sexual desire
  • Bupropion
  • Special effort to enhance displays of physical affection
  • Counseling to recruit past sexual fantasies and explore expanding erogenous zones (eg, new breast sensitivity)
Delayed or absent orgasm
  • Use of lubricants to permit increased stimulation without skin irritation
  • Vibrator or sex toys
Changes in reception to touch
  • Increased effort and alteration of habitual sexual experiences
  • Increased sexual communication
Infertility
  • Sperm banking

Relationship changes

Partnership
  • Counseling to aid couple’s adjustment
  • Increased efforts toward emotional and physical connectedness
  • Patient and partner education about potential relational consequences/challenges before starting ADT
Chart adapted from Elliot et al, 2010.4
Maintaining sexual function during ADT is important for a patient’s quality of life
ADT, androgen deprivation therapy.
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View recommendations for psychological health

Psychological Health

References: 1. Kokorovic A, So AI, Serag H, et al. Canadian Urological Association guideline on androgen deprivation therapy: adverse events and management strategies. Can Urol Assoc J. 2021;15(6):E307-E322. 2. Higano CS. Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer. J Clin Oncol. 2012;30(30):3720-3725. 3. Crawford ED, Garnick MB, Eckel RH, et al. A proposal for the comprehensive care of men on androgen deprivation therapy: recommendations from the Multidisciplinary Prostate Cancer 360 Working Group. Urol Pract. 2024;11(1):18-29. 4. Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW; ADT Survivorship Working Group. Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life. J Sex Med. 2010;7(9):2996-3010.

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