In males, chemotherapy associated
infertility results from the destruction of sperm producing cells. Males over
13, who may wish to have children later in life, should be given the option
of banking sperm. Depending on the drug used and the duration of treatment,
some recovery of spermatogenesis after completion of therapy is believed to
be possible. Most men on chemotherapy still have normal erections. Erections
and sexual desire often decrease after a course of chemotherapy, but recur within
several weeks. Some cytotoxic drugs such as cisplatinum or vincristine can permanently
damage parts of the nervous system. These drugs may interfere with the nerves
that control erection. Chemotherapy can sometimes affect sexual desire and erections
by slowing down the amount of testosterone produced.
Women may experience various
degrees of gonadal dysfunction as a consequence of receiving chemotherapy, including
perimenopause or premature menopause. Symptoms may include decreased sexual
desire, amenorrhea, vaginal atrophy, dryness, hot flashes, itching, irritation,
dyspareunia, and sterility. Many chemotherapy drugs can either temporarily or
permanently cause ovarian damage, reducing hormonal output this affects
fertility and libido. Chemotherapy associated infertility occurs in women due
to direct injury to the ova. The length of time patients remain infertile is
not well understood. Some women regain ovarian function after treatment, some
do so with time, and some never do. Menstrual cycles may be disrupted or stopped,
but it is still possible to become pregnant. Vaginal infections are common during
chemotherapy, particularly in women taking steroids or the powerful antibiotics
used to prevent bacterial infections. Flare-ups of genital herpes or genital
warts may also occur during chemotherapy.
Women over 30 years of age
are less likely to regain ovarian function. Although it is possible to conceive
during chemotherapy, the toxicity of some drugs may cause birth defects. Therefore,
it is suggested that all men and women take precautions and use some type of
birth control if they are sexually active. Reproduction after chemotherapy remains
controversial because some cytotoxic drugs in a laboratory setting have shown
the potential to cause birth defects and genetic mutations.
a. Advising the patient about the physical, sexual, and reproductive changes that may occur after therapy. Inform the patient of the potential for sterility.
b. Educating male patients about sperm banking.
c. Stressing the importance of avoiding pregnancy during therapy and provide information about contraception.
d. Referring the patient to resources such as the American Cancer Societys booklet on "Sexuality and Cancer."