Effects on the Reproductive System

Due to the increasing number of cancer survivors, the effects of chemotherapy on male and female sexual function have become increasingly important. Chemotherapy associated sexuality and fertility reactions include gonadal dysfunction, infertility, testicular dysfunction, teratogenicity (abnormal fetal structural development) or mutagenicity (genetic mutations).

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.

Pregnancy should be avoided during chemotherapy treatment.

Management strategies for the effects of chemotherapy on the reproductive system include:

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 Society’s booklet on "Sexuality and Cancer."