Bowel / rectal cancer

Content written by John P. Mulhall, MD

Cancers of the bowel/rectum are generally treated with surgical removal often combined with chemotherapy and/or radiation. The bowel cancer most likely to affect a man’s sexual function exists in the rectum. Men are often treated with chemotherapy and radiation to the pelvic area prior to their surgery and frequently receive chemotherapy following the surgery. As mentioned elsewhere chemotherapy can impair a man’s ability to produce testosterone and low levels of testosterone are associated with a variety of symptoms including loss of libido. Radiation to the pelvis may lead to exposure of the penis itself to some of the radiation and may over time cause damage to the blood vessels supplying the penis and erection chambers. The treatment most likely to interfere with a man’s sexual function, in particular his erectile function is the operation performed to remove cancer of the rectum. The surgery may leave the anus impact known as a low anterior resection, or it may require the removal of the anus known as an abdominoperineal resection. The surgeries are performed in approximately the same area as a radical prostatectomy under radical cystoprostatectomy for prostate and bladder cancers respectively. These operations are all associated with at least a temporary and sometimes permanent injury to the erection nerves. Erection nerve injury leads to absence of erection, which is believed in of itself to be bad for the health or erectile tissue. Second, erection nerve trauma leads to degeneration of the erectile tissue, which is believed to be dependent on the degree of injury to the nerves. For more detailed discussion on this see the section on penile rehabilitation.