Note: This episodes contains discussion and language of a sexual nature and may not be appropriate for all audiences.
In this episode of Marrow Masters, we sit down with Dr. Christian Nelson, a psychologist at Memorial Sloan Kettering Cancer Center and an expert in psycho-oncology, to address a deeply personal yet often overlooked topic: male sexual dysfunction following cancer treatment. Together, we explore how treatments can impact not only physical function but emotional well-being, identity, and relationships.
We start by acknowledging that sexual dysfunction is one of the most common side effects of cancer treatment, second only to fatigue. Yet, it’s rarely discussed. Dr. Nelson emphasizes the importance of normalizing the conversation and encouraging patients to raise the issue with their treatment teams. He walks us through the emotional toll that erectile dysfunction can take on men, noting how it strikes at the core of masculinity and can lead to increased depression, frustration, and a general sense of brokenness. He stresses that it’s not just about what happens in the bedroom—erectile issues can spill over into all aspects of a man’s life, including his relationship with his partner.
Dr. Nelson outlines a range of treatment options, from well-known medications like Viagra to lesser-known but effective methods like penile injections and implants. He breaks down the fear around these options, especially injections, and highlights how pain levels are often far lower than anticipated. Beyond physical treatments, we discuss the emotional and relational work that’s often required. One key issue is avoidance—men avoiding sexual situations due to performance anxiety, which can snowball into long-term distance and silence between partners. Dr. Nelson makes it clear: the real risk isn’t failure, it’s not trying.
We also dive into how couples can redefine intimacy. Many men associate sex solely with penetration, while their partners often value closeness and emotional connection more. Dr. Nelson advocates for expanding the sexual repertoire and restoring non-sexual forms of affection, which can be just as meaningful. We talk about the impact of testosterone—how its depletion can lower libido and cause men to unknowingly withdraw from their partners—and how testosterone replacement may be a viable option for some, depending on cancer type and treatment history.
As roles shift from caregiver back to partner post-treatment, Dr. Nelson stresses the importance of open communication. He urges couples to work toward understanding each other's perspectives, not convincing each other. He shares an "aha" moment involving a couple who waited five years before seeking help, only to reconnect within three sessions after simply opening the lines of communication. The takeaway: don’t wait.
We close by pointing listeners toward additional resources, including certified sex therapists and specialized urologists, and Dr. Nelson highlights two key professional directories: SSTAR and AASECT. We’re reminded that even the simplest questions—like whether it's okay to kiss your partner—deserve answers. It’s on all of us, both patients and providers, to make room for these conversations.
More:
Episode with Dr. Flores: https://marrowmasters.simplecast.com/episodes/mens-sexual-health-gvhd
Episode with Dr. El Jawahri: https://marrowmasters.simplecast.com/episodes/dr-el-jawahri
SSTAR (Society for Sex Therapy and Research) – https://sstarnet.org
AASECT (American Association of Sexuality Educators, Counselors and Therapists) – https://www.aasect.org
Thanks to our Season 19 sponsors, Incyte and Sanofi.
https://incyte.com/
https://www.sanofi.com/en
00:00 - Introduction to Season 19 and Dr. Christian Nelson
01:16 - Normalizing Conversations on Sexual Dysfunction
04:50 - Emotional Toll of Erectile Dysfunction
07:06 - Treatments: Pills, Injections, and Implants
09:03 - Avoidance and Anxiety in Sexual Relationships
12:17 - Expanding the Definition of Intimacy
16:43 - Role of Testosterone in Sexual Health
20:05 - Shifting from Caregiver to Partner
22:17 - Resources and Where to Get Help
26:29 - A Patient Story: Five Years of Silence
28:07 - Closing Thoughts and Resources
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This content is provided for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. It is crucial to consult directly with a qualified healthcare professional regarding any medical conditions, treatment options, or other health concerns.
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