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Post treatment and further information

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After your treatment has been completed, your doctor will want you to have regular check-ups, blood tests, scans and x-rays. These will continue for several years. If you have any problems, or notice any new symptoms in between these times, you should let your specialist know as soon as possible.

AFFECT ON YOUR SEX LIFE AND FERTILITY

Many men worry that they may not be able to have children after they have been affected by testicular cancer. In fact, many men find that their fertility will return to normal 12 months after they have received their chemo or radiotherapy treatment. However, if you are worried or advised by doctors that your fertility may be at risk, the NHS runs a sperm storage service. You should discuss this with your specialist team before your treatment starts. If your sperm is suitable and you would like to store some for the future, you will need to produce a number of sperm samples over a period of a few days. These can be frozen and stored for some time by the hospital. When you want to father a child, your sperm can be thawed and used to make your partner pregnant 'artificially'.

The Human Fertilisation and Embryology Association (HFEA) require that the blood of men storing sperm is screened for HIV, hepatitis B and hepatitis C. Your team of doctors and nurses will arrange this for you. If you have any concerns regarding giving your consent for these tests, please discuss this with your doctor or nurse and they can arrange for you to see a counsellor experienced in these matters.

Currently, the NHS will pay for the costs of the initial consultations, blood tests and storage for the first year. Funding for further treatment is under review, and you should discuss this with your specialist healthcare team, as it can be expensive to store the sperm longer term.

One of the commonest questions asked by men before and after treatment for testicular cancer is whether their sex life will be affected. The important thing to remember is that the removal of one testicle will not affect your sexual performance or your ability to father children, if the other testicle is healthy. This is because the remaining healthy testicle will produce more testosterone and sperm to make up for the removal of the affected testicle.

Chemotherapy can cause infertility during and for a time after treatment in men with testicular cancer. This is usually temporary but for some men it may be permanent. For this reason, it is usually advisable to store sperm before starting chemotherapy treatment. The rate at which the sperm count recovers varies from person to person, but it generally returns to normal within two to three years.

The effect of chemotherapy on semen (the liquid that contains the sperm) and sperm is uncertain. Because of this, it is advisable to use a condom during treatment and for about a month after treatment (this protects your partner and avoids any stinging sensation for your partner). Although there is no evidence that chemotherapy can harm children fathered after the treatment has finished, doctors usually advise that you avoid having a child for about a year after treatment.

Some men with testicular cancer have a low sperm count before they start any treatment, and sometimes successful treatment with chemotherapy may actually cause the sperm production to improve.

Sometimes it is necessary to surgically remove lymph glands in the abdomen, if they are still enlarged after radiotherapy or chemotherapy. Unfortunately, this can affect your fertility, as the operation can damage the nerves that control the discharge of sperm through the penis (ejaculation). New surgical techniques mean that this problem can usually be avoided but your surgeon will be able to advise if it is likely to happen to you. If there is a possibility that you may need such surgery, and if you are fit enough to produce sperm samples for storage before treatment starts, some of your sperm can be stored.

Although this further surgery may make it more difficult for you to father a child, it will have no physical effect on your ability to get an erection or have an orgasm.

Radiotherapy does not normally cause sterility. However, a small dose of radiation does reach the remaining testicle. There is no evidence that this radiotherapy has any effect on children fathered after the treatment, but men are usually advised to use contraceptives for 6-12 months after treatment has ended.

Any course of treatment may make you too tired to be interested in sex. This is called loss of libido and is common to many illnesses, not just cancer. It is worrying, but remember that it is a temporary side effect and once treatment is over and your body begins to return to normal, your libido will also return.

Sexual problems are very personal and very important, and talking about them can be a great help.

Although this can sometimes be difficult, once they have summoned up the courage to talk openly to their partners, many men find that their fears of rejection are unfounded. Sexual relationships are built on many things including love, trust and common experiences. You may even find a new closeness after talking through a problem with your partner.

In some cases, your doctor, nurse, close friend or relative may also be able to offer help and advice. Some hospitals have nurses or social workers who have been specially trained to help people with sexual problems.

One common fear is that cancer cells can be passed on to your partner during sex. This is not true. Cancer is not infectious and it is perfectly safe for you to have sexual intercourse.

Your feelings

Most people feel overwhelmed when they are told they have cancer, even if the chance of cure is very high, as it usually is with testicular cancer. Many different emotions arise, which can cause confusion and frequent changes of mood. You might not experience all the feelings associated with being diagnosed with testicular cancer, but they may occur. This does not mean, however, that you are not coping with your illness.

Reactions differ from one person to another - there is no right or wrong way to feel. These emotions are part of the process that many people go through in trying to come to terms with their illness. Partners, family members and friends often experience similar feelings and frequently need as much support and guidance in coping with their feelings as you do.

The Cancer Counselling Trust is a registered charity providing face to face and telephone counselling for people with cancer, their families, friends and carers. They can be contacted via: www.cancercounselling.org.uk

Learn more about testicular cancer

Click here to view the Testicular Cancer Patient Information Film by the BMJ Group featuring Colin Osborne, Orchid's Founder and President and Dr Thomas Powles MBBS, MD, MRCP MRC Senior Clinical Fellow and Senior Lecturer in Urology Cancer and Honorary Consultant in Medical Oncology.