Rationale:
This project addresses the critical need for support resources tailored to individuals undergoing medical castration due to endocrine treatments for hormone-related cancers. Common side effects include significant loss of libido and genital changes. Drawing from the author’s six-year lived experience with cancer and professional background in oncosexual occupational therapy, somatic sexology and neurological rehabilitation, this work highlights the gap in guidance and care. A neurological understanding of desire—and the distinction between libido (wanting) and arousal (enjoying)—is essential for effective, targeted interventions.
Method:
Participants were recruited via global, online cancer support communities and invited to join a program, solo or partnered, following endocrine cancer treatments. Open to all genders and genital configurations, the initiative delivered three online Masterclasses: one on libido recovery, and two on genital rehabilitation (vulvovaginal and penis-focused). These programs integrated neuroplasticity, sensate therapy, and polyvagal regulation, and were designed for in-home use to ensure privacy and accessibility.
Participants completed a mixed-methods survey upon program completion, including multiple-choice and qualitative response items. Outcomes assessed included libido restoration, increased intimacy, improved communication with partners and healthcare teams, enhanced genital sensation, erectile function, and reduced symptoms of vulvovaginal atrophy.
Impact on Practice:
The program resulted in substantial improvements in libido, genital pleasure and function, sexual confidence and relational intimacy. Many participants reported greater emotional connection, mental well-being, and—in unexpected cases—orgasmic recovery. The findings exceeded expectations, demonstrating the powerful role of neurological and somatic interventions in rehabilitating sexual health after medical castration.
Discussion:
This project reinforces the importance of moving beyond physiological models of sexual dysfunction and embracing neurological focused care. It is recommended that this program be further developed and integrated into cancer care pathways through collaboration with healthcare providers, addressing a neglected yet vital aspect of medical castration survivorship: sexual health and pleasure.