Hi is it common to have an inability to get an erection while on opdivo/yervoy

Sexual Side Effects with Opdivo/Yervoy

Yes, erectile dysfunction (ED) can occur with immunotherapy combinations like Opdivo (nivolumab) and Yervoy (ipilimumab), though it's not among the most commonly reported side effects. Let me explain what's happening and what you should know.

How This Happens

Immunotherapy works by activating your immune system to fight cancer, but this can trigger immune-related adverse events (irAEs) affecting various body systems. ED can develop through several mechanisms:

• Endocrine effects: These drugs can affect hormone-producing glands (pituitary, thyroid, adrenal), and testosterone imbalances directly impact sexual function
• Cardiovascular effects: Immunotherapy can affect blood vessel function, which is essential for erections
• Neurological effects: Immune activation can affect nerve signaling involved in sexual response
• General fatigue and inflammation: Common with immunotherapy and can reduce sexual function

What the Medical Literature Shows

According to ASCO (American Society of Clinical Oncology) guidelines on managing immunotherapy side effects, sexual dysfunction is recognized as a potential irAE, though specific incidence rates vary. The NCCN (National Comprehensive Cancer Network) Guidelines for managing immunotherapy toxicities recommend evaluating hormonal function and cardiovascular health when patients report sexual dysfunction.

Important Questions to Ask Your Oncology Team

1. "Could my ED be related to my immunotherapy, or could it be from other causes?" (They'll want to rule out other factors like medications, underlying conditions)

2. "Should I have my testosterone and other hormone levels checked?" (This is a standard workup for ED during immunotherapy)

3. "Are there safe treatment options for ED while I'm on Opdivo/Yervoy?" (Medications like sildenafil are often compatible, but your team needs to assess your specific situation)

4. "Could adjusting my immunotherapy dosing or schedule help, or should we continue as planned?" (Your oncologist weighs ED severity against cancer treatment benefits)

5. "Should I see a urologist or endocrinologist for additional evaluation?" (Specialists can help identify the specific cause)

What You Should Do Now

• Report this to your oncology team at your next visit (or sooner if it's significantly affecting you)
• Be specific about when it started relative to your treatment
• Mention any other symptoms (fatigue, mood changes, hot flashes, etc.)
• Don't stop treatment without discussing it first—your team may have solutions

This is a manageable side effect in many cases, and your doctors have experience addressing it while keeping you on effective cancer treatment.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.