Sexuality and Prostate Cancer

The information on this page comes from our Tool Kit fact sheet on sexuality. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download amd print a PDF version of this fact sheet.

This page is for men who have been diagnosed with prostate cancer and their partners. It describes how prostate cancer and its treatment can affect your sex life and your fertility. It covers the available treatments for erectile dysfunction and lists sources of help and support.

How does prostate cancer affect your sexuality?
What is erectile dysfunction?
Causes of ED

Emotional or psychological problems
Other medical conditions
Treatment for prostate cancer

Treatments for ED

Lifestyle
Tablets
Injections
Pellets
Vacuum pump
Surgery

ED and sexual relationships
How does prostate cancer affect sexual desire (libido)?
How soon after prostate cancer treatment can I be sexually active again?
Will prostate cancer treatment affect my ability to orgasm and ejaculate?
Will prostate cancer treatment affect my fertility?
Links

How does prostate cancer affect your sexuality?

Many men continue to enjoy sex throughout their lives and well into old age. If you are one of these men you will need to think about how treatment for prostate cancer may affect your sexuality. Treatments can affect your:

desire to have sex
ability to get an erection
ability to ejaculate and orgasm
fertility

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What is erectile dysfunction?

This is the frequent inability to get or keep an erection strong enough for intercourse or other sexual activity. Erectile dysfunction is also known as ED or impotence. It is a common problem that can have many possible causes, including treatment for prostate cancer.

Causes of ED

Erectile dysfunction can be caused by one or a combination of the following:

Emotional or psychological problems

Stress and anxiety, worries about sexual performance and depression can cause ED.

Other medical conditions

These include high blood pressure and its treatment, diabetes, heart disease, high cholesterol, diseases of the nervous system, penile and prostate conditions and hormone abnormalities.

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Treatment for prostate cancer

Surgery, external beam radiotherapy, brachytherapy, High Intensity Focused Ultrasound (HIFU) and cryotherapy may damage the nerves and blood vessels that allow erections to occur in a normal way. Hormone therapy (either injections or surgery to remove the testicles) reduces levels of testosterone – a hormone needed for sexual desire and erections.

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Treatments for ED

For some men and their partners the loss of erectile function is not a problem and they may choose not to have treatment. Others are less happy about losing what may be a very important part of their lives and may choose to seek treatment.

An erection results from blood rushing into the penis and filling the spongy tissue, making the penis stiff. Many of the treatments for ED work by improving the flow of blood into the penis.

Men with prostate cancer can get some treatment free on the NHS ¹. There is no age limit for receiving treatment. If you wish to continue to have intercourse, your doctor can prescribe treatment. There are possible side effects when taking any medication. Your doctor or specialist nurse will discuss these with you before you start a specific treatment.

Some treatments are not suitable for men with a condition called Peyronie’s disease or with sickle cell trait, because they can cause a persistent and painful erection. Ask your doctor for advice if you have these conditions.

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Lifestyle

There may be some changes that you can make to your lifestyle which could help to improve erectile dysfunction. Some research has shown that maintaining a healthy weight and being physically active may benefit men with ED ². Following a low fat diet and getting regular exercise will help you to lose weight gradually and healthily.

Some studies have also shown that smoking increases the risk of ED and that smokers may find it more difficult to get erections back after having ED ³.

Although there is limited evidence, some early research shows that pelvic floor exercises may help to improve the quality of a man’s erection ^4.

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Tablets

There are now a number of drugs available in the UK to help men get an erection. These are called PDE5 (phosphodiesterase type 5) inhibitors. Viagra (sildenafil) was the first to be used, but other drugs such as Cialis (tadalafil) and Levitra (vardenafil) have also shown good results. These tablets are normally taken 30 minutes to an hour before attempting sexual activity and can be effective for many hours, depending on which drug is used ⁵.

If the maximum dose of a drug does not work, you may still find that one of the other drugs may be more effective. You should try each tablet at least a few times (six to eight ⁶) before deciding how effective it is or changing to an alternative tablet. Generally you will need to have a desire or interest for sex and some stimulation to the penis for the tablets to work.

These drugs are usually well tolerated and generally do not cause significant or troublesome side effects, but can cause facial flushing and headaches. Importantly, they are not recommended for men who take a group of heart drugs called ‘nitrates’ ¹. If you have a heart condition or are using nitrates you should discuss this with your GP or specialist before starting treatment for your ED.

Some men are given tablets for ED during the weeks and months after radical prostatectomy, before they are ready to attempt intercourse ⁷. The idea behind this is that the drug, together with some gentle self-stimulation to the penis, may encourage regular blood flow to the penis and help your erections to return.

These drugs do not alter your level of sexual desire (known as your libido). They will only help you to get an erection if you are sexually stimulated.

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Injections

Another form of treatment is an injection of a drug called Caverject or Viridal Duo (alprostadil) into the penis, which causes an erection. You will be shown how to inject the drug into the base of the shaft of the penis with a very fine needle before sexual activity. The drug causes the penis to fill with blood and you will get an erection fairly quickly, within around 15 minutes. An erection, after an injection, will normally last for up to 60 minutes if the treatment is successful ⁵. The idea of an injection may sound alarming but the nurse will make sure you are confident giving the injection yourself in the clinic before you go home and that it works at the prescribed dose.

Many men find this method effective, and generally this treatment does not cause significant side effects. If you have any problems, tell your doctor or nurse. Very occasionally the erection may persist beyond a comfortable length of time. This is called a priapism which is rare and affects about one per cent of men (about one in 100). If your erection lasts for over four hours some health professionals suggest putting a cold compress at the base of the penis. Alternatively, exercising to help you raise your heart beat may help your body to flush out the drug more quickly. If this does not work you should go to your local hospital Accident and Emergency department for treatment ⁸.

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Pellets

If you are uncomfortable with the idea of an injection, the same drug is also available as a small pellet, called MUSE. A disposable applicator is used to insert the pellet into the opening or ‘eye’ of the penis. The penis is then massaged or stimulated to melt the pellet and help the absorption of the drug. Most men get an erection within five to 15 minutes, which will last between 30 and 60 minutes ⁵. MUSE doesn’t generally cause significant side effects but some men may notice some pain in the penis or testicles after using this drug.

Injections or pellets can be used by men who have little or no sexual desire, but they work better when there is some sexual interest and stimulation.

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Vacuum pump

A plastic cylinder is placed like a sleeve over the penis. A pump (manually or battery operated) creates a vacuum within the cylinder, drawing blood into the penis which then becomes erect. A rubber ring is then slipped onto the base of the penis which prevents most of the blood escaping once the vacuum is removed, maintaining the erection. The ring in most cases should be in place for no longer than 30 minutes ⁹. It can take a bit of practice to get used to using the pump but some men prefer this option because it avoids the use of drugs. It is also a very reliable method of getting an erection with no limit on how often it can be used. Some men may notice that the penis feels slightly cooler than usual when using a vacuum pump.

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Surgery

Implants in the penis are usually only considered if other treatments have been unsuccessful or are not recommended because of a pre-existing illness or treatment. One type of implant is a semi-flexible rod, which makes the penis permanently rigid.

An alternative is an inflatable implant in the penis, which uses a pump device placed in the scrotum. The implant is filled with air or fluid when you squeeze the inflation device. The erection lasts for as long as the implant is inflated. A disadvantage of this type of surgery is that it can cause a shortening of the penis. Any surgery also carries the risk of infection.

Some of the treatments for ED may seem a little artificial and contribute towards ‘losing the moment’ when you are feeling aroused. This may affect the quality of your sex life both for you and your partner and make it more difficult to enter into sex in the first place. However, with a little understanding and patience, some of the embarrassments and difficulties can be overcome and the ways you achieve an erection can be used in foreplay.

To find out more about ED and its treatment, ask your GP or hospital specialist to refer you to your local ED clinic. Read the information leaflet that comes with your treatment for details of how to use the treatment and possible side effects. You can also get more information from the Sexual Dysfunction Association.

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ED and sexual relationships

If you have a partner, it is important that you involve them in any decisions you make about treatment for ED. The loss of sex in a relationship, changes in the way a couple have sex or starting sex again after cancer treatment can all affect a relationship.

Emotional or psychological problems can play a part in the development of ED so discussing any problems or worries with your partner can help. Your partner can go with you to your GP or hospital appointments, and relationship therapy clinics may be available.

If you are the partner of a man with ED, it can be difficult to cope with changes in your sexual relationship. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. It may help if you explain to your partner how important non sexual touching and intimacy such as kissing and cuddling is to you. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in them avoiding intimate situations where they may feel under pressure to make love. It is important to be patient and to avoid putting pressure on a man to perform.

The Sexual Dysfunction Association has further information written for partners.

Treatment for ED is available to all men, whether you are in a relationship or if you are single. You may be single and want an erection for masturbation or you may be thinking of starting a relationship in the future. There is no right or wrong time to consider getting help and treatment for ED.

You can speak to a specialist nurse by calling our confidential Helpline on 0800 074 8383. If you would like to share your experiences and ask questions about ED, you may like to visit our online message boards.

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How does prostate cancer affect sexual desire (libido)?

Prostate cancer and its treatment can affect your desire for sex. Every man is different but the emotional impact of diagnosis and the physical demands of treatment can affect the way you feel about your body and your relationships.

Hormone treatment for prostate cancer, in the form of injections (LHRH agonists) or surgical removal of the testicles (orchidectomy), stops testosterone from being produced and this can cause you to lose interest in sex. Hormone tablets (anti-androgens) are less likely to have this effect, but can still cause a loss of interest in sex for some men. If your loss of desire for sex is a big problem to you, you may wish to discuss the option of ‘intermittent hormone therapy’ with your doctor ¹⁰. Desire for sex should return to normal after hormone treatment is stopped, but it can take up to a year.

Some men describe feelings of a loss of their role within the partnership or family. This can sometimes affect a man’s self esteem and confidence. For others, the physical effects of treatments may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance (your body image). All of these factors may result in a lack of interest in sex.

If you are feeling tired or under stress, tell your partner how you feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having intercourse. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support and do not have to lead to intercourse.

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How soon after prostate cancer treatment can I be sexually active again?

This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never get back the ability to maintain an erection without the help of artificial methods.

If you have had radiotherapy you may not feel like having intercourse for the first few weeks after treatment, but if you are able to, there is no reason why you should not resume sexual activity sooner. If you have had surgery you will need to wait for six to eight weeks to allow your wound to heal ¹¹ but you can use masturbation during this time if you like. You can have intercourse straight after brachytherapy although most men do not feel like it for the first couple of weeks. You should wear a condom for three to six months in case any radioactive seeds pass out of your body when you ejaculate.

As long as you follow advice from your doctor, sexual activity will not harm you or your partner. It is not possible to pass cancer on to your partner through intercourse.

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Will prostate cancer treatment affect my ability to orgasm and ejaculate?

If you have had a radical prostatectomy you will not be able to ejaculate after surgery. This is because the prostate gland and seminal vesicles, which store and transport semen, are removed during the operation. Instead, you will experience what is sometimes called a ‘dry ejaculation’ where you feel the sensations of orgasm but do not release any semen from the tip of the penis.

Occasionally, some men will have a small amount of liquid coming out from the tip of the penis during orgasm, which may be fluid from glands lining the urethra. Some men find that the sensation of orgasm after prostatectomy is different to what they were used to before the operation.

If you have had radiotherapy or brachytherapy you may notice that you produce less semen after your treatment is completed. Your ability to orgasm is not normally affected, but you may find the sensation is different to before treatment.

After HIFU, if you have a TURP (Trans Urethral Resection of the Prostate) together with the HIFU, you may experience retrograde ejaculation. This is when the semen is released backwards into the bladder instead of out through the end of the penis. This is not harmful but may affect your ability to father children normally in the future.

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Will prostate cancer treatment affect my fertility?

Treatment for prostate cancer can affect your ability to produce sperm or ejaculate and lead to infertility. It may be possible for you to store some sperm before treatment so that they can be used later to fertilise an egg. Other infertility treatment options may also be available to you. There may be age restrictions for this, and you may need to pay for sperm storage and possibly for infertility treatment.

After brachytherapy you should avoid fathering children for two years because the radiation may harm an unborn child.Talk to your partner about your plans for having children and what this would involve. Your GP or specialist can give you more information and can refer you for counselling.

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Sexuality and Prostate Cancer

How does prostate cancer affect your sexuality?

What is erectile dysfunction?

Causes of ED

Emotional or psychological problems

Other medical conditions

Treatment for prostate cancer

Treatments for ED

Lifestyle

Tablets

Injections

Pellets

Vacuum pump

Surgery

ED and sexual relationships

How does prostate cancer affect sexual desire (libido)?

How soon after prostate cancer treatment can I be sexually active again?

Will prostate cancer treatment affect my ability to orgasm and ejaculate?

Will prostate cancer treatment affect my fertility?

Links

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Written and edited by:

References used in the production of this page.