What is erectile dysfunction?
Erectile dysfunction (ED) is when you have difficulty getting or keeping an erection. It is also known as impotence. It is more likely to occur as men get older. It can have many possible causes, including treatment for prostate cancer. For more information on the risks of ED with prostate cancer treatment, read our Treatment pages.

How does prostate cancer treatment cause erectile dysfunction?
Surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) and cryotherapy can all damage the nerves and blood vessels that are needed for an erection.

Hormone therapy reduces levels of the hormone testosterone, which is needed for sexual desire and erections.

Stress, anxiety and other medical conditions can also cause ED

Treatments for erectile dysfunction
There are a number of treatments available for ED including, lifestyle changes, tablets, injections, pellets and vacuum pumps.

You can ask your GP or hospital specialist to refer you to your local ED clinic.

Some men may not worry about erectile dysfunction and so choose not to have
any kind of treatment. For others it is an important part of their lives and they may choose to seek treatment.

Read more about treatments for ED

How hormone therapy affects sexual desire
Hormone therapy for prostate cancer is likely to reduce, or cause you to lose your desire for sex (libido). This is because it causes a decrease in testosterone, the hormone responsible for giving you your 'sex drive'. One study suggested that about one in two men (50 per cent) taking a type of hormone therapy called LHRH agonists or who have had surgery to remove their testicles (orchidectomy) will lose their interest in sex.

If the loss of sex drive is a big problem to you, you may wish to discuss the option of 'intermittent hormone therapy' with your specialist team. Desire for sex should return to normal after hormone treatment is stopped, but it can take up to a year. You can read our booklet Living with hormone therapy: A guide for men with prostate cancer for more information.

Physical and emotional impact
Testosterone is not the only factor that can affect your sex drive. Both physical and psychological factors can effect how you feel about sex. Read more

If you have had surgery to remove the prostate (radical prostatectomy), you will not be able to ejaculate after surgery. This is because the prostate gland and seminal vesicles, which store and carry semen, are removed during the operation.
Instead you may 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. This may feel different to the orgasms you were used to.

If you have had radiotherapy or brachytherapy, you may notice that you produce less semen after your treatment is completed. You should still be able to have an orgasm but you may find that it feels different to before treatment.

Some men have also found that they have less intense orgasms when they are having hormone therapy.

Read our Treatment pages for information on the side effects of each treatment.

Some studies have shown that around five out of ten men (50 per cent) will find that their penis is shorter after treatment with surgery (radical prostatectomy). This happens because of changes to the tissue inside the penis.

Men may be less likely to experience these changes if the surgeon has tried to save the nerves that control erections during surgery (nerve sparing surgery).

Some studies have shown that encouraging blood flow to the penis after surgery may help you get erections and prevent your penis becoming smaller. In particular using a vacuum pump might be helpful.

It some cases other types of prostate cancer treatment such as radiotherapy and hormone therapy may also cause changes to the size of your penis. There is not as much research into this but it may be less common than changes to men's penis size after surgery.

Changes to your body and your penis can feel difficult to cope with. Talking to someone about this might be helpful. Read about what support is available to you below.

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.

Brachytherapy may have less of an effect on fertility than other treatments for prostate cancer 28 but we still need more research into this. You may notice that you produce less fluid when you ejaculate but it is possible that you are still fertile.
Read more

Having problems with erections or losing your desire for sex is a problem that many men have at some point in their lives. Different men deal with changes to their sexual function in different ways.

Some men who are on hormone therapy may find that because they no longer have a desire for sex, it may be easier for them to come to terms with problems getting an erection.

For some men the ability to have sex or get an erection is an extremely important part of how they see themselves as men. There are many other ways of having an intimate relationship without having penetrative sex.

If you are used to a close physical relationship, it is important to remember that physical contact - through cuddles and kissing - maintains intimacy, provides support and does not have to lead to intercourse. Some men find they become closer to their partner even though they have erectile dysfunction.

If you have a partner, or are starting a new relationship, try and talk to them about any changes to your sex life. You may find that talking helps to reduce any worries you may have about what your partner thinks.

Talking may help them to understand more about any physical or emotional changes you might be going through. The Sexual Advice Association has further information.

Talking about sex can be difficult, even for a couple who have known each other for a long time. Some people might not want to talk about their feelings at all and prefer to cope using their own emotional and practical resources.

Some people find it easier to talk to someone they do not know. Counsellors are trained to listen and can help you to understand your feelings and find your own answers. Your GP may be able to refer you to a counsellor or you can see a private counsellor. To find out more contact the British Association for Counselling and Psychotherapy.

• How could my treatment for prostate cancer affect my sex life?
• How soon after prostate cancer treatment can I have sex again?
• What are the treatments for erectile dysfunction and which will be best for me?
• What are the side effects of treatment for erectile dysfunction?
• What happens if the treatment does not work? Are there other treatments I can have?
• Which drugs and equipment can I get from my local NHS?
• What other support is available to me?
• Can my partner also get support?