Sex and prostate cancer

How can treatment for prostate cancer affect your sex life?

Many men continue to enjoy sex throughout their lives and well into old age. You might be worried about how treatment for prostate cancer may affect your sex life.

Treatments can affect:

  • Your ability to get an erection (erectile dysfunction)
  • Your desire to have sex (libido)
  • Your ability to ejaculate and have an orgasm
  • Your fertility

Updated February 2012

To be reviewed October 2012

Will I be able to have sex or masturbate after treatment? +


This will depend on what type of treatment you have had and how you feel. Some men will have problems with their erections (erectile dysfunction) and some may never get back the ability to achieve or maintain an erection without the help of treatment. For more information about the effect of each treatment on sex and masturbation read our treatment pages.

If you have had radiotherapy you may not feel like masturbating or having sex for the first few weeks after treatment, but if you are able to, there is no reason why you should not start sexual activity sooner.

If you have had surgery to remove your prostate (radical prostatectomy) you will need to avoid having sex for the first six to eight weeks after open surgery while the wound is healing. However, masturbation and night-time erections are safe during this time. If you have had keyhole surgery, you may feel like having sex sooner than this. However, you may not be able to get an erection while you are recovering from the operation.

You can have sex straight after brachytherapy although most men do not feel like it for the first couple of weeks. It is rare for any seeds to be passed when you ejaculate, but as a precaution, you should use a condom for the first few times you have sex after treatment. Ask your doctor or nurse for advice. As long as you follow their advice, sexual activity will not harm you or your partner.

Some men worry that cancer can be passed on when having sex. It is not possible to pass cancer through intercourse. Having sex will not affect your cancer or the success of your treatment.

What is erectile dysfunction?+

Erectile dysfunction (ED) is when you have difficulty getting or keeping an erection. It is also known as ED or impotence. ED is more likely to occur as men get older.1 It can have many possible causes, including treatment for prostate cancer. For more information on the risks of ED for each different prostate cancer treatment, read our treatment pages.

Causes of ED
Many men will have problems with their erections. Erections work by your brain sending signals to the nerves in your penis when you become sexually aroused. The nerves increase the blood flow to your penis, causing the tissue to expand and harden. So anything that interferes with your nervous system, your blood or affects your level of desire (libido) can also cause ED.

Problems with erections can be caused by one or a combination of the following:

Treatment for prostate cancer
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.

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

Emotional or psychological problems
Stress and anxiety, worries about sexual performance and depression can cause ED.

Hormone therapy may also affect sex, as it reduces levels of the hormone testosterone. Testosterone is needed for sexual desire and erections. You can read more about this below.

What treatments are there for ED?+

What treatments are there for erectile dysfunction?
For some men the loss of erectile function is not a problem and they may choose not to have any kind of treatment. Others are less happy about losing what may be a very important part of their lives and may choose to seek treatment. If you are single then treatments for ED are available to you as well, for masturbation or if you are sexually active or thinking of starting a relationship in the future.

To find out more about ED and its treatment, ask your GP or hospital specialist to refer you to your local ED clinic. Men with prostate cancer can get treatment for ED free on the NHS. There is no age limit for receiving treatment. If you wish to continue to have erections for masturbation or sex, your GP or doctor or nurse at the hospital can prescribe treatment. There is a limit to the amount of treatment GPs can prescribe.2 If you are receiving treatment from your GP and you need more, or treatment has not worked, let them know. They may refer you to a specialist for further advice, support and further treatment. 3

Read the information leaflet that comes with your treatment for details of how to use the treatment and possible side effects. There are possible side effects when taking any medication. Your doctor or nurse will discuss these with you before you start a treatment.

Some treatments are not suitable for men with a condition called Peyronie's disease or with sickle cell trait, because they can an erection that last for a long time and can be painful. Ask your doctor or nurse for advice if you have these conditions.

Lifestyle
Some research has shown that maintaining a healthy weight and being physically active may benefit men with ED.4 Read more about diet, exercise and prostate cancer.

Some studies have also shown that smoking increases the risk of ED and that treatments for ED may be less effective if you smoke.5

Some research shows that pelvic floor exercises may help to improve a man's erections.6 Read more about pelvic floor exercises.

Tablets
Viagra® (sildenafil), Cialis® (tadalafil) and Levitra® (vardenafil) are all drugs that can help men get erections. They belong to a group of drugs called PDE5 (phosphodiesterase type 5) inhibitors. You will need to have a desire for or interest insex and some stimulation to the penis for the tablets to work. After taking these tablets you need to wait a minimum of 30 minutes to an hour before they start to work. Viagra® and Levitra® will have an effect for around four hours although some men find the effect lasts longer.4 Cialis® can have an effect for about 36 hours.7

If the maximum dose of one drug does not work, one of the other drugs may be more effective for you. The drugs may not work straight away. You should try each tablet at least eight 8 times before deciding how effective it is or changing to an alternative tablet. These tablets may not work as well after a big meal, particularly one that contains a lot of fatty foods.8

Cialis® (tadalafil) also comes in a one-a-day version. This is also a successful treatment for erectile dysfunction.9 You might prefer to take a tablet once a day if you want to have sex often or if you prefer spontaneous rather than pre-planned sex.

All of these drugs can cause some side effects including:
• headaches
• indigestion
• a flushed face
• itchiness or swelling in your nose (rhinitis)
• back pain.8
These side effects are usually mild and do not last long.

You should not take PDE5 tablets if you are taking a type of heart drugs called nitrates10. Nitrates are usually used to treat heart problems. If you have a heart problem or are taking nitrates you should discuss this with your GP or specialist before starting treatment for your ED.

PDE5 tablets do not increase your level of sexual desire, known as your libido. They will only help you to get an erection if you are sexually stimulated.

Injections
Another type of treatment is an injection of a drug called alprostadil (brand names Caverject® or Viridal Duo®) into the penis. This can be a successful treatment for ED in around seven out of ten men (70 per cent).11 The first time you use the drug a nurse or doctor in clinic will show you how to inject it into the base of the penis with a very fine needle. The drug causes the penis to fill with blood and you will get an erection, within around 15 minutes. The erection will normally last for 30 to 40 minutes if the treatment has worked8 The idea of an injection may sound alarming but the nurse or doctor will make sure you are confident giving the injection yourself in the clinic before you go home. You may also be able to use an injection pen which means you do not have to look at the needle.

Generally this treatment does not cause significant side effects although many men do find that the injection is moderately painful.12 If you have any other problems, tell your doctor or nurse. Occasionally the erection may persist beyond a comfortable length of time. This is called a priapism which is rare and affects less than one in 100 men (one per cent).12 If the erection does not go away after four hours you should go to your local hospital accident and emergency (A&E) department as they can give you some treatment to make the erection go away. 10

Pellets
The drug alprostadil is also available as a small pellet, called MUSE®. This is not as effective as using the injections 13 but may be a good alternative if you do not like the idea of an injection. You use a disposable applicator to insert the pellet into the opening or 'eye' of the penis. You or your partner can then massage or stimulate your penis to melt the pellet and help the absorption of the drug. If the pellet works you should get an erection within five to 15 minutes, which will last between 30 and 60 minutes14 MUSE® may cause some pain in the penis or testicles and dizziness in some men.15 Injections or pellets can be used by men who have little or no sexual desire (libido), but they work better when you have some sexual interest and stimulation.

Vacuum pump
Using a vacuum pump can also help you to get an erection. It is made up of a plastic cylinder that you put your penis into and a pump that you operate by hand or battery. The pump creates a vacuum inside the tube, this makes blood flow into your penis to make it erect. You then slip a rubber ring onto the base of your penis. This stops most of the blood escaping once you remove the vacuum pump. You should only wear the ring for 30 minutes at a time.16 There is also no limit to how often you can use it. Some men may notice that the penis feels slightly cooler than usual when using a vacuum pump and the base of the penis remains soft. It can take a bit of practice to get used to the pump but some men prefer this option because it avoids the use of drugs. The success of this treatment varies quite a lot with three to eight out of ten men (30 to 80 per cent) finding it effective. 17 18

Starting treatment early
Some men use tablets, injections or vacuum pumps for ED during the weeks and months immediately after surgery, before they are ready to have sex19 The idea behind this is that the medication or treatment alongside gentle masturbation, encourages blood flow to the penis and makes sure that the tissue you need for erections (which is mainly muscle) is kept healthy. You may hear this called penile rehabilitation.

Although some research shows that starting treatment early may help men maintain erections, we need more research to say how effective early treatment is and it may not help every man.19 20

Surgical implants
This is usually only considered if you have tried other treatments first and they have not worked, or if you are unable to have other treatments because you have another health condition.

There are two main types of implants. The first type uses semi-rigid rods that keep the penis fairly hard all the time but allow it to be bent down when you do not need an erection. The second type is an inflatable implant in the penis, and a pump placed in the scrotum. When you squeeze the pump the implant fills with fluid (saline) which will make the penis become erect. Your erection will last for as long as the implant is inflated.

Two out of 100 men (two per cent)10 who have this surgery get an infection which means the implant has to be taken out. The implant can be put back in again once the infection has been treated with antibiotics. Five out of 100 men (five per cent) 21 22 may need further surgery after five years because the implant has stopped working. In general, the implant may only work for about ten to 12 years, before it needs to be replaced.

Getting used to ED treatments
Some of the treatments for ED may seem a little artificial and contribute towards 'losing the moment' when you are feeling aroused. This might change your sex life, if you have a partner. However, with a little understanding and patience, you should be able to overcome some of the embarrassments and difficulties. Some couples even find that they use the preparation needed for some of the treatments, such as the vacuum pumps or pellets, as part of their foreplay.

How does prostate cancer affect sexual desire (libido?)+

Prostate cancer and its treatment can affect your desire for sex.

Hormone therapy
Hormone therapy for prostate cancer is likely to reduce, or cause you to lose your desire for sex. This is because of the decrease in testosterone, which is the hormone responsible for giving you your 'sex drive'. One study suggested that about one out of 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.23

You may wish to discuss the option of 'intermittent hormone therapy' with your doctor or nurse. For some men desire for sex may return after hormone treatment is stopped, but this varies.24 It can take three to nine months or sometimes longer for side effects of hormone therapy to wear off. You can read our booklet Living with hormone therapy: A guide for men with prostate cancer for more information.

Physical and emotional impact
Physical and psychological factors can also affect how you feel about sex. Some men withy prostate cancer describe feeling that they have lost their role within the partnership or family. This can sometimes affect a man's self esteem and confidence, particularly about their masculinity. For others, treatments may lead to tiredness and a lack of energy. Physical changes after hormone therapy such as putting on weight or breast swelling can also affect the way you feel about your body and appearance. All of these factors may result in a lack of interest in sex and may also make some men feel down. Talking with your doctor, nurse or another health professional may help. Support from your partner or family and friends might also help. You can read more about coping with these changes below.

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

If you have had surgery (radical prostatectomy) you will not be able to ejaculate afterwards. This is because the prostate gland and seminal vesicles, which store and transport semen, are removed during the operation. Instead you may experience what is sometimes called a 'dry orgasm' 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. Occasionally, some men will find that a small amount of liquid comes out from the tip of the penis during orgasm, which may be fluid from glands lining the urethra.

If you have had radiotherapy or brachytherapy you may notice that you produce less semen after you finish treatment. You should still be able to have an orgasm but you may find that it feels different to before treatment. Some men find that they have less intense orgasms when they are having hormone therapy.

For information on the side effects of each treatment read our treatment pages.

Will prostate cancer treatment affect the appearance of my penis?+

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).25 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).26 Some studies have shown that encouraging blood flow to the penis after surgery may help you get erections and prevent your penis becoming smaller.27 In particular using a vacuum pump might be helpful.28

Other types of prostate cancer treatment such as radiotherapy and hormone therapy29 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.

Will prostate cancer treatment affect my fertility?+

Treatment for prostate cancer can affect your ability to produce sperm or ejaculate and lead to infertility. If you have surgery the prostate gland and seminal vesicles, which produce and store some of the fluid in semen, are removed during the operation. You may still be able to experience orgasm, even without an erection, but you will not ejaculate any semen. This is called a 'dry' orgasm and means that you will be infertile after the operation.

Radiotherapy can damage the cells that make semen and cause fertility problems. Brachytherapy may have less of an effect on fertility than other treatments for prostate cancer30 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.
Changes to your sperm during radiotherapy, brachytherapy and chemotherapy could affect any children you may conceive during this time31 but the risk of this happening is very low. 32 33 You may wish to avoid fathering a child during treatment and for a while after having treatment, for example by using a condom or other form of contraception.

If you are planning to have children you may be able to store some sperm before treatment so that they can be used later in fertility treatment. There is no age limit to storing your sperm for your own use.34 Sperm banking is usually available on the NHS. This is not always the case so you may need to pay for sperm storage and possibly for infertility treatment. Ask your doctor or nurse about what fertility treatment is available locally.

If you are planning to have children you should seek further information from your GP or doctor or nurse. If you have a partner, talk to them about your plans for having children and what this would involve.

Macmillan Cancer Support produce more detailed information about other fertility treatments options that may be available.

Common feelings+

Having problems with erections or losing your desire for sex are problems that many men have at some point in their lives. Men deal with changes to their sexual function in different ways. Some men on hormone therapy find that because they no longer have a desire for sex, it is easier for them to come to terms with problems getting an erection. For other men who have had treatment for prostate cancer, the ability to get an erection, to have sex or to masturbate is an extremely important part of their lives. For some men masturbation and sex may also be a way of relaxing, working through difficult emotions, coping with difficult times, or boosting self esteem. So, losing the ability to have sex or get an erection can be difficult to come to terms with. See below for ways to get support.

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. Your partner could go with you to your GP or hospital appointments. Emotional or psychological problems can play a part in the development of ED so talking about it may help.

If you have a partner then there are many other ways of having an intimate relationship without having penetrative sex. If you are used to a close physical relationship, physical contact - through hugging and kissing - maintains intimacy, provides support and does not have to lead to intercourse. Some men find they become closer to their partner.

What support is available to me?+

If you have any questions about any of the issues described in this fact sheet you can call our confidential Helpline to speak to a specialist nurse.
Some people feel embarrassed about discussing personal issues over the phone. You can also send a query to the Helpline by using our email contact form.

You could also try our telephone peer support service. Call our confidential Helpline and a specialist nurse will match you, where possible, with one of our volunteers who may have had similar experiences or treatments. Our volunteers include both men and women whose lives have been affected by prostate cancer either as a patient, partner or other family member.

If you have access to the internet, you may also like to sign up to The Prostate Cancer Charity online community, where you can share your views and experiences with others affected by prostate cancer.

It can sometimes be difficult to speak to those close to you because you do not want to upset them, or because you are finding it hard to show your emotions. 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. Contact the British Association for Counselling and Psychotherapy to find a counsellor.

Support for partners+

Some men may distance themselves from close relationships, but this does not mean that they no longer care for their partner or loved ones. Some men may avoid intimate situations where they may feel under pressure to have sex, because they are struggling with changes to their body and sexual function.

This can be hard, so if you are the partner of a man with prostate cancer you might find it useful to get some support for yourself. The services described above are also open to you.

The Sexual Advice Association has further information written for partners. Talking about sex can be difficult, even for a couple who have known each other for a long time. If you or your partner is finding it difficult to approach the issue of sex, you may find it helps to see a psycho-sexual counsellor.

Questions to ask your doctor or nurse+

How could my treatment for prostate cancer affect my sex life?

  • How soon after prostate cancer treatment can I have sex or masturbate 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?
Links+

The following organisations provide further information relevant to this page.

British Association of Counselling and Psychotherapy (BACP)
www.itsgoodtotalk.org.uk
01455 883316
BACP will help you find qualified counsellors. They are happy to discuss any queries or concerns you have about choosing a counsellor or the counselling process.

College of Sexual and Relationship Therapists (COSRT)
www.cosrt.org.uk
020 8543 2707
Information on sexual and relationship therapy, including a list
of therapists.

Healt hwith Pride
www.healthwithpride.nhs.uk
An online resource for lesbian, gay and bisexual patients. This website has information on cancer issues and erectile dysfunction for gay men.

Macmillan Cancer Support
Email Address: www.macmillan.org.uk
Practical, financial and emotional support for people with cancer, their family and friends. Macmillan also has further information on sex, relationships and cancer.

Rela te
www.relate.org.uk
Relate provide relationship counseling and sex therapy and a range of other relationship support services.

Relationships in Scotland
www.relationships-scotland.co.uk0845 119 2020
Relationship counselling across Scotland

Sexu alAdvice Association
www.sda.uk.net
For detailed information on treatments for erectile dysfunction. They also produce a fact sheet on sexual difficulties in gay men.

Reviewers+

Reviewed by:

  • Charlotte Etheridge, Macmillan Urology CNS, Ipswich Hospital
  • Jane Booker, Macmillan Urology Clinical Nurse Specialist, The Christie NHS Foundation Trust, Manchester
  • Dr David Ralph, Consultant Uroandrologist, The Institute of Urology, London
  • Jill Simpson, Clinical Nurse Specialist (Urology), The Royal Derby Hospital, Derby
  • The Prostate Cancer Charity Support & Information Specialist Nurses
  • The Prostate Cancer Charity Information Volunteers

Written and edited by:
The Prostate Cancer Charity Information Team

References+

References used in the production of this page.

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