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Sex and relationships

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Prostate cancer and its treatment can affect your sex life. We describe the treatment and support that is available, and ways for you to work through any problems.

Whether you're single or in a relationship, heterosexual, gay or bisexual we hope you will find this helpful. If you're a partner of a man with prostate cancer you may also find it useful.

There's also more information in our How to manage sex and relationships guide.

How will prostate cancer affect my sex life?

Prostate cancer can affect your sex life in three overlapping ways - your mind, body and relationships.

Mind

Finding out you have cancer can make you feel down or anxious, changing your feelings about sex.

Body

Treatment can damage the nerves and blood supply needed for erections. Hormone therapy can affect your desire for sex.

Relationships

Coping with cancer can change your close relationships, or your thoughts about starting one.

Some common worries

  • You can’t pass on cancer through sexual activity.
  • Having sex will not affect your cancer or the success of your treatment.
  • Having sex has no effect on the chances of your cancer coming back.
  • Erections are still safe even if you have a  catheter in.

What causes erection problems?

When you're sexually aroused your brain sends signals to the nerves in your penis. The nerves increase the blood flow to your penis, making it stiff and giving you an erection. Anything that interferes with your nerves, blood supply or your sexual desire (libido) can make it difficult to get or keep an erection. You may hear this called erectile dysfunction or impotence.

Many men get problems with their erections and this is more likely to happen as men get older.

Treatments for prostate cancer

Some treatments for prostate cancer can damage the nerves and blood vessels that are needed for an erection. Treatments that can have this effect include surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound and cryotherapy.

All types of hormone therapy can cause erection problems. Having less interest in sex can also play a part.

Other health problems

Other health problems can cause erection problems, including:

  • high blood pressure or high cholesterol
  • diabetes or heart disease
  • neurological conditions such as epilepsy, stroke, multiple sclerosis or Parkinson's disease
  • Other prostate problems
  • hormone problems, such as low testosterone

Certain medicines, feeling low or anxious and lifestyle factors such as smoking, drinking too much alcohol or being overweight can also cause erection problems.

Treatments for erection problems

Many of the treatments for erection problems work by improving the flow of blood to the penis. There are a number of treatments available.

Tablets

A group of drugs called phosphodiesterase type 5 (PDE5) inhibitors can help men get erections. These include:

  • sildenafil (generic sildenafil or Viagra®)
  • tadalafil (Cialis®)
  • vardenafil (Levitra®)
  • avanafil (Spedra®)

PDE5 tablets don’t cause spontaneous erections - they only work if you are sexually aroused. They normally take 30 minutes to an hour before they start to work.

Sildenafil, vardenafil and avanafil are taken when needed and will work for four to six hours. This means you’ll be able to get an erection if you’re sexually aroused in that time.

Tadalafil can work for up to 36 hours, so it allows you to have more spontaneous sexual activity. Your doctor may suggest you take a low-dose tablet (5mg) every day.

Don’t take PDE5 tablets with nitrates: Nitrates are usually used to treat heart problems and are used in some recreational drugs (called poppers). If you have a heart problem or you’re taking nitrates discuss other ways to treat your erection problems with your doctor or specialist.

Injections

Erection problems can also be treated with a drug called alprostadil (Caverject® or Viridal Duo®) injected into the side of your penis.

An injection may sound alarming but many men find it isn’t that bad and doesn’t hurt. The first time you use the drug a nurse or doctor in the clinic will show you how to inject into your penis with a very fine needle.

The drug causes the penis to fill with blood and you’ll get an erection within 5 to 10 minutes. The erection will normally last for 30 to 40 minutes.

Pellets or cream

The drug alprostadil is also available as a small pellet, called MUSE®, and as a cream called Vitaros®.

These may not work as well as the injections but are a good alternative if you don’t like the idea of an injection.

You use an applicator to insert the pellet into the opening or ‘eye’ of the penis. You or your partner can then massage your penis to help absorb the drug. You’ll get an erection within 5 to 10 minutes, which will last between 30 and 60 minutes.

The cream may take a little longer to work. The cream is put onto the tip and ‘eye’ of the penis and gently rubbed in.

Vacuum pump

You use a pump and a plastic cylinder to create a vacuum, which makes blood flow into your penis to make it hard. You then slip a constriction ring from the end of the cylinder onto the base of your penis. This stops most of the blood escaping when you remove the vacuum pump. You shouldn't wear the ring for longer than 30 minutes at a time.

The vacuum pump may help men get an erection hard enough for penetration. It may also help maintain the length and thickness of the penis if used daily within four to eight weeks after surgery.

Implant

You have an operation to put an implant inside your penis. Implants are usually only recommended if other treatments haven’t worked. There are two main types:

  • Semi-rigid rods that keep your penis fairly firm all the time but allow it to be bent down when you don’t want an erection.
  • An inflatable implant in your penis and a pump in your scrotum. When you squeeze the pump the implant fills with fluid (saline) to make the penis hard. Your erection will last for as long as the implant is inflated.

Testosterone replacement therapy

If you’ve had treatment for prostate cancer that was contained inside the prostate and have erection problems caused by low testosterone levels, then you may be able to have testosterone replacement therapy.

Sex therapy

Because getting an erection also relies on your thoughts and feelings, tackling any worries or relationship issues as well as having medical treatment for erection problems, often works well.

Self-help 

Keeping a healthy weight, stopping smoking and doing pelvic floor exercises may help improve your erections.

Getting treatment and support

Speak to your GP or doctor or nurse at the hospital.

Men with prostate cancer can get free medical treatment for erection problems or other sexual problems on the NHS. Your GP or doctor or nurse at the hospital can prescribe treatment if you want help getting erections for masturbation or sex. There is no age limit for receiving treatment but there may be a limit on how much your GP can prescribe.

Talking about sex

It can be tricky talking about sex, but talking to your doctor or nurse will mean you can get treatment and support. It can also help you feel better and more in control.

Before prostate cancer treatment

Before you start prostate cancer treatment, talk to your doctor or nurse about the possible side effects, and how they will affect your sex life. Knowing what to expect can help you deal with side effects.

During or after prostate cancer treatment

If you have any sexual problems, concerns or questions, talk to your doctor or nurse. They should ask you about your erections and sex life before, during and after treatment for prostate cancer. But if they don't then you may need to bring it up yourself.

Your desire for sex (libido)

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

Hormone therapy for prostate cancer reduces your sex drive so you may have less interest in sex. This is because of the drop in testosterone - the hormone responsible for giving you a sex drive. Read more about how hormone therapy affects you.

You could ask your doctor or nurse about intermittent hormone therapy. This involves stopping treatment when your PSA level is low and steady, and starting it again if your PSA level starts to rise. Your desire for sex may improve after hormone therapy is stopped, but this can take several months.

You might want to try treatments for erection problems, even if your sex drive is low. Some of the treatments for erection problems may still work for you.

What else can affect your sex drive?

Your thoughts and feelings
If you are feeling stressed or down then you may have less interest in sex.

Tiredness
All treatments for prostate cancer can cause tiredness (fatigue). This can be during and after treatment. If you're feeling very tired - you may lose interest in sex or not have enough energy for it.

Other side effects
Other side effects of prostate cancer treatments such as urinary and bowel problems can affect your sex life. Physical changes caused by hormone therapy, such as weight gain or breast swelling, may make you feel embarrassed and less interested in sex.

Changes in penis size

Some men find that their penis is shorter after surgery (radical prostatectomy). This happens because of changes to the tissue inside the penis. Other treatment such as hormone therapy with radiotherapy may also cause changes to the size of your penis.

Encouraging blood flow to the penis after surgery may improve erections and prevent your penis becoming smaller. In particular, using a vacuum pump on its own or with PDE5 tablets may help maintain your penis size and improve erections.

Keeping your penis active after surgery

Although you may not be ready or recovered enough for sex, you can still start treatment for erection problems in the weeks immediately after surgery. It could be taking a low-dose PDE5 tablet once a day or using a vacuum pump, or sometimes both together. The treatment along with masturbation encourages blood flow to the penis. This can help keep your penis healthy. You may hear this called penile rehabilitation. Think of it in the same way as having physiotherapy if you had injured your arm or leg. Starting treatment soon after surgery may help improve your chance of getting and keeping an erection. But it may not work for every man.

Changes to orgasm and ejaculation

After prostate cancer treatment you will still have feeling in your penis and you should still be able to have an orgasm, but this may feel different from before.

After radical prostatectomy you will no longer ejaculate when you orgasm, as the prostate and seminal vesicles, which make some of the fluid in the semen, are removed during the operation. Instead you may have a 'dry orgasm' where you feel the sensation of orgasm but don't ejaculate any semen. Occasionally, you might release a small amount of liquid from the tip of your penis during orgasm, which may be fluid from glands lining the urethra.

If you've had radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) or hormone therapy, you may produce less semen during and after treatment. Some men on hormone therapy say their orgasms feel less intense.

If you've had surgery for an enlarged prostate called a called TURP (transurethral resection of the prostate) or radiotherapy you may get retrograde ejaculation. This is when you orgasm and the semen doesn't come out straightaway, but is passed out of the body when you  next urinate. It isn't harmful and shouldn't affect your enjoyment of sex but it may feel quite different to the orgasms you're used to.

Some men leak urine when they orgasm, or feel pain. Others find they don't last as long during sex and reach orgasm quite quickly.

Having children

After prostate cancer treatment you might not be able to have children naturally. For example, you won't ejaculate any semen after surgery. If you have radiotherapy or brachytherapy, the radiation might affect your ability to produce sperm, although this is very unlikely.

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

You may want to think about storing your sperm before treatment, so that you can use it later for fertility treatment (IVF), if needed. Ask your doctor or nurse whether sperm storage is available locally. You can usually store your sperm for up to 10 years. In certain circumstances it might be stored for longer.

Changes to your sperm during radiotherapy, brachytherapy and chemotherapy could affect any children you may conceive during or after treatment but the risk of this happening is very low. You may wish to avoid fathering a child during treatment, and for up to two and a half years afterwards. 

If you and your partner are planning to have children speak to your GP or specialist team. Macmillan Cancer Support and Infertility Network UK have more information on fertility and treatment options.

Your thoughts and feelings

If your ability to get erections and your experience of sex have changed then this can have a big impact on you. You may feel worried, unsatisfied, angry and as if you've lost a part of yourself. But there are ways to tackle these issues and find solutions that work for you.

Getting support

If you are stressed or down about changes to your sex life you may need to deal with this before you can address any sexual issues.There are lots of different ways to get support.

Remember a lot of men have sexual problems - you are not alone. Talking to other men who have had similar experiences can help.

Trained counsellors

Prostate Cancer UK and Relate are working together to offer counselling sessions to individuals, couples or family members affected by prostate cancer.

Lorraine Grover, a psychosexual therapist at The London Clinic, explains why we should all be more open to talking about sex.

Sex and relationships

If you have a partner, then coping with cancer and side effects may have changed your relationship and the way you have sex.

Even though your sex life is unlikely to be the same as it was before cancer, you don't have to give up on having pleasure, closeness or fun together. Keeping some kind of physical closeness alive, in whatever ways possible, can protect or even improve your relationship.

Some couples find it useful to see a relationship counsellor. The charity Relate provides relationship counselling and a range of other relationship support services. Sex therapy is available on the NHS or privately.

Watch Ally's story: Find out about communicating as a couple.

Watch other men's personal stories about sex after prostate cancer.

If you're a gay or bisexual man

To be the active partner (‘top’) during anal sex you normally need a strong erection, so erection problems can be a particular issue. You could try using a constriction ring around your penis with another treatment like PDE5 tablets, to help keep your erection hard enough for anal sex.

If you’re the receptive partner (‘bottom’) during anal sex a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find that after having their prostate removed their experience of sex changes.

Bowel problems and sensitivity in the anus after radiotherapy can also be an issue. It’s best to wait until your symptoms have settled before trying anal play or sex. If you’ve had permanent seed brachytherapy there is a risk in the first few months that your partner might be exposed to some radiation during sex. Talk to your doctor or nurse about when it’s safe to have sex.

With all sexual changes you may be able to find ways to work through this.

Watch Martin's story: For one gay man's experience.

Watch other men's personal stories about sex after prostate cancer.

Sex when you're single

Being sexually active and feeling attractive can be just as important if you are a single man. All the treatments described here are available to you if you're single - whether you want to be able to masturbate, have sex, or want to start a new relationship.

If you are starting a new relationship, sexual problems and other side effects like urinary or bowel problems could be a worry. Some men worry that having problems with erections will affect their chances of having a new relationship. Fear of rejection is natural, and everyone has their own hang-ups whether they have had cancer or not. If you're single, you may want time to come to terms with any changes prostate cancer has caused for you, before you start having sex or dating.

Try talking over your worries with someone you feel comfortable with, such as a friend. Counselling or sex therapy may also help if you would prefer to talk to someone you don't know.

Prostate Cancer UK and Relate are working together to offer counselling sessions to individuals, couples or family members affected by prostate cancer.

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 masturbate or have sex?
  • What are the treatments for erection problems and which will be best for me?
  • What happens if the treatment doesn't work? What other treatments could I try?
  • Which treatments can I get from my local NHS?
  • What other support is available to me?
  • Can my partner also get support?

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References

Updated: January 2015 | Due for Review: January 2017


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