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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, and whatever your sexuality, 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 sex.
  • Having sex won't affect how well your treatment works.
  • Having sex has no effect on your cancer or the chance of it coming back after treatment.
  • It's safe to have an erection if you have a catheter in.

What causes erection problems?

When you're sexually aroused (turned on) your brain sends signals to the nerves in your penis. The nerves then cause blood flow in to your penis, making it hard. Anything that interferes with your nerves, blood supply or desire for sex (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, including surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound and cryotherapy.

Hormone therapy can also lower your desire for sex and the lack of activity means your penis will stop working so well.

Other health problems

Other health problems can cause erection problems, including:

  • high blood pressure 
  • diabetes
  • heart disease
  • high cholesterol
  • neurological conditions such as epilepsy, stroke, multiple sclerosis or Parkinson's disease
  • Other prostate problems such as an enlarged prostate or prostatitis, and their treatments
  • 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

There are a number of treatments available which work in different ways. Treatments include:

  • tablets
  • vacuum pump
  • injections
  • pellets or cream
  • implant
  • testosterone therapy

Tablets

A group of drugs called PDE5 inhibitors (phosphodiesterase type 5 inhibitors) could help you get an erection. These include:

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

You need to be sexually aroused for the tablets to work. The tablets normally start to work about 30 minutes to an hour after taking them.

You can take sildenafil, avanafil and vardenafil when you need to. They will keep working for four to six hours or up to eight hours for vardenafil. So if they work you should be able to get an erection if you're sexually aroused during that time.

You can take tadalafil when you need to. It can work for up to 36 hours so it lets you be more spontaneous. Or your doctor may suggest you take a low-dose (5mg) tadalafil tablet 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 take nitrates ask your doctor or specialist about other ways to treat erection problems. 

Injections

Erection problems can also be treated with drugs using an injection that you give yourself. These include:

  • alprostadil (Caverject®, Caverject® Dual Chamber, Viridal Duo®) 
  • aviptadil with phentolamine mesilate (Invicorp®)

An injection may sound off-putting but many men find it isn’t that bad and doesn’t hurt. Your nurse or doctor will show you how to inject the side of your penis with a very thin needle. 

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

Pellets or cream

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

These don't tend to work as well as the injections, but they're a good alternative if you don’t like the idea of an injection.

You use an applicator to insert the pellet or cream into the opening or ‘eye’ of the penis. With the pellet, it helps if your urethra, which is the tube you urinate through, is already moist, so urinate first. With the cream, you or your partner can rub in any cream that's left on the tip and massage your penis to help it absorb the drug.

If the pellet works you should get an erection within 5-10 minutes which lasts for up to an hour. The cream may take a little longer to work. 

Vacuum pump

You use a pump and a plastic cylinder to create a vacuum which makes the blood flow into your penis. This can give you an erection. After using the pump to get an erection, you slip a constriction ring from the end of the cylinder around the base of your penis. This stops most of the blood escaping when you remove the pump. You shouldn't wear the ring for longer than 30 minutes at a time.

The vacuum pump can be an effective way to get an erection hard enough for penetration. It may also help maintain the length and thickness of the penis if used regularly and soon after surgery.

Implant

This involves having an operation to put an implant inside your penis. Although it sounds quite off putting, it can be a good option 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 the penis and a pump in your scrotum (the skin around testicles). 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 and you can deflate it when you want to.

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.

Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether it's for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.

Talking about sex

It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.

You can ask about sexual problems at any stage - before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.

Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they don't then you may need to bring it up yourself.

Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic - they will be used to talking about sexual problems.

Your desire for sex (libido)

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

Hormone therapy for prostate cancer is likely to lower your sex drive. This is because some types of hormone therapy lower your testosterone levels, which is what gives you your sex drive. Read more about how hormone therapy affects you.

If you're on long-term hormone therapy, ask your doctor or nurse about intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if it 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 notice that their penis is shorter after surgery (radical prostatectomy). Some men notice other changes such as a curve in their penis or a narrower area. We don't know for certain why these changes happen, but it could be because of low oxygen levels in the penis, caused by not having erections. Other treatments 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 help prevent this. In particular, using a vacuum pump, either on its own or with PDE5 inhibitor tablets could 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. Some men lose the ability to orgasm, especially if they're on hormone therapy.

If you've had radical prostatectomy, you will no longer ejaculate when you orgasm. This is because the prostate and seminal vesicles, which make some of the fluid in semen, are both removed during the operation. Instead you may have a dry orgasm - where you feel the sensation of orgasm but don't ejaculate. 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. With radiotherapy, brachytherapy and HIFU you may also notice a small amount of blood in the semen. This usually isn't a problem but tell your doctor or nurse if this happens. Some men on hormone therapy say their orgasms feel less intense.

If you've had surgery for an enlarged prostate called TURP (transurethral resection of the prostate) or radiotherapy you may get retrograde ejaculation. This is where the semen travels backwards into the bladder when you orgasm, rather than out through your penis. The semen is then 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. If you have surgery (radical prostatectomy) you won't ejaculate any semen. And if you have radiotherapy or brachytherapy, the radiation might affect your ability to produce sperm, although this is can be temporary.

With radiotherapy or brachytherapy you may produce less fluid when you ejaculate but you may still be fertile.

You may want to think about storing your sperm before treatment, so that you can use it for fertility treatment later. Ask your doctor or nurse whether sperm storage is available locally. You can usually store your sperm for up to 10 years and sometimes 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 and it hasn't been proven. 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, you can get information on fertility and possible treatments from your GP or specialist team, Macmillan Cancer Support and Infertility Network UK.

Your thoughts and feelings

Changes to your body and your sex life can have a big impact on you. You may feel worried, unsatisfied, angry and some men say they feel like they've lost a part of themselves. 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, finding some support may improve how you feel. There are lots of different ways to get support.

You are not alone. A lot of men, with and without prostate cancer have sexual problems. Talking to other men who have had similar experiences can help.

Trained counsellors

Counsellors are trained to listen and can help you find your own ways to deal with things. Many hospitals have counsellors or psychologists who specialise in helping people with cancer - ask your doctor or nurse if this is available.

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, there are still many ways of having pleasure, closeness or fun together. Being physically close 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 together with another treatment like PDE5 inhibitor tablets, to help keep your erection hard enough for anal sex.

If you are receiving anal sex, a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find that their experience of sex changes if they have their prostate removed (radical prostatectomy).

If you receive anal sex, then bowel problems or sensitivity in the anus may be an issue after radiotherapy. 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 for further advice.

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 worries, whether or not they've had cancer. If you're single, you may want time to come to terms with any changes prostate cancer has caused 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.

 

Questions to ask your doctor or nurse

  • How could my prostate cancer treatment affect my sex life?
  • How soon after treatment can I masturbate or have sex?
  • Which treatments for erection problems would be best for me? Can I get them on the NHS?
  • Is there anything I can do to prepare myself before I start my prostate cancer treatment?
  • What happens if the treatment doesn't work? Are there others I could try?
  • What other support is available to me?
  • Can my partner also get support?

References

Updated: June 2017 | Due for Review: June 2020


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