Sex and prostate cancer

Some treatments for prostate cancer can have an impact on your sex life. But there are solutions and things that can help.

We describe how men deal with a range of sexual side effects, including erection problems, changes to sex drive and fertility. We also look at how men tackle their thoughts and feelings and deal with relationships.

This information is for you whether you're single or in a relationship, heterosexual, gay, bisexual or transgender. It may also be helpful if you're a partner of someone with prostate cancer.

Watch men tell their own story about sex after prostate cancer.

Contents

How can treatment for prostate cancer affect my sex life?

Having treatment for prostate cancer can affect:

  • how you feel about yourself sexually
  • your desire to have sex (libido)
  • your ability to get an erection (erectile function)
  • your ability to ejaculate and have an orgasm
  • your sexual satisfaction
  • your fertility
  • the appearance of your body
  • your relationships.

For more detailed information on the risks of sexual problems for each different prostate cancer treatment, read our treatment pages.

Some common worries

  • It is not possible to pass cancer through sex.
  • Having sex will not affect your cancer or the success of your treatment.
  • Erections are safe even if you have your catheter in.

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How can I get treatment and support?

Speak to your GP or doctor or nurse at the hospital to find out more about treatments for sexual problems. They might refer you to a specialist service such as an erectile dysfunction (ED) clinic.

Men with prostate cancer can get free medical treatment for problems with erections 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's no age limit for getting treatment but there may be a limit on how much your GP can prescribe.

If you start treatment and find that you need it more regularly or the treatment has not worked, go back and let your GP know. They may review your treatment or refer you to a specialist.

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Erection problems and treatment

After treatment for prostate cancer you may have difficulty getting or keeping an erection. This is also known as erectile dysfunction (ED) or impotence. Many men get problems with their erections and this is more likely to happen as men get older.

Causes of erection problems include one or a combination of the following: treatment for prostate cancer, other health problems, certain medicines and depression or anxiety.

Treatments include:

  • tablets
  • injections
  • pellets
  • vacuum pump
  • surgical implant
  • 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.

Keeping a healthy weight, being physically active, stopping smoking and trying pelvic floor muscle exercises may also help improve your erections. Read more about diet and physical activity or pelvic floor muscle exercises.

If you are on hormone therapy then you may have lost your desire for sex, so treatments that only work when you have desire, such as PDE5 inhibitor tablets like sildenafil (Viagra®), are unlikely to work. However injections, pellets, vacuum pumps and surgical implants should be able to give you an erection as you don't need to have sexual desire for them to work.

Read more about treatments for erections problems.

Watch Paul's story: Find out more about trying different treatments for erection problems.

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

Read about the end of Pfizer’s monopoly on Viagra and what this means for men with prostate cancer.

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How does prostate cancer affect your desire for sex?

Prostate cancer and its treatment can affect your desire for sex. Hormone therapy for prostate cancer will change your sex drive and may mean you have much less interest in sex. This is because of the decrease in testosterone, which is the hormone responsible for giving you your sex drive. You could ask your doctor or nurse specialist team about the option of 'intermittent hormone therapy'. Desire for sex should return to normal after hormone treatment is stopped, but it can take up to a year. Read more about the side effects of hormone therapy.

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

Other things that effect your sex drive include: feeling depressed or anxious feeling tired and dealing with other physical side effects such as urinary, bowel problems and physical changes after hormone therapy, such as putting on weight, or breast swelling.

Read more about dealing with these changes in the booklet, Prostate cancer and your sex life.

Watch Bruce's story: Find out how he dealt with changes to his sex drive.

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

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Will prostate cancer treatment affect the size of my penis?

Some men find that their penis is shorter after surgery (radical prostatectomy). Men may be less likely to experience these changes if the surgeon has been able to save the nerves that control erections during surgery (nerve sparing surgery).

Other types of prostate cancer treatment such as radiotherapy and hormone therapy 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 after surgery may stretch the tissue and help maintain your penis size.

Dealing with these changes can be difficult, read more about the support that is available to you below.

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Will prostate cancer treatment affect my orgasm and ejaculation?

After surgery (radical prostatectomy) you will not be able to ejaculate, as the prostate gland and seminal vesicles, which store and transport semen, are removed during the operation. Instead you may have a 'dry orgasm' where you have the feeling of orgasm but semen does not come out of your penis. If you have had radiotherapy, brachytherapy , high intensity focused ultrasound (HIFU) or hormone therapy you may produce less semen during and after treatment.

If you have had surgery called TURP (transurethral resection of the prostate) you may have a retrograde ejaculation. This is when you orgasm and the semen does not come out straightaway, but is passed out of the body the next time you pass urine. It is not harmful and should not affect your enjoyment of sex but it may feel quite different to the orgasms you are used to.

Some men leak urine when they orgasm,or experience some pain. Others find they don't last as long during sex and ejaculate too quickly. Read more about this and ways to manage these issues in our booklet: Prostate cancer and your sex life.

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Will prostate cancer treatment affect my fertility?

Prostate cancer treatment can affect your ability to produce sperm or ejaculate and can lead to infertility. If you've had surgery then the prostate gland and seminal vesicles, which produce some of the fluid in semen, are removed during surgery. The cells that make semen can also be damaged during other treatments such as radiotherapy. 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 that you produce less fluid when you ejaculate but it is possible that you are still fertile.

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. Sperm banking is usually available on the NHS, but this varies. Ask your doctor or nurse about what fertility treatment is available locally.

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

Macmillan Cancer Support and Infertility Network UK produce more information about fertility treatments.

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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.

Your sex life is unlikely to be the same as it was before cancer - but 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 provide relationship counselling and a range of other relationship support services. Sex therapy is available on the NHS or privately.

Prostate cancer and your sex life provides practical tips to help with your sex life, further information about sex therapy and specific information for partners.

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

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

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Gay and bisexual men

Prostate cancer affects gay and bisexual men in many of the same ways as heterosexual men, but there can be some other separate issues too.

If you give anal sex you could try using a constriction ring around your penis, together with another treatment like PDE5 tablets, to help keep your erection hard enough for anal sex. If you receive anal sex, then bowel problems after radiotherapy may be a particular issue. Some men also find that the skin inside their anus is more sensitive. If you are experiencing bowel problems or sensitivity in this area then wait until these side effects have subsided before trying anal play or sex. Talk to your doctor or nurse for further advice.

Some men who receive anal sex find that if they have they had surgery to remove their prostate then their experience of sex changes. As with all sexual changes, you may be able to find ways to work through this and find new ways of giving and receiving pleasure.

There is more information about talking to health professionals about your sexual orientation in Prostate cancer and your sex life or Prostate facts for gay and bisexual men.

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

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

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Sex when you're single

Being sexually active and feeling attractive can be just as important if you are a single man. Remember all of the treatments and tips that have been described here are available to you if you are single - whether you want to be able to masturbate, because you are single but sexually active, 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 in the first place. Fear of rejection is natural, and everyone has their own hang-ups whether they have had cancer or not. If you are 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.

Read Prostate cancer and your sex life for more tips.

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Tackling your thoughts and feelings

Dealing with sexual problems can make you feel depressed, worried, unsatisfied, angry and as if you've lost a part of yourselves. But there are ways to tackle your issues and find solutions that work for you.

If you are feeling very down you may need to deal with this before you can address any sexual issues. Counselling can help some men. Counsellors are trained to listen and work with you to understand your feelings and find your own answers. Your GP can refer you to a counsellor or you can see a private counsellor. British Association for Counselling and Psychotherapy. Other organisations such as the Sexual Advice Association and the College of Sexual and Relationship Therapists can also help.

There are also other ways to face these challenges:

Read more about what you can do to help yourself in our booklet: Prostate cancer and your sex life.

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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 again?
  • What are the treatments for erection problems and which will be best for me?
  • What happens if the treatment does not work? Are there other treatments I can have?
  • Which treatment can I get from my local NHS?
  • What other support is available to me?
  • Can my partner also get support?

Watch men's personal stories about sex after prostate cancer. These also feature in our DVD, Prostate cancer and your sex life.

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