Your sex life after penile cancer

It can be very difficult coping with changes to your body after surgery, especially to your penis. Immediately after your surgery your genital area will be swollen. It can be a shock to see the changes even if you have been told beforehand what to expect.

How you will look will depend on the surgery you have had. If you have had a wide local excision there will be a scar. Depending on how much tissue was removed, the shape of your penis may have changed slightly.

If you have had a glansectomy with a skin graft, your penis will be smaller and the glans will no longer be there. It will look like a circumcised penis. You will still have an opening in the middle of your penis for passing urine.

If you have had a total penectomy, you will have a scar where your penis was removed. You will have an opening between your anus and your scrotum for your urine to pass through. You will need to sit down on the toilet to pass urine.

It is normal for men who have surgery to this area to feel angry, confused and upset for some time after their surgery. You are likely to feel generally different about yourself. It’s common to worry that you are less attractive to your partner. This can all have an effect on your self esteem.

It is normal to think these things. Remember that those closest to you won’t think of you any differently than they did before. They will want to support you as much as they can, so let them know how you are feeling. If you don’t speak to them you may feel more isolated and less able to cope with things.

How much penile cancer affects your sex life and sexuality depends on what treatment you have. Whenever possible, your doctors will try to give you treatment that preserves your penis and allows you to continue a normal sex life.

Most men are able to continue to have a fulfilling sex life after treatment. It is important to communicate openly with your sexual partner and for you both to share how you feel about it. You may need the help of a specialist counsellor or nurse to help you talk about these things.

The following information tells you about

• Sexuality after surgery
• Sexuality after radiotherapy

Sexuality after surgery

If you have had a wide local excision you should still be able to have an erection and carry on with your sex life as you did before treatment.

Most men who have had a partial penectomy are able to have a fulfilling sex life. Even though you don’t have the sensitive top part of the penis, it is often still possible to have an erection and orgasm. You can still have penetrative sex if you have 4 cm of the shaft of the penis remaining. A study in 2005 found that over half (56%) of men who'd had a partial penectomy said they had enough of an erection to have sexual intercourse.

If you have had a glansectomy with reconstruction and you were sexually active before the operation you are likely to be able to remain active. This is because the blood supply and nerves are not affected in most men.

If you have had a total penectomy, you will need to think differently about how you express your sexuality. It is still possible to have a fulfilling sex life. But it is even more important to be able to talk openly with your partner about this and share your feelings. You will still have sensitive areas around your scrotum, testicles and perianal area, and you may still be able to achieve orgasm. You will need to take time to experiment and explore your body, and what gives pleasure to you and your partner. You could try using massage, a vibrator or oral sex. It may help to improve both you and your partner's sexual arousal through fantasy with films or pictures.

If you’ve had reconstructive surgery after a penectomy your ability to have an erection will depend on whether the surgeon has been able to reconnect the nerves and the blood supply needed to get an erection. Talk to your doctor about what you should expect before you have the surgery.

Of course it will take time to adjust to these changes in your sex life, and it is important to talk about this as a couple and share your feelings.

Sexuality after radiotherapy

Radiotherapy to your penis may have a temporary effect on your ability to have an erection. Often this is due to tiredness, caused by the radiotherapy, and the worry about your diagnosis. The nerves in and around the penis may also be affected temporarily. If you have any thickening of the tissue from the radiotherapy this may make it more difficult and painful to have an erection and sensation will be reduced. Most side effects improve once treatment is finished and many men are able to carry on their sex life as before.

Talking about these changes and how you’re feeling can help you cope with your situation. They won’t take all of the emotional pain away but can make it easier to deal with. You might find it helps to

• Talk to your surgeon before the operation
• Talk to your partner and those close to you

Talk to your surgeon before the operation

Ask your surgeon to be honest as it will help you to know exactly what to expect after the operation. Don’t be afraid to ask questions. Your surgeon will be sensitive to how you are feeling and will want to reassure you when possible.

Talk to your partner and those close to you

You may find that you can get support from your partner, your family and friends, and other people close to you. There might be only a few people you can speak to openly, and you could feel shy or embarrassed to speak to some because of where you have had surgery. This is normal but you may be surprised how much better you feel by sharing how you are feeling.

If you are having problems with your intimate or sexual relationships because you no longer feel attractive, try letting your partner know how you are feeling. You may find it helpful to read our section on sex and cancer for men in the coping with cancer section.

The kind of support you need can depend on what makes you comfortable. Some people prefer to cope with things on their own, while others would like help from other people.

A multidisciplinary health care team will look after you. This means there will be professionals who can help you who have experience of caring for people in similar situations to you. This team includes a specialist urology nurse, doctors and psychologists amongst others. These specialists may be able to put you in touch with other men with penile cancer, or refer you to a counsellor or sex therapist. Remember, don’t be afraid to ask for help - that is what the team are there for.

There is more information about how to get support on the penile cancer organisations page. You may also find it helpful to read or hear about other people’s experiences. There is an account of life after penile cancer in the your stories section.