Sex and erection problems after treatment for prostate cancer

Prostate cancer treatments can affect your sex life. Some treatments can damage the nerves that you need to get an erection. Other treatments can affect the levels of hormones you need to get and maintain an erection.

Even if you can't get a full erection, you can still have a sex life. There are several treatments that may help you. But not everyone chooses to have treatment. Treatments might include:

drug treatments such as tablets and creams
vacuum pumps
injections
implants

Sex therapy and counselling can also help. Speak to your doctor or specialist nurse if this is something you think might help.

How prostate cancer surgery affects your sex life?

Surgery to remove the prostate gland is called radical prostatectomy. This treatment can affect your sex life in different ways.

Problems getting an erection

Radical prostatectomy can damage the nerves you need to get an erection. So you might have problems getting an erection after surgery. This is called impotence or erectile dysfunction

There are 2 bundles of nerves attached to the prostate. These help you get erections. Nerve sparing surgery means your surgeon tries to save these nerves. This can help lower the risk of erection problems. But you might not be suitable for this type of surgery. If your cancer is growing close to the nerves, the surgeon will have to remove one or both bundles of nerves.

Some men will be able to get erections again after surgery. But this can take time. Others may need support or treatment to help with erections for the rest of their lives.

Ejaculation problems

After a radical prostatectomy, you no longer ejaculate semen. This is because the surgeon removes the seminal vesicles and the prostate gland, which make most of the fluid in semen.

After surgery, you should still be able to have an orgasm. But you won’t be able to ejaculate when you orgasm. You may hear this called retrograde ejaculation. This means you are still able to have an orgasm, but this is a dry orgasm. Your testicles continue to make sperm cells but they are reabsorbed back into your body.

Some men say that a dry orgasm feels normal. But others find them less intense and pleasurable. The loss of a visible ejaculation can also be significant for some people.

Same sex relationships

A radical prostatectomy can also change the way anal sex feels if you are the receiving partner. Some men find the penis rubbing against the prostate gland pleasurable. So if the prostate is no longer there, anal sex might feel different.

How hormone therapy and radiotherapy affect your sex life?

Hormone therapy lowers the amount of testosterone Open a glossary item in the body. This affects:

your ability to have and maintain an erection
the intensity of orgasms
your interest in having sex - this is called libido

Radiotherapy to the prostate can also damage the nerves that control getting an erection. Erection difficulties often develop slowly after treatment. It might be a few years years before you notice any problems.

How high intensity focused ultrasound (HIFU) and cryotherapy affect your sex life?

HIFU and cryotherapy usually cause fewer problems than surgery or radiotherapy. But there is still a risk of erection problems with these treatments. Researchers are still looking into these treatments and their long term side effects.

Treatments for sexual problems

It can be difficult talking about sex. Your doctor or nurse should ask you about your erections and sex life during your treatment. You can also ask about sexual problems at any stage of your treatment. You might need to bring it up more than once, or with a different person in your healthcare team.

There are different treatments available to help you manage sexual problems. Try to talk through your options with a doctor or specialist. Ask them to refer you to an Erectile Dysfunction Clinic if they are not able to give you this specialist advice. Or they might refer you to an andrology clinic. These specialise in the diagnosis and treatment of sexual health issues for men.

Penile or erectile dysfunction rehabilitation

Treatments for sexual problems are usually part of a programme called penile rehabilitation. This is also called erectile dysfunction rehabilitation. The aim of penile rehabilitation is to:

maintain blood flow to the penis
reduce damage to the muscle and tissue in the penis
provide a stimulus for erections

A penile rehabilitation programme includes:

counselling and sex therapy
healthy living
tablets
vacuum pumps
creams
injections or pellets
implants

Why is penile rehabilitation important?

Whether you're single or in a relationship, it's important to discuss penile rehabilitation. You can speak to your doctor or specialist nurse, even if you're not currently sexually active or don’t plan to be.

Using and stimulating the penis keeps the tissues active, healthy and flexible. It is best to start rehabilitation before or soon after your prostate cancer treatment.

Counselling and sex therapy

Talking to your partner about your erection difficulties can help. Or it may help to talk to a close friend if you are not in a relationship.

Counsellors or therapists can help if you’re worried about anything to do with your sex life and sexuality. Your GP or specialist nurse can refer you to a counsellor or therapist within the NHS. You might need to go on a waiting list to see them.

Talk to your GP or nurse to find out what is available in your area. Your local hospital or your local Erectile Dysfunction Clinic might have this service.

Healthy living

Making lifestyle changes can help you feel better and might improve your sex life. Being active and having a healthy weight can improve your interest in sex and might help you get an erection. Stopping smoking and cutting down on alcohol can also improve erections.

Some studies have shown that pelvic floor exercises can also help erection problems. The pelvic floor muscles are the sling of muscles in between your legs that run from the tailbone to the pubic bone. These muscles support the bladder and bowel.

Taking tablets

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

tadalafil (Cialis)
sildenafil citrate (Viagra)
vardenafil (Levitra)
avanafil (Spedra)

These medicines work by increasing blood flow to the penis. For the drugs to work, men need to be aroused and have some sort of sexual stimulation. In other words, the drugs won’t cause an immediate erection and some foreplay is usually needed.

As drugs work best in men who have sexual desire, they might not help some men having hormone therapy. But some specialists believe that they are still worth a try if you would like to give them a go.

Talk to your doctor about the best PDE 5 drug for you and the best way to take it.

Possible side effects of PDE 5 inhibitors include:

back pain
indigestion
headaches and dizziness
a flushed face

Vacuum pumps

Vacuum pumps are also called vacuum erection devices (VEDs). The pump fits over the penis and draws blood into the penis to form an erection. You can then put a soft plastic ring called a constriction ring around the base of your penis. The ring keeps the erection firm. You shouldn’t leave the ring on for more than 30 minutes. As the ring restricts blood flow, using it for longer can damage the tissues.

You can use a vacuum pump to get an erection for sex or masturbation. Or you can use one without the ring, to exercise the penis as part of penile rehabilitation. The vacuum pump may also help maintain the length of your penis.

Vacuum pumps can work well with practice, but they don't suit everyone. It’s worth knowing that the pump can cause the penis to have a blue tinge, this is normal.

Men with prostate cancer can usually get a vacuum pumps on the NHS. Or you can buy one. Ask your doctor, or nurse about what to buy and where to buy it.

Your doctor might suggest you use the vacuum pump in combination with PDE 5 drugs. Or you might have:

the vacuum pump alone
the pump in combination with other treatments such as injections

Creams

Your doctor might suggest you use alprostadil cream. It is also called Vitaros. You use an applicator to put this cream onto the opening of the penis. You usually get an erection within 5 to 30 minutes. The erection can last for 1 to 2 hours.

Injections or pellets

Injection or pellets also contain the drug alprostadil.

Injections are also known as Viridal Duo. You put the injection into the shaft of the penis. Or if you have a partner, you might prefer them to do it. Your doctor or specialist nurse will show you how to do this. You usually get an erection within 15 minutes of having the injection. The erection can last up to an hour.

Pellets containing alprostadil are called MUSE. They are about the size of a grain of rice. You put them in the opening of your penis, using a small plastic device. The pellet is absorbed into the surrounding tissue. You usually get an erection within 10 minutes. The erection can last up to 60 minutes.

There’s currently a supply problem with MUSE pellets, so they’re not available right now.

Implants

Implants might be an option if other treatments haven't worked. Implants or penile prostheses are put into the penis during a short operation. Not everyone is suitable to have this operation. Your doctor or specialist nurse can refer you to a specialist doctor called an andrology urologist.

There are 2 main types of implants:

inflatable implants - these are the most common type
malleable implants

Inflatable implants are made up of 2 or 3 cylinders, a pump and a small bag of saline. Your surgeon puts:

the cylinders in the penis
the pump into your scrotum
and a small bag of saline may be put behind in your tummy (abdomen)

Malleable implants are 2 flexible rods that your surgeon puts into the penis. Your penis will be erect all the time. But the implant has joints that allow you to position your penis. You can position your penis up for sexual intercourse and down to pass urine.