Your diagnosis of prostate cancer and its treatments can cause a loss of interest in sex. This is also called a low libido or sex drive. This can be for a few different reasons including tiredness.
Lack of interest in sex and erection problems are less likely to occur with anti androgen drugs like bicalutamide, than other types of hormone therapy. So changing your hormone treatment might help. You would need to discuss this with your specialist.
You can ask your doctor about intermittent hormone therapy if you're struggling with a low libido. For example you have 6 months of hormone therapy, then have a break, then start treatment again. Or you only restart when your PSA level starts to rise.
Some trials have shown that the side effects of hormone therapy were reduced with intermittent therapy. But there might be a risk that this may not control the cancer for as long. It is difficult to predict whether your interest in sex will improve with a break in treatment. It may take some time before this happens.
You can talk to your doctor about some of the treatments for erection problems. They might help your low libido. Your doctor might recommend you try treatment with a PDE 5 drug such as tadalafil (Cialis) or sildenafil citrate (Viagra) and a vacuum pump.
Talking and staying close
It’s important to talk to your partner about how you feel, if you are in a relationship. Many people find it difficult to talk about sex even with a long term partner. But not talking about it can affect your relationship with them. Even if you are not interested in having sex, you can still enjoy physical contact.
Hugging, cuddling and kissing are comforting and can help you to relax. If you have physical contact it might help to be clear with your partner about how far you want to go. Some men find that feeling relaxed and having other physical contact can gradually lead to them becoming aroused and wanting to have sex. So a break may help in the long run.
It may also be helpful to speak to a counsellor or therapist, either separately or together.
Changes to the way you see yourself
Weight gain and change in body weight
The way you feel about your body can affect how you feel about yourself and your relationships. Hormone therapy for example can contribute to weight gain and can cause a loss of muscle in the body. Eating a healthy diet and being active might help to a degree.
Painful swollen breasts
Hormone therapy can make the breast tissue feel tender, or even painful. Breasts can become larger.
There are treatments that might help if you are finding this side effect particularly difficult. For example, there are drugs that might help reduce the swelling and pain. Some men can have radiotherapy to the breast to reduce the swelling. These treatments have risks and side effects so it is important to talk it though with your doctor.
Leaking urine during arousal or orgasm
Prostate surgery causes some men to leak urine during arousal or at the point of orgasm. This might become less of a problem as a man recovers from his surgery. But it could be a long term problem for some.
Understandably men can find this embarrassing. It might to help to talk things through with your partner if you have one. Discussing it with a new partner may be particularly difficult. But it could be a relief to consider ways of adjusting to this. It might help to pass urine before you have sex, or to use a condom.