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Sex and prostate cancer

The information on this page comes from our Tool Kit fact sheet on sex and prostate cancer. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download and print a PDF version of this fact sheet.

This page is for men who have been diagnosed with prostate cancer and also for their partners. It describes how prostate cancer and its treatment can affect your sex life and your fertility. It includes information about the available treatments for problems getting an erection (erectile dysfunction). It also lists sources of help and support. Each hospital and specialist team will do things slightly differently so use this fact sheet as a general guide and ask your specialist team for more details about the care you will receive. You can also call our confidential Helpline on 0800 074 8383.



How can treatment for prostate cancer affect your sex life?

Many men continue to enjoy sex throughout their lives and well into old age. You might be worried about how treatment for prostate cancer may affect your sex life. Treatments can affect:

  • Your ability to get an erection (erectile dysfunction)
  • Your desire to have sex (libido)
  • Your ability to ejaculate and have an orgasm
  • Your fertility

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What is erectile dysfunction?

Erectile dysfunction (ED) is when you have difficulty getting or keeping an erection. It is also known as ED or impotence. ED is more likely to occur as men get older. 1 It can have many possible causes, including treatment for prostate cancer. For more information on the risks of ED with prostate cancer treatment, read our Treatment pages.

Causes of ED

Many men will have problems with their erections. These problems can be caused by one or a combination of the following:

Emotional or psychological problems

Stress and anxiety, worries about sexual performance and depression can cause ED.

Other medical conditions

These include high blood pressure and its treatment, diabetes, heart disease, high cholesterol, diseases of the nervous system, penile and prostate conditions and hormone abnormalities.

Treatment for prostate cancer

Surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) and cryotherapy can all damage the nerves and blood vessels that are needed for an erection. Hormone therapy reduces levels of the hormone testosterone. Testosterone is needed for sexual desire and erections. You can read more about this below.

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What treatments are there for ED?

For some men and their partners the loss of erectile function is not a problem and they may choose not to have any kind of treatment. Others are less happy about losing what may be a very important part of their lives and may choose to seek treatment.

An erection results from blood rushing into the penis and filling the spongy tissue, making the penis stiff. Many of the treatments for ED work by improving the flow of blood to the penis.

Men with prostate cancer can get treatment for ED free on the NHS. There is no age limit for receiving treatment. If you wish to continue to have sex, your specialist team can prescribe treatment. There are possible side effects when taking any medication. Your specialist team will discuss these with you before you start a treatment.

Some treatments are not suitable for men with a condition called Peyronie’s disease or with sickle cell trait, because they can cause a persistent and painful erection. Ask your specialist team for advice if you have these conditions.

Lifestyle

Some research has shown that maintaining a healthy weight and being physically active may benefit men with ED 2. Following a low fat diet and getting regular exercise will help you to lose weight gradually and healthily. You can read more about eating a healthy diet on our page about Diet and prostate cancer.

Some studies have also shown that smoking increases the risk of ED and that treatments for ED may be less effective if you are a smoker.3

Some early research shows that pelvic floor exercises may help to improve the quality of a man’s erection. 4 For more information about pelvic floor exercises read on our page about Urinary problems and prostate cancer.

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Tablets

Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil) are all drugs that can help men get erections. They belong to a group of drugs called PDE5 (phosphodiesterase type 5) inhibitors and all work as well as each other. 5 You will need to have a desire or interest for sex and some stimulation to the penis for the tablets to work. After taking these tablets you need to wait 30 minutes to an hour before they start to work. Viagra and Levitra will have an effect for around four hours. 4 Cialis can have an effect for about 36 hours. 6

If the maximum dose of one drug does not work, one of the other drugs may be more effective for you. The drugs may not work straight away. You should try each tablet at least four to eight 4 times before deciding how effective it is or changing to an alternative tablet. It may also take a few tries to get the timing right with your partner. These tablets may not work as well after a big meal, particularly one that contains a lot of fatty foods.4

Cialis (tadalafil) also comes in a one-a-day version. This is also a successful treatment for erectile dysfunction. 7 You might prefer to take a tablet once a day if you want to have sex often or if you and your partner prefer spontaneous rather than pre-planned sex.

All of these drugs can cause some side effects including:

  • Headaches
  • Indigestion
  • A flushed face
  • Itchiness or swelling in your nose (rhinitis)
  • Back pain.4, 8,

These side effects are usually mild and do not last long.

You should not take PDE5 tablets if you are taking a group of heart drugs called nitrates9 . Nitrates are usually used to treat heart problems. If you have a heart problem or are using nitrates you should discuss this with your GP or specialist before starting treatment for your ED.

Some men take tablets for ED during the weeks and months immediately after surgery, before they are ready to have sex. 9 The idea behind this is that the medication, alongside some gentle self-stimulation to the penis, may encourage regular blood flow to the penis, help your erections to return and could stop your penis becoming smaller.

These drugs do not increase your level of sexual desire, known as your libido. They will only help you to get an erection if you are sexually stimulated.

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Injections

Another form of treatment is an injection of a drug called Caverject or Viridal Duo (alprostadil) into the penis. This can be a successful treatment for ED in around seven out of ten men (70 per cent of men). 10 The first time you use the drug a nurse or doctor in clinic will show you how to inject it into the base of the penis with a very fine needle. The drug causes the penis to fill with blood and you will get an erection, within around 15 minutes. The erection will normally last for 30 to 40 minutes if the treatment has worked. 4 The idea of an injection may sound alarming but the nurse or doctor will make sure you are confident giving the injection yourself in the clinic before you go home. You may also be able to use an injection pen which means you do not have to look at the needle.

Generally this treatment does not cause significant side effects although many men do find that the injection is moderately painful. 11 If you have any other problems, tell your specialist team. Occasionally the erection may persist beyond a comfortable length of time. This is called a priapism which is rare and affects less than one in 100 men (one per cent).11 If your erection lasts for over four hours some health professionals suggest putting a cold compress at the base of the penis. Alternatively, exercising to help you raise your heartbeat, for example running up and down stairs, may help your body to flush out the drug more quickly. If this does not work you should go to your local hospital accident and emergency (A&E) department for treatment. 9

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Pellets

The same drug alprostadil is also available as a small pellet, called MUSE. This is not as effective as using the injections 12 but may be a good alternative if you do not like the idea of an injection. You use a disposable applicator to insert the pellet into the opening or ‘eye’ of the penis. You or your partner can then massage or stimulate your penis to melt the pellet and help the absorption of the drug. If the pellet works you should get an erection within five to 15 minutes, which will last between 30 and 60 minutes. 13 MUSE may cause some pain in the penis or testicles and dizziness in some men. 14 Injections or pellets can be used by men who have little or no sexual desire (libido), but they work better when you have some sexual interest and stimulation.

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Vacuum pump

Using a vacuum pump can also help you to get an erection. It is made up of a plastic cylinder that you put your penis into and a pump that you operate by hand or battery. The pump creates a vacuum inside the tube, this makes blood flow into your penis to make it erect. You then slip a rubber ring onto the base of your penis. This stops most of the blood escaping once you remove the vacuum pump. You should only wear the ring for 30 minutes at a time. 15 It can take a bit of practice to get used to the pump but some men prefer this option because it avoids the use of drugs. There is also no limit to how often you can use it. Some men may notice that the penis feels slightly cooler than usual when using a vacuum pump and the base of the penis remains soft. The success of this treatment varies quite a lot with three to eight out of ten men (30 to 80 per cent) finding it effective. 16, 17

Personal experience
“I find it helps to shave the hairs around my penis before I use my vacuum pump. This makes it easier to use the ring at the base of my penis.”

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Surgical implants

This is usually only considered if you have tried other treatments first and they have not worked, or if you are unable to have other treatments because you have another health condition.

There are two main types of implants. The first type uses semi-rigid rods that keep the penis fairly hard all the time but allow it to be bent down when you do not need an erection. The second type is an inflatable implant in the penis, and a pump placed in the scrotum. When you squeeze the pump the implant fills with fluid (saline) which will make the penis become erect. Your erection will last for as long as the implant is inflated.

Two out of 100 men (two per cent) 9 who have this surgery get an infection which means the implant will have to be taken out. The implant can be put back in again once the infection has been treated with antibiotics. Five out of 100 men (five per cent) 18,19 may need further surgery after five years because the implant has stopped working. In general, the implant may only work for about ten to 12 years, before it needs to be replaced.

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Getting used to ED treatments

Some of the treatments for ED may seem a little artificial and contribute towards ‘losing the moment’ when you are feeling aroused. This might change your sex life for you and your partner. However, with a little understanding and patience, you should be able to overcome some of the embarrassments and difficulties. Some couples even find that they use the preparation needed for some of the treatments, such as the vacuum pumps or pellets, as part of their foreplay.

Personal experience
“My husband keeps his injection in the bathroom. He just pops in and uses it before we get started, so we can be quite spontaneous. ”

To find out more about ED and its treatment, ask your GP or hospital specialist to refer you to your local ED clinic. Read the information leaflet that comes with your treatment for details of how to use the treatment and possible side effects. You can also get more information from the Sexual Dysfunction Association.

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How does prostate cancer affect sexual desire (libido?)

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

Hormone therapy

Hormone therapy for prostate cancer is likely to reduce, or cause you to lose your desire for sex. This is because of the decrease in testosterone, which is the hormone responsible for giving you your ‘sex drive’. One study suggested that about one in two men (50 per cent) taking a type of hormone therapy called LHRH agonists or who have had surgery to remove their testicles (orchidectomy) will lose their interest in sex. 20 If the loss of sex drive is a big problem to you, you may wish to discuss the option of ‘intermittent hormone therapy’ with your specialist team. 21 Desire for sex should return to normal after hormone treatment is stopped, but it can take up to a year. You can read our booklet Living with hormone therapy: A guide for men with prostate cancer for more information.

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Physical and emotional impact

Testosterone is not the only factor that can affect your sex drive. Both physical and psychological factors can effect how you feel about sex. Some men affected by prostate cancer describe feeling that they have lost their role within the partnership or family. This can sometimes affect a man’s self esteem and confidence particularly about their masculinity. For others, treatments may lead to tiredness and a lack of energy. Physical changes after hormone therapy such as putting on weight, or breast swelling, can also affect the way you feel about your body and appearance. All of these factors may result in a lack of interest in sex and may also make some men feel down. Talking with your specialist team or another health professional may help. Support from your partner or family and friends might also help. Read more about coping with these changes below.

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How soon after prostate cancer treatment can I have sex again?

This will depend on what type of treatment you have had and how you feel. It could be several weeks but for others it may take longer for erections to return. Some men will never get back the ability to maintain an erection without the help of artificial methods.

Couples occasionally worry that cancer can be passed on when they are intimate together. It is not possible to pass cancer on to your partner through intercourse. Having sex will not affect your cancer or the success of your treatment.

If you have had radiotherapy you may not feel like having intercourse for the first few weeks after treatment, but if you are able to, there is no reason why you should not resume sexual activity sooner.

If you have had a radical prostatectomy you will need to avoid full sexual intercourse for the first six to eight weeks after open surgery while the wound is healing. However, masturbation and night-time erections are safe during this time. If you have had keyhole surgery, you may feel like having sex sooner than this. However, you may not be able to get an erection while you are recovering from the operation.

You can have intercourse straight after brachytherapy although most men do not feel like it for the first couple of weeks. It is rare for any seeds to be passed in your ejaculate but, as a precaution, you should use a condom for the first few times you have sex after treatment.

Ask your specialist team for advice and read our Treatment pages for more information. As long as you follow advice from your specialist team, sexual activity will not harm you or your partner.

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Will prostate cancer treatment affect my ability to orgasm and ejaculate?

If you have had a radical prostatectomy you will not be able to ejaculate after surgery. This is because the prostate gland and seminal vesicles, which store and transport semen, are removed during the operation. Instead you may experience what is sometimes called a ‘dry ejaculation’ where you feel the sensations of orgasm but do not release any semen from the tip of the penis. This may feel different to the orgasms you were used to. Occasionally, some men will find that a small amount of liquid comes out from the tip of the penis during orgasm, which may be fluid from glands lining the urethra.

If you have had radiotherapy or brachytherapy you may notice that you produce less semen after your treatment is completed. You should still be able to have an orgasm but you may find that it feels different to before treatment. Some men have also found that they have less intense orgasms when they are having hormone therapy.

Read our Treatment pages for information on the side effects of each treatment.

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Will prostate cancer treatment affect the appearance of my penis?

Some studies have shown that around five out of ten men (50 per cent) will find that their penis is shorter after treatment with radical prostatectomy. 22 This happens because of changes to the tissue inside the penis. Men may be less likely to experience these changes if the surgeon has tried to save the nerves that control erections during surgery (nerve sparing surgery). 23 Some studies have shown that encouraging blood flow to the penis after surgery may help you get erections and prevent your penis becoming smaller. 24 In particular using a vacuum pump might be helpful. 25

It some cases other types of prostate cancer treatment such as radiotherapy and hormone therapy 26 may also cause changes to the size of your penis. There is not as much research into this but it may be less common than changes to men’s penis size after surgery.

Changes to your body and your penis can feel difficult to cope with. Talking to someone about this might be helpful. Read about what support is available to you below.

Personal experience
“My penis has shrunk and my orgasms are much less intense. I have a loving and understanding partner, so it hasn't been a problem.”

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Will prostate cancer treatment affect my fertility?

Treatment for prostate cancer can affect your ability to produce sperm or ejaculate and lead to infertility. It may be possible for you to store some sperm before treatment so that they can be used later to fertilise an egg. Other infertility treatment options may also be available to you. There is no age limit to storing your sperm for your own use. 27 Sperm banking is usually available on the NHS. This is not always the case so you may need to pay for sperm storage and possibly for infertility treatment.

Brachytherapy may have less of an effect on fertility than other treatments for prostate cancer 28 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.

Changes to your sperm during radiotherapy, brachytherapy and chemotherapy could affect any children you may conceive during this time 29 but the risk of this happening is very low. 30, 31 You may wish to avoid fathering a child during treatment and for a while after having treatment, for example by using a condom or other form of contraception. If you are planning to have children you should seek further information from your GP or specialist team. It will also be important to talk to your partner about your plans for having children and what this would involve.

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Changes to your sex life

Having problems with erections or losing your desire for sex is a problem that many men have at some point in their lives. Different men deal with changes to their sexual function in different ways. Some men who are on hormone therapy may find that because they no longer have a desire for sex, it may be easier for them to come to terms with problems getting an erection. For some men the ability to have sex or get an erection is an extremely important part of how they see themselves as men. There are many other ways of having an intimate relationship without having penetrative sex. If you are used to a close physical relationship, it is important to remember that physical contact – through cuddles and kissing – maintains intimacy, provides support and does not have to lead to intercourse. Some men find they become closer to their partner even though they have ED.

Personal experience
“Our love making has improved in ways that are very fulfilling, despite lack of penetration”

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Support for partners

If you have a partner, or are starting a new relationship, try and talk to them about any changes to your sex life. You may find that talking helps to reduce any worries you may have about what your partner thinks. Talking may help them to understand more about any physical or emotional changes you might be going through. Your partner could go with you to your GP or hospital appointments. Emotional or psychological problems can play a part in the development of ED so talking about it may help.

If you are the partner of a man with ED it could be helpful to find out more about it. Being patient and helping him understand that there is no pressure to perform may help him feel supported. But you might also find it useful to get some support for yourself. Some men struggle to come to terms with changes in their body image or their ability to perform sexually. This can result in avoiding intimate situations where they may feel under pressure to have sex. Some men may distance themselves from close relationships, but this does not mean that they no longer care for their partner or loved ones.

The Sexual Dysfunction Association has further information written for partners. Talking about sex can be difficult, even for a couple who have known each other for a long time. If you or your partner are finding it difficult to approach the issue of sex, you may find it helps to see a psycho-sexual counsellor.

Treatment for ED is available to all men, whether you are in a relationship or if you are single. You may be single and want an erection for masturbation or you may be thinking of starting a relationship in the future. There is no right or wrong time to consider getting help and treatment for ED.

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What support is available to me?

If you, your partner or your family have any questions about prostate cancer, treatments, or any of the issues described in this fact sheet you can call our confidential Helpline to speak to a specialist nurse. Call 0800 074 8383.

You can also send a query to the Helpline by using our email contact form.

We also provide a one-to-one support service which can give you the opportunity to talk to someone who has experience of ED and understands what you are going through. Our Support Volunteers are all personally affected by prostate cancer. There are men with prostate cancer, wives, partners, family members or friends. They have been trained to listen and offer support.

You may also like to use our online message board. This is an internet discussion group for people affected by cancer where you can share your views and experiences.

It can sometimes be difficult to talk to people close to you because you do not want to upset them, or you may find it hard to show your emotions. Some people might not want to talk about their feelings at all and prefer to cope using their own emotional and practical resources. Some people find it easier to talk to someone they do not know. Counsellors are trained to listen and can help you to understand your feelings and find your own answers. Your GP may be able to refer you to a counsellor or you can see a private counsellor. To find out more contact the British Association for Counselling and Psychotherapy.

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Questions to ask your specialist team

  • How could my treatment for prostate cancer affect my sex life?
  • How soon after prostate cancer treatment can I have sex again?
  • What are the treatments for erectile dysfunction and which will be best for me?
  • What are the side effects of treatment for erectile dysfunction?
  • What happens if the treatment does not work? Are there other treatments I can have?
  • Which drugs and equipment can I get from my local NHS?
  • What other support is available to me?
  • Can my partner also get support?

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Links

The following organisations provide further information relevant to this page.

British Association of Counselling and Psychotherapy (BACP)
www.bacp.co.uk
BACP will help you locate qualified counsellors. They are happy to discuss any queries or concerns which may arise whilst choosing a counsellor or during the counselling process.

British Association for Sexual and Relationship Therapy (BASRT)
www.basrt.org.uk
For information on sexual and relationship therapy, including a list of therapists.

Health with Pride
www.healthwithpride.nhs.uk
An online resource for lesbian, gay and bisexual patients. This website has information on cancer issues and erectile dysfunction for gay men.

Macmillan Cancer Support
Email Address: www.macmillan.org.uk
Practical, financial and emotional support for people with cancer, their family and friends. Macmillan also has further information on sex, relationships and cancer.

Relate
www.relate.org.uk
Relate provide relationship counseling and sex therapy and a range of other relationship support services.

Sexual Advice Association
www.sda.uk.net
For detailed information on treatments for erectile dysfunction. They also produce a fact sheet on sexual difficulties in gay men.

Reviewed by:

  • Dr Kate Bullen, Head of Department, Psychology, Aberystwyth University
  • Christopher Eden, Consultant Urologist, The Royal Surrey County Hospital, Guildford
  • Claire Moynihan, Medical Sociologist and Senior Research Fellow, The Institute of Cancer Research, Royal Cancer Hospital, London,
  • Dr David Ralph, Consultant Uroandrologist, The Institute of Urology, London
  • Jill Simpson, Clinical Nurse Specialist (Urology), Royal Derby Hospital, Derby
  • Heather Wilkins, Macmillan Uro-Oncology CNS, Sandwell General Hospital, West Bromwich
  • The Prostate Cancer Charity Support & Information Specialist Nurses
  • The Prostate Cancer Charity Information Volunteers

Written and edited by:

The Prostate Cancer Charity Information Team

References used in the production of this page.

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Page last updated: March 23 2010