Sex and cancer for men

Chemotherapy can affect your sex life because it makes you feel tired. So you may be less interested in having sex. There is information about sex and chemotherapy in our main chemotherapy section. Some chemotherapy drugs can also make you infertile. There is more about fertility and chemotherapy in the main chemotherapy section of CancerHelp UK.

Some operations for cancer can affect your sex life. These include

• Having prostate surgery
• Having bowel or rectal surgery
• Having both testicles removed
• Having your bladder removed
• Having all or part of your penis removed
• Surgery to remove lymph nodes from the back of the abdomen

Having prostate surgery

Prostate surgery can cause several changes that affect your sex life. These include

• Ejaculation and fertility problems
• Problems with erections

Ejaculation and fertility problems

If you have a radical prostatectomy you will no longer produce semen at all. This is because the prostate gland and seminal vesicles are removed. Your testicles will still make sperm cells but they will be reabsorbed back into your body. So you are still able to have an orgasm, but it will be what’s known as a ‘ dry orgasm’. Some men say that a dry orgasm without semen feels normal. But others say that it is less intense and pleasurable.

If you have dry orgasms, you will not be able to have children by natural sexual intercourse because your sperm cannot be passed into your partner's vagina during sex. If you want to have children, it may be possible to take sperm directly from your testicles or from your urine after you have had sex. The sperm can be used to fertilise your partner directly or with the “test tube baby” technique (in vitro fertilization or IVF).

Problems with erections

Depending on the surgery you have, there is also a risk of difficulty getting or maintaining an erection. This is called impotence. After any surgery to the prostate you may be impotent temporarily. Impotence is more likely to be permanent if you had a radical prostatectomy. But men who were sexually active with good erections before treatment are more likely to be able to have good erections after surgery. Erection problems can be very difficult to come to terms with if they occur.

Hormone therapy may be used for a time after surgery and can also reduce your ability to have an erection. When you stop having the injections or tablets, your erections may improve.

If you are going to have a total prostatectomy, you may want to ask your surgeon about a procedure called 'nerve sparing surgery'. This means that the surgeon will be very careful not to disturb the nerves that control erection - these go through the prostate gland. Nerve sparing surgery is only suitable for men with very early prostate cancers. However small the cancer, if it has grown into the nerve bundles, then your surgeon will not be able to avoid them. The nerve bundles will have to be taken out to try and cure your cancer. So, you will not be able to have erections after the operation.

There is more information on nerve sparing surgery in the prostate cancer surgery section. There is information about managing erection problems further down this page.

Having bowel or rectal surgery

Sometimes, surgery to the bowel or back passage (rectum) can cause nerve damage that makes it difficult for you to get an erection afterwards. This is more likely if your surgeon has to operate in the area that contains the nerves that control erection. You may want to ask your surgeon about this before your surgery. Sometimes radiotherapy or chemoradiation is given before surgery and that raises the chance of causing sexual changes or problems.

Having both testicles removed

Your testicles produce your sex hormones. These give you the urge to have sex and get an erection. Having both testicles removed is sometimes used as a treatment for prostate cancer. If you have both testicles removed, you will not be able to have an erection and will have a low sex drive. Some people have no interest in sex at all after this.

If you have testicular cancer you will most likely only have one of your testicles removed. It is very rare to have both testicles removed to treat testicular cancer. Having one testicle removed should not stop you getting an erection. Your remaining testicle will produce extra hormones to make up for the one you have lost.

There is information about coping with a lower sex drive and managing erection problems further down this page.

Having your bladder removed

If you have your bladder removed this is not likely to make you impotent afterwards. But if you have a radical cystectomy for cancer of the bladder, you also have your prostate and urethra removed. The urethra is the tube that runs from the bladder to the penis. Unfortunately, you won’t get erections after this operation. There is information about managing erection problems further down this page.

There is more information about your sex life after bladder cancer in the living with bladder cancer section of CancerHelp UK.

Having all or part of your penis removed

Removing all or part of the penis is called a penectomy. It is a treatment for cancer of the penis, which is very rare. Most treatment for penile cancer will not affect your physical sex life in the long run. Some men who have part of their penis removed (partial penectomy) can still enjoy sex. The remaining part of your penis can still become erect and is usually large enough to enjoy penetration. The most sensitive part of the penis (the’ head’) is removed. But you will still be able to have an orgasm and ejaculate.

But if you have the whole of your penis removed (total penectomy) your sex life will obviously be seriously affected. This can be devastating for a man’s self image and intimate relationships. Some men decide to give up all sexual activity after having a total penectomy. But with some effort a man can still have sexual pleasure. Stroking and touching sensitive areas such as the scrotum and the skin behind the scrotum can lead to an orgasm. Sexual fantasies can help to make this easier.

It can be awkward to talk about this type of surgery, and many people feel uncomfortable about discussing things that are so personal or private. But professionals who work in this area are very sensitive to this and are used to talking about these issues. If you can talk to your partner about how you feel, it usually helps both of you come to terms with the change in your relationship.

Specialist nurses and counsellors have skills and experience in helping men to adjust after having a partial or total penectomy. Some men might find it helpful to talk to a nurse or counsellor. Your GP should be able to arrange this for you. Or you could contact some of the organisations that deal with relationships and sexual issues.

Surgery to remove lymph nodes from the back of the abdomen

This operation is called 'retroperitoneal lymph node dissection'. You may have it to treat testicular cancer, or another type of cancer that has spread to these lymph nodes. This operation usually causes 'retrograde ejaculation'. This means that when you ejaculate your semen and sperm go back into your bladder instead of coming out of your penis. This is because the nerves that control a valve to shut off the route to the bladder when you climax may be damaged in the operation.

Retrograde ejaculation is not dangerous or harmful. And it will not stop you having an orgasm. But it will feel different because it will be 'dry'. Some men say that an orgasm without semen feels normal. But others say that it is less intense and pleasurable.

If you have dry orgasms, you will not be able to have children by natural sexual intercourse because your sperm cannot be passed into your partner's vagina during sex. If you want to have children, it may be possible to take sperm directly from your testicles or from your urine after you have had sex. The sperm can be used to fertilise your partner directly or with the “test tube baby” technique (in vitro fertilization or IVF).

Sometimes ‘retroperitoneal lymph node dissection’ can also make you lose erections due to nerve damage. Before you have surgery, it is worth talking to your surgeon about this possible side effect. There is information about managing erection problems further down this page.

Radiotherapy to the pelvic area can cause

• Painful ejaculation
• Problems with erections
• Lowered interest in sex

Painful ejaculation

You may find that ejaculating is painful during your course of radiotherapy. This is because the urethra gets inflammed by the treatment. This side effect should disappear a few weeks after you finish your course of radiotherapy. Meanwhile it is probably best to avoid intercourse if it is painful. But you may be able to find other ways of enjoying sexual relationships.

Problems with erections

Radiotherapy to the pelvis does not usually cause permanent sexual problems. But it may if you are having radiotherapy specifically to your prostate. About 70 out of every 100 men (70%) having radiotherapy for prostate cancer have impotence or erectile problems afterwards.

In some cases, radiotherapy to the bowel or bladder can also cause erection difficulties, but this is less common.

But sometimes radiotherapy for

• Prostate cancer
• Bladder cancer or
• Lower bowel cancer

can cause other problems with erections. You may find your erections are not as strong as before. Or you may be able to get an erection but then lose it. These side effects tend to come on gradually over a year or two following your treatment. They are due to the radiotherapy causing scar tissue that damages the nerves and blood vessels that help you to get an erection. There is information about managing erection problems further down this page.

Lowered interest in sex

You may also find you are less interested in sex following radiotherapy to the pelvis. Radiotherapy to the areas close to the testicles may lower your production of testosterone. Testosterone is the hormone that gives you your sexual desire. If you produce less testosterone, your interest in sex will be lower.

But this does not happen to most men who have radiotherapy to the pelvis. You may feel that your desire for sex is lower but it is more likely to be for other reasons, including

• Tiredness (fatigue)
• Anxiety about having cancer
• Loss of confidence and self esteem
• Side effects from other treatments such as chemotherapy

Usually these problems disappear once your treatment finishes and your interest in sex will go back to normal. But it may take a bit of time, so don’t worry too much if you don’t feel like having sex for a while. There is information about coping with a lower interest in sex below.

There is information about fertility and radiotherapy in our section about radiotherapy side effects

Prostate cancer is the most common men's cancer to be treated with hormones. Testosterone is thought to stimulate the growth of prostate cancer cells. So you may have treatment to block testosterone from working, or to stop your body producing it. There is more about this in the CancerHelp UK section on hormone therapy for prostate cancer.

Rarely, men are diagnosed with breast cancer. You may have hormone therapy for this.

If you are having hormone treatment for prostate or breast cancer you may have some side effects such as

• Having less interest in sex
• Not being able to have an erection
• Hot flushes and sweats
• Loss of energy, feeling sluggish

If flushes and sweats are a real problem, you may want to talk to your doctor about ways to reduce the number and severity of the attacks you are having. There is some information about ways of dealing with hot flushes in the section on sex and cancer for women because these are common menopausal symptoms. Ways of controlling hot flushes are the same for men and women. We have information about dealing with sweating in our section on coping physically with cancer.

All these side effects can be difficult to cope with. You may want to talk through how you feel with a counsellor or therapist. Or you could contact some of the organisations that deal with relationships and sexual issues. To find out more about counselling look in our what is counselling section. There is information about managing erection problems next on this page, and on coping with a lowered interest in sex further down this page.

Even if you can't get a full erection, you can still have a sex life. You may find you can still get a partial erection and are able to have intercourse. If your erection problems are caused by surgery, they may get better with time.

Even if you can't get an erection at all, it is worth talking to your doctor or urology nurse specialist, if you have one. There are treatments that may help you including

• Drugs
• Injections or pellets
• Vacuum pumps
• Implants

Drugs

The following are drugs that can help you to get an erection

• Sildenafil citrate (Viagra)
• Vardenafil (Levitra)

They work by relaxing the smooth muscle of the penis, allowing the blood flow that makes the penis stiffen. These drugs have been reported to help some men who have had prostate surgery causing nerve damage.

Some of these drugs interact with drugs known as nitrates, which are sometimes used to treat a heart problem called angina. Check with your doctor if you have any history of heart problems and are using these drugs. Your doctor may recommend that you do not use these drugs. Or they may want you to have your heart checked by a specialist before trying them. If you are interested in finding out more about these drugs, talk to your oncologist, urologist or GP.

Injections or pellets

Injections of prostaglandin can help you to get an erection. You have to give the injection into the penis just before you have sex. If you would like to try this type of treatment, you have a test dose first, from your urologist. If this type of treatment is right for you, you should be able to get an erection within 10 minutes of having the injection. And if you’re happy to continue with the injections, your specialist or nurse will teach you how to give them yourself.

Pellets are about the size of a grain of rice and contain the same drug as the injections. You put them in the entrance of the urethra, at the end of your penis. The pellet is absorbed into the surrounding tissue. Again your specialist or nurse can teach you how to use them.

Vacuum pumps

Vacuum pumps are useful if you can't get an erection, or if your erection isn't firm enough. The pump fits over the penis and draws blood into the penis to form the erection. You then put a soft plastic ring called a constriction ring around the base of your penis. This keeps the erection for as long as you want it. Vacuum pumps don't suit everyone, so you will need to talk to your doctor about whether a pump would suit you.

Implants

Implants are semi rigid rods that are put into the penis during a short operation. The rod stiffens your penis enough for you to be able to have sex. If you have this treatment, your penis will be partly erect all the time. Implant surgery is usually only used if other methods of treating your erection problems haven't worked.

Of course, you don't have to try any of these 'treatments'. You may just want to try to deal with things as they are. Not being able to get an erection doesn't mean the end of your sex life completely. There are other things you and your partner can enjoy apart from penetrative sex.

Cancer and its treatment can make you lose interest in having sex. Your sexual desire may be lower because of

• Tiredness (fatigue)
• Anxiety about having cancer
• Loss of confidence and self esteem
• Side effects from other treatments such as chemotherapy
• Changes in the male sex hormones

Many of these problems will disappear once your treatment finishes and your desire for sex will return to normal. But it may take a bit of time, so don’t worry too much if you don’t feel like having sex for a while.

If you’re in a relationship it will be important to talk about this with your partner. Sometimes if you lose your interest in sex it stops you making the effort to enjoy other physical contact with your partner. This can be very difficult for you both. Just because you don’t feel like having sex doesn’t mean that you can’t still enjoy kissing, cuddling and being close to your partner. Kissing and touching can be very comforting and relaxing, as long as you’re both clear about how far you’re expecting to go.

It may be helpful (or necessary) to put intercourse on hold for a while and concentrate on showing each other affection in other ways. But some people find that even though they don’t feel like having sex, once they become physical with a partner or pleasure themselves, they do become aroused. It may help to talk things through with a counsellor or therapist.

There is information about talking about sex and sexuality in this section of CancerHelp UK.

Having advanced cancer means that your cancer can’t be cured. But it very rarely means that you’re already terminally ill. Whatever your situation, you’ll still have needs and desires. Even if you don’t feel like having sexual intercourse, you may still have sexual feelings even if you are very ill.

If your cancer is in the advanced stages you may have an even stronger need for intimacy in your life than before you had cancer. Physical closeness, sharing your feelings and touching may become very important. Knowing your cancer can’t be cured can bring up some very strong emotions. This can be very difficult to cope with, possibly even more if you are single and don’t have the support of a caring partner. But it may help to talk to someone else about how you’re feeling. If you’d like to talk to someone outside your own friends and family, look on our general organisations page for organisations that help with relationships and sexuality.

If you’re at all worried about anything to do with your sex life and sexuality you may want to talk through how you’re feeling with a counsellor or therapist. Or you could contact some of the organisations that deal with relationships and sexual issues. To find out more about counselling look in the what is counselling section.