How might radiotherapy affect my sex life

Sex after radiation therapy for prostate cancer

After radiation therapy (radiotherapy), you should expect some changes in your sex life. These changes can affect your body, mind and relationships. It can affect all of these areas as sexuality is not only physical, it includes your thoughts and feelings as well.

Take a look at the Body, Mind and Relationships diagram below
for a deeper understanding.

Mind Body Relationship venn diagram
1

Relationship
Coping with cancer and sexual challenges with a partner, or your feelings about starting a new one.

2

Body
Treatment can damage the nerves and blood supply needed for erections.

3

Mind
Cancer and sexual challenges following treatment can make you feel down and anxious, changing your feelings about sex.

If you’re experiencing changes to your body, remember that you’re not alone. Make sure to speak to your healthcare team. They’ll have advice and can help find a treatment plan to help you.

Click on the list below to see
the most common changes
following radiation therapy.

Penis not getting as hard (erectile dysfunction)

Radiation therapy affects the nerves and blood supply around your penis. This creates an issue, as your penis needs a healthy blood flow to get an erection. Without an adequate blood supply, your penis will not become as hard as it did before radiation therapy.

Although you may feel aroused, these messages from your body aren't able to make blood flow to the penis.

How soon after radiation therapy will I notice this?
You may experience a decline in the firmness of your erection – this can happen anywhere from weeks to months to years after treatment. As you recover, check in with your doctor about how your erections are going. That way, you'll get proper guidance on getting your sex life to a good place.

Can I still have pleasurable sex?
Even though your erection may be less firm, you'll still have a desire and can get pleasure from sex. There are many steps you can take to get back to satisfactory sex life. If you're comfortable, you can:

  • Try erectile aids and medication (you may need a prescription for these) 

  • Experiment with different positions with a partner

  • Adapt your routine and expand your role in the bedroom

Remember, you can still have great sex and can get plenty of pleasure without a firm erection.

“So far I have not been able to get my penis as hard as I want. I do feel angry at times and miss my old sex life. I’ve had to try new things, it’s a struggle."

Sam, 68 years

Changes to your orgasm

Orgasms may feel different, but they can still be pleasurable. They can be either more intense or less intense — but still ultimately satisfying.

Orgasms and erections
Because of how the nerves have been affected by radiation therapy, many men have trouble with erections. Without an erection, it might take longer to climax, but orgasms can still feel amazing.

You might also have some pain when you reach orgasm. This should go away with time.

“For months I thought my sex life was over and I would never orgasm again. I was playing around in the shower and low and behold - ACTION! it was an incredible feeling."

Iain, 48 years

Changes to your semen

Radiation therapy can sometimes bring on some changes to your semen, but it's usually nothing to worry about.

You might notice:

  • blood in your semen (will usually go away after about a month)

  • you produce less semen than before

"I had some blood in my semen at first – which was a worry, for sure. But it settled down after about 6 weeks and I don’t have it anymore."

Reggie, 80 years

Changes to your sex drive (libido)

Sometimes hormone treatments (either injections or tablets) are given in combination with the radiation or after you’ve had radiation. These treatments can zap your sex drive – you just don’t feel horny anymore

How long will I feel this way?

The hormone treatments are usually given for a few months but sometimes they are given for several years depending on how aggressive your cancer is. If you’re getting hormone shots, your body will take a while to recover, and some men (usually older men) won’t return to normal. Speak to your doctor about how long the hormones will be prescribed, what the average recovery is and whether hormone replacement is appropriate for you.

Can I still have pleasurable sex?

Even though your erection may be less firm or you don’t feel like having sex, you can still have a satisfactory sex life or be intimate with your partner.

Generally men with low sex drive won’t be able to get a natural erection even with the use of tablets. You can:

  • try medications that you can inject straight into the penis to get a firm erection – just speak with your doctor

  • try other forms of intimacy that don’t require an erection (cuddling, massages, oral sex)

Remember, you can still have great sex and can get plenty of pleasure without a firm erection

Bowel issues during sex

Bowel issues after radiation therapy can include diarrhoea, bloody stools, extra-sensitive anal tissue and more. And when it comes to sex, these issues can be embarrassing to talk about at the moment. It can be hard to feel comfortable having sex or even just think about it.

Don't be afraid to speak to your care team about the issues you're experiencing. They can give you helpful advice on things to try. It might take a little time, but you can work back up to feeling good and in control of your sex life.

Anal sex after radiation therapy can be especially painful, because the skin inside your anus (the hole where you poo) may be sensitive. It may help to let things settle 3 to 4 weeks after treatment before having anal sex again. Too much irritation can cause permanent damage to your anal canal, which you need to avoid. You should also stay away from products that numb the anal area — as this can equal more unnecessary damage. Talk to your doctor or care team about how to best work through things while you heal.

Fortunately, bowel issues after radiation therapy are often temporary and there are things you can do to help.

Before sex

  • several hours before sex, avoid eating foods that cause you bowel issues

  • empty your bowels just before having sex

  • maintain good personal hygiene to help boost your confidence

  • light scented candles if you're concerned about smells

During sex

  • have tissues and towels nearby

  • use an anal plug (available to purchase online)

"…we talked about how it may be unpleasant but once we had a few things to help with the odour it was grand."

Liam, 68 years

Remember, you probably won't have to deal with bowel issues for too long. Talk to your partner about how you feel and other ways you can stay close and connected. Your care team can give you advice and help find a treatment plan that works for you. Your doctor can also refer you to a sex therapist or sexual health counsellor who can provide some helpful guidance.

Coping with sexual changes

Many individuals say that after having prostate cancer and treatment, they initially struggled with sexual changes. And after working through these changes, although their sex life is different, they now feel satisfied with their ‘new’ sex life.

Additional
Resources

Treating erection problems
Erectile dysfuntion (impotence)
Find a sexual health clinic near you
How surgery can affect your orgasms
How radiotherapy can affect your orgasms
How brachytherapy can affect your orgasms
How hormone therapy can affect your orgasms

What's next?

Now that you've read up on How might radiotherapy affect my sex life, here are some related articles to explore as you continue to build your knowledge and understanding of this topic.
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