How might surgery affect my sex life?

After a radical prostatectomy, you should expect some changes in your sex life. These changes can affect your body, mind and relationships because sexuality is not only physical, it includes your thoughts and feelings too.

Sex after prostate cancer surgery

Common sexual changes to expect

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

Diagram: Mind Body Relationship
1

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

2

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

3

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

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

Changes in orgasm

Your prostate gland and seminal vesicles both help your body make semen (ejaculate). During surgery, these are removed, which means you won't produce semen anymore. It doesn't mean you can't have an orgasm.

After surgery, you'll no longer produce semen, so your orgasms will be 'dry.' They'll still be pleasurable, but might feel a bit different - either more intense or less intense.

You may feel some pain when you reach orgasm, because of how the nerves have been affected by surgery. This pain should go away over time.

Orgasms and erections

After surgery, most men experience erectile dysfunction (ED). Without an erection, it might take longer to climax, but orgasms can still feel amazing.

“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

Penis not getting as hard (erectile dysfunction)

Surgery to remove your prostate 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 surgery.

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

How soon after surgery does this start?

You will likely have trouble getting a hard erection immediately after surgery. It may take up to 3 years to improve but returning to the function you had before surgery is unlikely. 

How can I maintain a satisfying sex life?
Remember, you will still have the desire and can get pleasure from sexual intimacy.

If you're comfortable, you can:

  • Try medication and erectile aids to help get a firmer erection 

  • Try different positions

  • Adapt your role and expand your routine in the bedroom

“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

Penis size

Sometimes the penis can shorten because of changes to the tissues inside the penis. If you go for long periods without having erections, this can cause some scarring of the tissues in your penis, which can also lead to shortening.

What can you do?

  • Try encouraging blood flow to the penis after surgery. This might improve erections and stop your penis from becoming shorter.

  • Try an erectile aid called a vacuum pump (or penis pump). It can be used on its own or with PDE-5 inhibitor tablets (like Viagra) — which can help encourage blood flow to the penis. This may stretch the tissue and help maintain your penis size.

"My partner kept reassuring me that it doesn’t matter but it did to me. I did try the pump. My penis felt cold and strange but it did help."

Gary, 69 years

Leaking urine when aroused

Because the muscles around the prostate may have been damaged by the surgery, they are not able to control the flow of urine as well. Remember, urine is a normal body fluid, just like ejaculate (semen) or saliva. Usually only small amounts of urine leak.

What can you do?

  • Urinate (wee) before sex, wait a few seconds and use your fingertips to push the urine from gently behind the scrotum and down the urethra. You can then shake the last few drops out.

  • Put a soft towel under you when having sex

  • Have some warm water and towel next to you

  • You can disguise urine by using a lubricant to moisturise the penis

  • Wearing a condom to catch any urine should catch any urine that comes out during sex

  • Having sex in the shower can help to relax you and will wash away any urine that comes out

  • If urine leakage is a problem for you talk to your doctor or care team.

Some men use a constriction ring around the base of their penis when it is erect. The ring presses down on the urethra, stopping urine from passing through. Talk to your doctor or care team to check if using a ring will be suitable for you. You may need to experiment until you find the right tightness so that it prevents urine leaking but still feels comfortable. As a guide, you should not keep the ring on for more than 30 minutes at a time. Keeping it on for longer periods may damage the tissues in the penis.

“I seem to leak a bit just before orgasm, it has got better as my incontinence has improved. We’ve got used to it.” 

James, 68 years

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.

If you’re experiencing changes to your body, remember that you’re not alone. 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.

What's next?

Now that you've read up on How might surgery 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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