Frequently asked questions about sex after prostate cancer
Prostate cancer can bring big changes to your sex life. Get answers to common questions about sex, intimacy and everything in between.The information provided here is general in nature and does not replace medical advice from your healthcare team. Always check with your doctor before starting any new physical activities, or if you have questions about medications and devices.
Prostate cancer itself doesn’t directly cause ED, but the treatments for prostate cancer typically do. Almost all men who get treatment for prostate cancer will have some erectile dysfunction at some point.
ED can happen due to:
- Damage to the nerves near the prostate that help erections happen.
- Poor blood flow to the penis.
- Inability to keep blood in the penis during an erection.
- Anxiety or depression about performance.
You’ll likely have trouble getting an erection right away after surgery for prostate cancer (prostatectomy). It may take up to 3 years to improve. The level of function you get back depends on:
- How strong your erections were before treatment.
- Your age.
- If you have other medical problems that affect sexual function, like heart disease or diabetes.
- Your lifestyle (smoking and not exercising will make erectile dysfunction worse).
- Your medications (for example, beta-blockers can cause problems with erections).
- Whether you had nerve-sparing surgery, which can reduce the likelihood and severity of ED after prostate surgery.
- Your willingness to work on penile rehabilitation (there are options).
Erectile dysfunction after prostate cancer treatment
Sex can be uncomfortable to talk about. We get it. But remember — this is common side effect after surgery and your doctor has seen it all before. They can advise on penile rehabilitation, prescribe medications to help with erections and help you access support groups and sexual health counselors. Writing down what you want to discuss is a good start. You might also find it helpful to have a loved one with you.
Open and honest communication is key. This can feel awkward if you’re not used to talking about your feelings. But the truth is, not talking to your partner about what’s going on for you can just make things worse.
Most couples who talk openly about sexual challenges, changes and worries have a stronger connection — and a better sex life after prostate cancer. It can help to:
- Acknowledge that your sex life is different now.
- Express your grief about the changes.
- Remember the good feelings you have about your relationship.
- Communicate your sexual needs.
- Get support from a couples counselor or sex therapist.
Absolutely. And it can have benefits outside of feeling good and pleasurable. Your doctor may even recommend masturbation as part of a plan to strengthen your erectile function (penile rehabilitation).
Surgery itself won’t directly change your desire for sex. (That’s because surgery does not have any effect on your testosterone levels — the hormone responsible for your sex drive). Instead, you might find that other reasons put you off sex. Like erection problems, dry orgasms, leaking urine, being anxious or stressed about pleasing your partner, or simply feeling drained of energy.
Yes — although it may not be ‘sex as usual.’ Depending on what treatment you’ve had, you may need to explore different ways to enjoy sex. It will take time and you may need medications or devices to help you.
It’s generally safe to have sex once your catheter is removed — usually two weeks after surgery — but check with your doctor to be sure. It’s unlikely, however, that you’ll be able to have erections hard enough for penetrative sex soon after surgery. Other factors can also impact your ability to have erections after a prostatectomy.
Recovering your desire for sex after surgery involves:
- Addressing the changes in your sexual function and activity.
- Finding suitable medications and/or devices to help recover erections.
- Finding ways to cope with feelings of grief and sadness.
- Working as a team with your partner to explore different (non-penetrative) ways to have sexual pleasure.
Yes — not having a prostate doesn’t mean your sex life is over. Your sex life will look different to what it was before surgery (radical prostatectomy). You can still feel sexual desire and get aroused, but you’ll likely need medications or devices to help with erections. You’ll still be able to have orgasms, but they will be “dry.” Without your prostate or seminal vesicles (which are also removed during surgery) you’ll no longer be making semen, which is ejaculated during orgasm.
Yes — not having a prostate doesn’t mean your sex life is over. Your sex life will look different to what it was before surgery (radical prostatectomy). You can still feel sexual desire and get aroused, but you’ll likely need medications or devices to help with erections. You’ll still be able to have orgasms, but they will be “dry.” Without your prostate or seminal vesicles (which are also removed during surgery) you’ll no longer be making semen, which is ejaculated during orgasm.
ED medications can help to recover erectile function by increasing blood flow to the penis. When they are used as part of penile rehabilitation, this increased blood flow helps to keep penile tissues healthy.
First stop — speak to your doctor. They can advise on which medication or device might fit your needs and any side effects you might experience. Depending on where you live, cost may also be a factor. Work with your doctor to get the medication you can afford.
All ED medications (and devices) have pros and cons. Deciding on which one is best for you should take into account your goals, preferences, and your doctor’s advice.
When you are sexually aroused the nerves around your penis increase blood flow to the penis causing an erection. ED pills help you get and keep an erection by relaxing and widening blood vessels in the penis (which increases blood flow) and keeping them this way for a longer time. Note: ED pills only work if you’ve had some form of nerve-sparing during your surgery (radical prostatectomy).
It’s usually safe to start ED pills—like Viagra—once your catheter has been removed following surgery. Your doctor will advise you on the timing as this can vary between people.
Urethral suppositories for ED contain a medication called alprostadil which relaxes and widens the blood vessels in the penis. This allows more blood flow to the penis and helps produce an erection. The suppository is placed into the urethra (urinary tube) at the tip of the penis using an applicator and the medication is released into the bloodstream from there.
Penile injections contain medication which increases blood flow to the penis without needing physical stimulation. The increased blood flow helps create an erection. The medication is injected into the side of the penis, midway along the shaft, and usually works quickly to produce an erection within 10 to 15 minutes of injecting. Penile injections are quite effective in producing erections, even if you have some nerve damage from surgery.
You’ll need a prescription from your doctor to get penile injections for ED. The cost will depend on the dose prescribed by the doctor, and whether Medicare or your private health insurance (if you have it) will pay some or all of the cost. Prices may also vary depending on where you live and the pharmacy you purchase from. Speak to your doctor and insurance provider about what is covered and what you’ll need to pay.
Penis pumps create a vacuum around the penis which increases blood flow to the penis. This increased blood flow helps to produce an erection. A ring placed at the base of the penis helps to keep the erection. As a cautionary measure, take off the penis ring after 30 minutes to prevent damage to the penis.
Penis pumps can be bought with or without a doctor’s prescription. However, it’s best to check with your doctor first to make sure a pump will be suitable for you. They can also advise you on getting a safe and effective medical grade pump. Having the pump prescribed by your doctor could make it easier to claim the cost from health insurance.
Penile implants (or prostheses) are devices surgically placed in the penis. They can help you get erections in one of two ways – depending on the type of device. Fluid from a reservoir is pumped into the implant when you want an erection, or the implant is manually raised into an upward (erect) position.
Note: There are some misconceptions about penile implants, but here are the facts: Penile implants will allow you to have an erection. They won’t boost your sex drive or make your penis feel more sensitive.
Penile implants are generally robust and long lasting — you can typically go for 20 years with a new implant.
Inflatable implants and non-inflatable or semi-rigid rods are the two main types of penile implants. Inflatable implants allow you to pump fluid from a reservoir into cylinders along your penis to create an erection. The non-inflatable penile implant has two flexible silicone rods which are pushed into an extended position when you want an erection.
Penile implants will not suit everyone. Your doctor can advise if you're a good candidate for having an implant (and undergoing surgery for the implant), and tell you more about the different types of implants.
If you have a semi-rigid implant your penis will always be a little stiff, which could be uncomfortable and may be noticed under your clothes.
An inflatable implant has more parts to it then the semi-rigid type and could malfunction. It also needs a separate reservoir which is implanted under your stomach muscles.
On the plus side, penile implants last for many years and are reliably successful in producing erections.
Penile implants generally won’t make your penis longer or bigger than its original size. In fact, your erection may seem shorter than what your natural erections used to be — as the implant does not extend into the head of your penis (glans).
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