Sexual effects of treatments
Prostate cancer treatment can certainly knock your sex life around and cause big changes. There will be physical changes to contend with (it feels different), as well as changes to the way you think and feel about having sex after prostate cancer treatment. If you have a partner, these changes will impact you both too.
It’s normal to feel angry, upset, confused or numb. You might even feel like a teenager again—figuring things out and wanting to experiment with new ways of being sexual.
The good news is most people work through these changes and manage to have a satisfying sex life once again. It may take time, but you can get there like many others have. You’re not alone in this journey.
Open communication with your partner and knowing what to expect will help you manage any challenges relating to sex after prostate cancer treatment and get back on track.
When can you have sex after prostate cancer treatment?
After having prostate cancer treatment, you might feel ready for sex right away, or you might not be interested for some time. Your medical team will advise when it’ll be safe to have sex after your prostate cancer treatment. This will depend on which treatment you had.
Sex after radiation therapy
You may be able to have sex right after, and even during, radiation therapy for prostate cancer. You may start to notice side effects from the treatment (like erection problems) right away, or gradually over time. Talk to your medical team about safe sex during radiation therapy.
Sex after hormone therapy
You can generally have sex during and right after hormone therapy, also called androgen deprivation therapy (ADT). That said, some men find that hormone therapy lowers their sex drive, because this type of therapy lowers your testosterone levels to stop the spread of cancer. This can affect you being in the mood for sex.
Sex after chemotherapy
It’s generally okay to have sex during chemotherapy, if you’re feeling up to it. Talk to your doctor about recommendations for using condoms during and after treatment.
Sex after surgery (radical prostatectomy)
You should be able to have sex again after surgery once your catheter is removed. If you are a receptive partner for anal sex, you’ll want to wait until you’re fully healed (about 6 weeks after surgery).
Physical recovery aside, it may take you or your partner a while to feel emotionally ready for sex and intimacy after prostate cancer treatment. That’s okay—it’s not something you need to rush back into.
Because of the physical changes from prostate cancer treatment, it may be difficult to engage in the same sexual activities you’re used to after prostate cancer treatment. You might choose to find other ways to enjoy pleasure and share intimacy during your recovery.
Physical changes to sex after prostate cancer treatment
Your body can go through many changes from prostate cancer and treatment. The most common side effects include:
Erectile dysfunction or ED (inability to get hard).
Changes to the way you orgasm or being unable to have an orgasm at all.
Change to penis size.
Leaking urine during sex or when aroused.
Some of these side effects may be temporary, while some people experience them long-term or forever. Read on below for a description of common side effects that can occur after the different treatments and recovery expectations for each of these.
Erectile dysfunction (ED)
Erections may improve over the next couple of years.
Erections usually do not go back to being as firm as they were before surgery.
Urinary incontinence
You might leak urine during foreplay or orgasm.
For many men, this stops after one year, but some men continue to have these symptoms.
Change to penis size
After surgery, you may notice that your penis is shorter.
The shortening may be limited with rehabilitation.
Changes to the way you orgasm
Your orgasms will be “dry” after surgery, meaning that you will not ejaculate when you reach orgasm. This is permanent.
Some men notice that orgasms take longer to achieve and are less intense. Rarely, some men have painful orgasms. This usually gets better with time and with sexual stimulation.
Erectile dysfunction (ED)
Erection problems may develop slowly and get worse over time.
Urinary incontinence
Some men leak urine during foreplay or orgasm.
For many men, this stops after one year, but some men continue to have these symptoms.
Changes to the way you orgasm
Some men experience loss of sensitivity in the penis in addition to ED.
For some men, orgasms are also less intense.
When you reach orgasm, less semen will come out.
Erectile dysfunction (ED)
If you have to stay on hormone therapy long-term, ED may be permanent.
If your therapy is short-term, you ED may get better about 6 months after stopping treatment.
Low sex drive
If your hormone treatment is temporary, your sex drive may return about 6 months after ending treatment.
Some men may not get back to a normal testosterone level even after stopping hormone therapy, and their sex drive may stay lower.
Changes to the size of your penis and testicles
Because your hormone levels decrease, you may notice that your testicles or penis get smaller.
These changes seem to plateau after about 15 months of treatment.
Changes to the way you orgasm or inability to orgasm
Lower testosterone makes it harder for some men to reach orgasm. This may continue even after stopping ADT.
When you reach orgasm, less semen will come out.
These changes can be very difficult to come to terms with and you are not alone if you’re struggling to cope. There are ways you can treat these symptoms, and tools you can use to help you and your partner experience pleasurable sex. You can always open up a conversation with your doctor about it.
Here are some of the questions you might have about the physical impact of prostate cancer treatment on your sex life.
Does prostate cancer treatment stop you from ejaculating?
If you have prostate cancer surgery (called a ‘radical prostatectomy’), you won’t be able to ejaculate semen during sex. This is because the prostate gland that produces semen will be surgically removed.
Most types of prostate cancer treatment will affect your fertility in some way, so it’s important to speak to your healthcare team if you’re planning to have kids at some point.
Can you have an erection after prostate cancer treatment?
Most people have some form of erectile dysfunction (ED) after prostate cancer treatment. How soon after treatment does ED start?
ED starts right away after surgery.
ED may start gradually after several months, or over the course of several years.
ED usually starts within six weeks of starting treatment.
Erectile dysfunction may or may not get better over time. It depends on your treatment, age, erection function before treatment, and other factors.
Most people can still have erections with the help of medication or devices. You should be able to stay sexually active and have penetrative sex if you want to.
Even if you do find you can’t get fully hard, rest assured you can still experience great sex. You don’t need a hard erection to reach orgasm, and you can still give pleasure to a partner, even without an erection.
Can you orgasm after prostate cancer treatment?
Generally, yes, you can still orgasm after prostate cancer treatment. There are some treatment-specific changes to be aware of though.
Many men continue to have pleasurable orgasms after surgery.
Some men notice that orgasms take longer to achieve and are less intense.
Rarely, some men have painful orgasms. This usually gets better with time and with sexual stimulation.
Low testosterone can make it harder for some men to reach orgasm.
When you reach orgasm, less semen will come out.
Some men experience loss of sensitivity in the penis.
For some men, orgasms are less intense.
When you reach orgasm, less semen will come out.
While most people experience ED at some point during their recovery journey, keep in mind that you can still have an orgasm without your penis getting hard.
Emotional changes to sex after prostate cancer treatment
It’s important to also recognize the emotional impact of prostate cancer treatment on your sex life—both for you and your partner (if you have one). Changes to your sexual function (like not being able to get fully hard when aroused) can really throw you off. Some people find they want to avoid thinking about sex or having sex as a result. It may not feel great going back to square one and rediscovering ways to find pleasure through sex, but keeping an open dialogue with your partner about what you’re both feeling can help.
Try to set realistic expectations about your recovery. If you’re overly optimistic, you may feel disappointed when you run into challenges. Expect that there may be some disappointments, yet there will also be successes. Your doctor may also be able to refer you to see a sex therapist or sexual health counselor, who can provide some helpful guidance.
Relationship changes after prostate cancer treatment
If you have a partner, you may worry that prostate cancer treatment will change your relationship beyond the bedroom. For example, some people struggle with a perceived loss of ‘manhood’ or sense of self following prostate cancer treatment. Particularly if there are physical changes in your sex life. It’s important to chat through these feelings with your partner, a good friend, or a counselor. Yes, these changes are difficult for most men. And also, there's more to you (and your relationship) than the physical stuff. Your worth goes well beyond your ability to get an erection.
Communicating openly with your partner is key to ensuring you’re on the same page and can support one another. It’s important for both of you to open up and get everything out in the open.
Know that you can get support through services like couples counseling and sex therapy. Prostate cancer treatment usually affects your fertility, and this could cause strain on a relationship. It’s important to discuss options before having treatment.
