Sexual effects of treatments
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Radiation and sex: learn how prostate cancer radiation therapy can affect your sex life.
Radiation therapy is a common and effective treatment option for prostate cancer, using high-energy rays to target and destroy cancer cells. Sex and intimacy during and after radiation treatment for prostate cancer can be a sensitive topic for men and their partners. We’ll answer questions such as can you have sex during radiation therapy and other valid, relevant concerns.
During and 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 because sexuality is not only physical, it includes your thoughts and feelings as well.
Understanding the potential changes and challenges can help you maintain a healthy, fulfilling intimate life during this journey.
Can you have sex during radiation therapy?
This is a question that comes up a lot—and the answer is generally yes, you can. There are side effects from radiation that will change your sex life:
Due to potential scarring around the nerves that control erections, you may face erectile dysfunction–i.e. issues with getting it up.
After treatment (either soon after or years later) erections may gradually become less firm.
You will still enjoy an orgasm, though it may be less intense and ejaculation may be affected (less semen will come out).
You may also leak urine during arousal, intercourse, or orgasm.
The importance of protection when having sex during radiation therapy
When it comes to radiation and sex, it’s important to use condoms to protect your partner if you’ve had internal seed radiation (brachytherapy). This is because the seeds can become loose and come out in your semen. Talk to your doctor about how long you will need to use condoms for. However, if you are having external beam radiation, there is not any radiation exposure risk to your sex partner.
It's also essential to prevent pregnancy due to potential risks involved. This is because sperm made during or after radiation therapy could be damaged.
Communicating with your healthcare team
Remember to talk openly with your healthcare team when undergoing radiation therapy, particularly about sexual health concerns. If you’re uncomfortable bringing up the topic during your appointment, you can prepare your care team in advance when scheduling. For example, say “During my next appointment, I’d like to discuss some questions about my sexual health.”
Make a list of questions to ask your doctor or care team before your appointment.
Questions to ask your provider after prostate cancer radiation therapy:
What are the potential short-term and long-term effects of radiation on my sexual health?
Are there any steps I can take to minimize these side effects?
How might these side effects change over time, and when can I expect improvements, if any?
Are there any resources like support groups or counseling for addressing sexual health concerns?
Sex after prostate radiation treatment
Arousal, orgasms, and sex may feel different after prostate cancer radiation therapy. Here’s a quick breakdown of what to expect:
You may feel less sensitivity in your penis, and it may take longer to become erect or reach orgasm.
Orgasms may feel less intense.
Less semen will come out with orgasm.
Bowel issues during sex (like diarrhea and bloody stools).
You can find out more about what you can expect during radiation therapy treatment here.
Penis not getting as hard (erectile dysfunction or ED)
Radiation therapy affects the nerves and blood supply around your penis. 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 ways to cope with the changes.
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 a satisfying 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 (and give!) plenty of pleasure without a firm erection.
Changes to your semen
Radiation therapy can sometimes cause 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.
Emotional impact on sex and intimacy
It's completely natural for you to experience a range of emotions, including fear, anxiety, and even grief while going through cancer treatment. Of course, all these feelings can get in the way of your sex life and cause stress in a relationship.
How to cope with the impact of prostate cancer treatment
Foster open communication.
Focus on non-sexual intimacy (like spending time together, doing the things you love).
Educate yourself and your partner.
Connect with others who have faced similar experiences.
Seek professional support, like a counselor or therapist.
Bowel issues during sex
Bowel issues after radiation therapy can include diarrhea, bloody stools, extra-sensitive anal tissue and more. And when it comes to sex, these issues can be embarrassing to talk about in 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 advice on ways to minimize your side effects.
Anal sex after radiation therapy can be especially painful because the skin inside your anus (the hole where you poo) may be sensitive. You may want to wait 3 to 4 weeks after treatment before having anal sex again. Too much irritation can cause permanent damage to your anal canal. 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.
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.
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.
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 counselor who can provide some guidance.
Sex after radiation therapy and chemo
Sometimes radiation therapy can be followed by chemotherapy, especially for high-risk prostate cancer. Radiation and chemo affect the body in different ways and can have very different effects on your sex life after treatment.
Is it safe to have sex after chemo and radiation therapy? Semen may contain traces of chemo for a while after treatment. Because of this it’s important to use a condom and speak to your doctor. However, it usually won’t affect your ability to have an erection.
Radiation therapy can sometimes affect your ability to keep an erection, or if the prostate is damaged may cause what’s known as a dry orgasm.
Both treatments have implications for fertility and so it’s important to speak to your health provider if you’re planning on having children or your partner can fall pregnant.
Sex after radiation and hormone therapy
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 have a low sex drive?
It depends on your age and treatment type, but most men have a lower sex drive during hormone treatment.
If your hormone treatment is temporary, your sex drive may come back about 6 months after stopping treatment. For some men, however, sex drive may stay lower even after stopping hormone therapy.
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. Speak to your doctor about how long the hormones will be prescribed, what the average recovery is and what options are available to 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 erection pills. 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.
Importance of fertility preservation (sperm banking and other options)
Radiation therapy may lower your fertility because of changes to your sperm and hormone levels. If you think you may want to have children in the future, talk to your doctor about your options, including storing your sperm before treatment (sperm banking).
Navigating the challenges of radiation therapy can be a complex journey for both patients and their partners. By fostering open communication, educating yourself, and seeking professional guidance, you can better manage the potential physical and emotional impacts on your sexual health and intimacy.
Remember that support and understanding from loved ones, healthcare providers, and fellow cancer survivors can be invaluable during this process.