Having sex after radical prostatectomy

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Radical prostatectomy is a common treatment for prostate cancer. It involves surgery to remove the prostate gland, surrounding tissue, and sometimes nearby nerves. If a radical prostatectomy is part of your prostate cancer treatment, you may experience changes to your sex life. Side effects from the procedure can have an impact on your body, your mind, and your relationship. Despite this, you can still enjoy sex after prostate removal.

Your sex life after prostate removal: what to expect

Is sex possible after prostate removal?

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

What’s physically different about sex after radical prostatectomy?

Some of the most common physical changes to sex after prostate cancer surgery include:

After surgery, most men experience erectile dysfunction (ED)—trouble getting or keeping an erection. Learn more about erectile dysfunction after prostate cancer surgery.

One of the biggest changes to sex after prostatectomy is that you'll no longer produce semen, so your orgasms will be 'dry.' This means they’ll probably feel a little different. It might also take longer to climax, but orgasms can still feel amazing. Learn more about changes to orgasms after radical prostatectomy.

Sometimes the penis can shorten because of changes to the tissues inside the penis after surgery. Learn more about penis shrinkage after radical prostatectomy.

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. This means you might leak pee when aroused or during sex. Learn more about leaking urine after radical prostatectomy.

Remember that you’re not alone as you experience these changes to your body. And your sex life isn’t over. You can talk to your healthcare team about ways to improve your sex life after prostate cancer surgery, including the use of medications or devices.

What’s the deal with morning erections after radical prostatectomy?

This one can throw some people. If you’re used to waking up to an erection (morning wood), not having that sensation first thing in the day may feel weird for a while. Over time, you may get your morning erection back. In other cases, you might need to adjust your expectations. Erections usually do not go back to being as firm as they were before surgery but may improve over the next couple of years.

Can sex after prostate cancer surgery get someone pregnant?

No. You won’t produce semen after your prostate is removed, which means you won’t be able to conceive through having sex. If there’s a chance you might want kids later in life, it’s important to discuss this with your partner and healthcare team before you have prostate cancer surgery. You could consider options such as sperm banking before you have the surgery done.

Where does sperm go after radical prostatectomy?

Interestingly, your testicles will still produce sperm cells—the sperm just won’t be able to go anywhere. Instead of being ejaculated, the sperm will be reabsorbed into your body.

Although you won’t be able to ejaculate following radical prostatectomy, you can still experience orgasms.

How might a radical prostatectomy affect your mental health and sexual well-being?

It’s normal to experience a change in your sexual well-being and sense of sexuality after having prostate cancer surgery.

Some people might think that prostate removal threatens their ‘manhood’ and sense of self, but here’s the thing: there's more to your identity as a man than just your physical parts. And having the treatment you need to take care of yourself takes a lot of inner strength. At the same time, it’s normal to feel upset by the procedure. Talking to your partner, friends, family, or a counselor can help you regain your confidence in your sexuality.

Talk to your partner about how you feel, and other ways you can stay close and connected. Plan time to talk and listen to each other about any changes in your sex life. It’s important to acknowledge that after radical prostatectomy, sexuality has changed for both of you. Talking about sex in this way may not be something you’ve done before, and it can be difficult at first. Some couples find it helpful to write their thoughts in a letter at first or seek support from a professional (such as a sexual health counselor).

A radical prostatectomy is major surgery, and you may find your mental wellbeing affected as you cope with side effects and navigate your way through recovery. Many men experience feelings of grief about the sexual changes that come with the surgery. You’re not alone in these feelings. It may help to talk to a counselor about your mental health if you’re feeling especially down or unlike your normal self.

Sex after radical prostatectomy: how soon can you get back to it?

Your medical team will likely clear you for sexual activity after your catheter is removed. However, if you're a receptive partner during anal sex, it’s important to wait until the tissue of your rectum and colon have healed before receiving anal sex. This happens about 6 weeks after surgery.

However, you may find that it takes you longer than 6 weeks to feel emotionally ready for sex again after your prostate cancer surgery. And that’s okay. Not everyone chooses to engage in sexual activity after prostate surgery. It's up to you (and your partner) to choose the ways in which you enjoy pleasure and share intimacy.

Do you lose your sex drive after prostate removal?

Prostate cancer surgery alone doesn’t change your ability to be aroused or experience physical desire. Surgery doesn’t impact your levels of testosterone (the hormone responsible for your sex drive), so you’re all good on that front. However, ED (being unable to get hard) usually starts right away after surgery and might make it difficult to get in the mood.

Loss of sex drive (also called libido) after prostate cancer surgery is generally to do with your thoughts and feelings, and the fact that you might not be able to get hard as easily. You’re still able to feel desire, but your body may not respond in the ways you’re used to.

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)

  • Practice patience

  • Educate yourself and your partner

  • Connect with others who have faced similar experiences

  • Seek professional support, like a counselor or therapist

When is anal sex after radical prostatectomy allowed?

It’s a good idea to chat with your surgeon about when you’re safe to resume anal sex after having a radical prostatectomy. The advice is usually to wait 6 weeks after surgery.

Dealing with painful sex after radical prostatectomy

1 in 10 men feel some pain with orgasm after surgery because of how the nerves have been affected. This pain should go away over time. Chat with your doctor if you’re experiencing painful sex after a radical prostatectomy. They may suggest a number of things, including taking an over-the-counter pain reliever before sex.

Remember, it’s normal to experience physical and emotional changes after having a radical prostatectomy. This is a significant surgery and many people feel rattled after going through it. The good news is, you can return to sex and enjoy sex after prostate removal surgery. It may not be the same as it was before, but it can still be great. If you’d like support with enjoying intimacy and sex after prostate cancer surgery, your doctor can refer you to a sex therapist or sexual health counselor who can provide some helpful guidance.