People who are having or have had treatment for prostate cancer sometimes have problems with sex. These include a loss of interest in sex, inability to get an erection, and fertility issues.
Prostate cancer, or cancer of the prostate gland, is a disease in which cells in the prostate tissue divide uncontrollably, forming a lump, or tumor. When the tumor grows large enough, it can block the urethra, which is the tube that carries urine from the bladder to leave the body.
In rare cases, prostate cancer may cause erection difficulties, but it does not usually affect sexual function.
However, the overall experience of cancer, including its effects on the reproductive system and its treatment, which may include radiation therapy, surgery, or hormone therapy, can cause problems.
Prostate cancer is the most common non-skin cancer in men in the United States. It affects around 13 in every 100 American men, according to the Centers for Disease Control and Prevention (CDC).
In this article, we explain how prostate cancer can affect sex and provide some tips on how to maintain a healthy sex life during this time.
Prostate cancer causes several physical changes that can affect a person’s sexual confidence. These may include:
- bowel problems and urine leakage
- difficulty getting an erection
- reduced semen production
- reduced fertility
These issues can affect sexual desire and performance.
If the cancer is slow-growing and in the early stages, a doctor may recommend monitoring the disease instead of active treatment. This option is known as watchful waiting.
Monitoring does not have side effects that cause sex problems, although anxiety may persist, and the person may still have less interest in sex as a result. Counseling may help them overcome this.
Sometimes, surgery is necessary to remove cancerous tissue or the entire prostate gland.
Surgery carries the risk of erectile dysfunction.
Nerves that help control an erection run close to the prostate gland. During surgery, the surgeon will try to protect the nerves from damage while treating the nearby prostate gland.
Nerve-sparing prostatectomy and a biopsy are two options that can help reduce the risk.
Nerve-sparing prostatectomy aims to preserve the nerves that control erections. However, there is the risk that the procedure will not eliminate cancer and that some of the tumor may remain.
Nerve-sparing surgery is not always possible. Whether or not it is a viable treatment option depends on the location and severity of prostate cancer.
A biopsy can help a doctor determine if cancer is present on only one side of the prostate. If this is the case, surgery may spare the nerves on the other side. Having a biopsy for prostate cancer does not appear to increase the risk of erectile dysfunction, according to 2012 research.
Cryotherapy is a less invasive procedure in which doctors use probes to freeze prostate cancer cells. However, there is also a risk of nerve damage with this type of treatment.
Radiation therapy kills cancer cells, but it can also affect the surrounding healthy tissue and possibly the rest of the body too.
Radiation therapy for the prostate can result in some loss of prostate function.
A more focused type of radiation therapy called brachytherapy may have a lower risk. This treatment involves implanting radioactive seeds into the prostate, and it is less likely to affect other parts of the body.
One way of treating prostate cancer is to block or reduce the production and use of these hormones. It might be possible to do this with the use of various types of drug or by surgically removing one or both testicles.
However, hormonal therapy can also have some side effects, including the risk of erection problems, loss of libido, and reduced fertility.
Androgen deprivation therapy (ADT) is a hormone treatment for prostate cancer, but there is a high risk of sexual dysfunction afterward. One expert, writing for the 2015 American Society of Clinical Oncology meeting, noted that after 3–4 months of use, irreversible damage may occur to the erectile tissue of the penis.
However, some men continue to be sexually active while using ADT. One option is to use the treatment intermittently. However, it can still take up to a year for testosterone to return to normal levels.
Different cancer treatments, including medications, chemotherapy, radiation therapy, and hormone therapy, can affect fertility.
Sperm production may fall or stop with radiation treatment. It usually comes back again afterward, although the individual may still produce a smaller quantity of sperm.
Even with a smaller amount of sperm, the person may still be fertile.
For those who wish to have children in the future, one option is to store sperm in a sperm bank before starting prostate treatment.
If the treatment results in infertility and the individual wishes to have children, doctors can use stored sperm for artificial insemination or in vitro fertilization (IVF).
If loss of sexual function occurs after prostate cancer treatment, several options can help a person find pleasure in sex again or return to normal sexual function.
Researchers and counselors offer advice to those who wish to pursue an active sex life during and after prostate cancer.
Here are some of their tips.
One choice to make is whether to pursue an active sex life or if the individual and their partner are happy to pursue new forms of intimacy.
This could involve experimenting with:
- new ways of touching
- vibrators and other aids
- the use of videos
Those in a relationship may find that their partner is happy to enjoy nonsexual intimacy.
A counselor can offer advice on alternative options. It is important to talk to a partner about what is happening and to discuss the alternatives. Good communication can lead to mutual trust and understanding, and this can help people to overcome fears and concerns in both partners.
Set aside time for physical stimulation. It may take extra physical and mental stimulation to get and sustain an erection.
A number of treatments can help a person achieve an erection, including:
- oral drugs, such as avanafil (Spedra), sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra)
- cream to apply to the penis, such as alprostadil (Vitaros)
- other drugs that come in injection or pellet form
- vacuum pumps that can draw blood into the penis before sex
- an inflatable implant may be an option if medications or other treatments are not effective
Placing a tension ring at the base of the penis may help reduce the risk of leakage.
Treatment for prostate cancer might mean that the person can have an erection but is not able to produce semen. As a result, they may experience a dry orgasm. Sex counselors generally advise that this may not matter very much. Some people learn to enjoy a dry orgasm.
For gay and bisexual men
A partner who is usually insertive, or top, during sex may want to consider changing to receive anal penetration, as sex may be difficult without a full erection.
In the case of a prostatectomy, a partner who usually receives penetration may find that sex is less pleasurable, as the prostate gland usually contributes to the sensation.
For trans women
Trans women who doctors assigned a male gender at birth will still have a prostate gland. They should have regular checks to ensure that the prostate remains healthy.
For single people
A person who is not in an established relationship may be uncomfortable with the changes in their sexual function at this time. It may be worth them waiting until they feel comfortable with their new sexuality before starting a new relationship.
Give it time
A loss of interest in sex may occur due to fatigue and other problems relating to prostate cancer and treatment. This disinterest can improve or disappear over time.
Open communication with a partner makes it easier to agree on expectations and share concerns. In some cases, a lower sex drive will not bother the partner. Others may enjoy finding new ways to be intimate.
Getting enough exercise may help boost a person’s sex life. Studies show that people with prostate cancer who exercise are more likely to return to an active sex life.
However, there is no evidence that exercise reduces erectile dysfunction.
The number of people whom erectile dysfunction persistently affects after prostate cancer surgery varies widely.
Factors influencing the likelihood of issues include age and general health before the operation.
In 2016, a study that appeared in European Urology looked at whether frequent ejaculation protects against prostate cancer.
The investigation involved almost 32,000 men and looked to build on previous research, which had found that more regular ejaculation seemed to lower prostate cancer risk.
This new research also concluded that ejaculating more often lowered the chances of prostate cancer.
However, the authors called for further research because other factors, aside from ejaculation, could account for the results. They could not confirm that ejaculation protects against prostate cancer.
One theory, which is known as prostate stagnation, suggests that ejaculating less often allows potentially cancer-causing secretions to build up.
It often helps people to hear about the experiences of others, which can make them feel less alone in their situation.
On healthtalk.org, men talk on camera about their experiences of sexual dysfunction and prostate cancer.
Most men develop prostate cancer after the age of 65 years.
Between one-third and one-half of those with prostate cancer already have some degree of sexual dysfunction at the point of diagnosis.
Other people may notice a change in function during treatment. Some will retain or regain their sexual function, but others will find that the changes do not reverse.
Open communication and experimenting with new ways of approaching sexuality can help.