How surgery for bladder cancer may affect your sex life
Apart from the psychological adjustments, the operation (cysectomy) may have made physical changes that can cause problems with sex.
If you have concerns about how your sex life might be affected, it’s important to talk this over with your surgeon and specialist nurse. They will be able to tell you how your surgery may affect you as well as what may help.
Although your doctors will do all they can to prevent nerve damage during the operation it may not be possible to avoid it. If the nerves are damaged, there’s a risk of erectile problems in men and altered sensation in women.
There are various treatment options for men with erectile difficulties following surgery. Your GP or cancer specialist will be able to advise you.
Tablets such as sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) help produce an erection, provided the nerves are intact, by increasing and restricting the blood supply in the penis. Sildenafil or vardenafil are usually taken about one hour before having sex; tadalafil can be taken up to 24 hours before. These treatments can’t be taken by men who take nitrate-based medicines for heart problems. Your doctor can advise you about this.
Pellets and injections
Pellets of alprostadil (MUSE®) are inserted into the tip of the urethra. This treatment is not suitable for men who have had their urethra removed during cystectomy. The pellet melts into the surrounding area and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is uncomfortable to begin with.
Alprostadil (Caverject®) can cause an erection when injected directly into the penis using a small needle. You may need to experiment to get the dose right. Your doctor will give you advice about this.
Pumps and other devices
Vacuum pumps can also be used to produce an erection. The pump is a simple device with a hollow tube that you put your penis into. The pump has a handle that draws blood into the penis by creating a vacuum. The blood then gets caught in the penis by a rubber ring placed around the base. The ring allows you to have sex without losing the erection. Once you have finished having sex, the ring is taken off and the blood flows normally again.
The advantage of a vacuum pump is that it doesn’t involve inserting anything into the penis, but it does need a bit of practice. It’s particularly helpful for men who are not able to take other medicines.
Penile implants are sometimes used after other methods have been tried. It means having a flexible rod or a thin, inflatable cylinder inserted into your penis during an operation. Your doctor can discuss penile implants with you.
In some women, the vagina may have been shortened or narrowed during the operation (cysectomy). This can make sex difficult or uncomfortable at first. Some women who have their vagina removed as part of their bladder surgery will need surgery to reconstruct their vagina.
Having sex regularly and gently as soon as you feel ready can help gradually stretch the vagina, making it more supple. This will make sex easier and more enjoyable.
If you find sex too uncomfortable to begin with or if you don’t have a regular sexual partner, you can use vaginal dilators. Your nurse or doctor can show you these and explain how to use them. Sometimes oestrogen (female hormone) gels or creams are prescribed to help ease discomfort in the vagina.
Some women find that they have different sensations during sex. It may be more difficult to have an orgasm.
You may find it difficult or embarrassing to talk about sexual problems. Most doctors are very understanding and can refer you to a specialist in sexual problems or to a trained counsellor for advice and support. These specialists can give emotional support and advice on how to cope with sexual difficulties.
If you have a partner, it may be helpful for them to see the specialist with you, and there are many useful organisations you can contact.
One common fear is that cancer can be passed on to your partner during sex. You can’t catch cancer by having sex. It is perfectly safe for you and your partner to have sex as soon as you feel ready.
We have more information on sexuality and cancer.