Effects of surgery on men

Any surgery can have an impact on your sex life. Having operations to the sexual areas of the body can cause certain changes:

  • Prostatectomy – surgery to remove the prostate gland. This may make erections difficult.
  • Cystectomy – surgery to remove the bladder. This may cause nerve damage and difficulty getting an erection.
  • Abdomino-perineal resection – surgery to remove cancers in the rectum. This can affect the nerves that control erections.
  • Local resection – surgery to remove very early-stage rectal cancers. This is likely to cause erection problems.
  • Orchidectomy – surgery to remove one or both of the testicles. If both testicles are removed, you won’t be able to have children and you may have erection problems.
  • Penectomy – surgery to remove part or all of the penis. The surgeon may be able to reconstruct it.
  • Surgery affecting visible areas, such as your face, can affect your sexual self-esteem and the way you communicate during sex.

Your surgeon and specialist nurse will talk to you about the surgery and how it might affect you.

Effects of surgery on sexuality

Any type of surgery can affect your sexuality and sex life, even if it doesn’t involve the sexual areas of your body. But surgery that directly affects these areas may cause quite noticeable changes. Your surgeon and specialist nurse will talk to you about the surgery and how it might affect you.


Prostatectomy

A radical prostatectomy is an operation to remove the prostate.

Many men who have a prostatectomy will have difficulty getting or keeping an erection after surgery. This is called erectile dysfunction (ED). It happens because of damage to the nerves that control an erection. It starts immediately after the surgery and can be permanent. Long-term ED is more likely to occur if you had difficulty getting an erection before your surgery.

Some surgeons specialise in surgery that is less likely to damage the nerves and can reduce the risk of problems. This is called nerve-sparing surgery. But because the surgeon needs to remove all the cancer cells during a prostatectomy, this often makes it impossible to avoid nerve damage.

If you’re under 60 and have had a nerve-sparing prostatectomy, your risk of erection problems afterwards may be 5 in 10 (50%) or higher.

If you’re over 70 and have had a nerve-sparing prostatectomy, your risk of erection problems afterwards is about 8 in 10 (80%) or higher.

Your risk may be higher if you haven’t had nerve-sparing surgery.

Because doctors can’t predict which men will be permanently affected by ED, it is important that you’re fully aware of the risks before surgery. Your doctor will discuss the operation, its possible side effects and other treatment options with you.

If you’ve had your prostate gland removed, you won’t be able to ejaculate. You’ll still make sperm, but it won’t be able to get out of the body. It will be harmlessly reabsorbed back into the body. It’s still possible to have an orgasm, but there will be no ejaculation. This is called a dry ejaculation or dry orgasm.

After a prostatectomy, you will have a tube (catheter) to drain urine from the bladder. This will stay in place for 1–3 weeks after the operation. Most men have some incontinence when the catheter is first removed, but this usually improves with time. About one year after the operation, up to 20% of (1 in 5) men will leak an occasional drop of urine. Incontinence can cause embarrassment if you’re sexually active, especially if you have to wear pads or need a catheter. It can usually be managed very well with advice from a specialist nurse or continence adviser.

You may have other side effects for a few months after a prostatectomy, such as diarrhoea or constipation.


Cystectomy

A cystectomy is an operation to remove the bladder. During a radical cystectomy, your surgeon will also remove the prostate gland.

It’s very common for men to have nerve damage after this type of operation. This may make it impossible for them to get a natural erection. Sometimes the ability to get an erection returns with time. It may be possible to have nerve-sparing surgery, which can reduce your risk of erection problems. Men who have the prostate removed will have dry ejaculations.

When the bladder is removed, your surgeon can often make a ‘new’ bladder using part of your bowel. If this isn’t possible, they will make an opening in the wall of the abdomen (a stoma) so that urine can drain into a bag.


Abdomino-perineal resection (AP resection)

This is an operation to remove cancers in the rectum. During the operation, the anus, rectum and part of the lower end of the large bowel (the sigmoid colon) are removed. The surgeon makes an opening in the wall of the abdomen (a stoma) so that your bowel motions can drain into a bag.

Having an AP resection can affect the nerves that control erections and ejaculation. Modern surgical procedures try not to damage the nerves in this part of the body, but even so, many men will have erection problems.

Having an AP resection will mean that if you used to have anal sex, you will no longer be able to. It may be possible to keep the rectum, although this will depend on your individual situation and it can increase the risk of the cancer coming back. You can discuss this issue with your surgeon before surgery.


Local resection

Very early-stage rectal cancers that are small and low down in the rectum can sometimes be removed using an operation called a local resection or a trans-anal resection. This is when instruments are passed through the anus into the rectum to remove the cancer.

This is a specialised technique that reduces the risk of removing or damaging the anal muscle. It also reduces the risk of needing a permanent stoma afterwards. However, there is a significant risk of erectile dysfunction after a local resection – especially a low or ultra-low resection.

Your doctor or specialist nurse can tell you more about this type of surgery.


Orchidectomy

An orchidectomy is an operation to remove a testicle.

Removal of one testicle

Men with testicular cancer usually have only one testicle removed. This will not cause infertility and it doesn’t usually affect your sex life. However, if you have testicular cancer, you may have testicles that aren’t working properly and are only producing fairly small amounts of testosterone. If you have one testicle removed, the other one might not be able to produce enough testosterone. This can cause problems such as a loss of interest in sex or difficulty getting or keeping an erection. Low levels of testosterone may also make your orgasms less intense.

Removal of both testicles

If you have both testicles removed, for example as a treatment for prostate cancer, you will be infertile. You may also be unable to have a natural erection, because of a lack of testosterone.

If you’ve had your testicle(s) removed, you may feel less masculine. However, neither the operation or hormonal changes will make you feminine, as some men fear.

Your surgeon or specialist nurse will discuss the surgery with you and answer any questions you have.


Retroperitoneal lymph node dissection

If you have testicular cancer, you may have an operation to remove the lymph nodes in your lower abdomen. This is called a retroperitoneal lymph node dissection.

This operation is done if the nodes are still enlarged after radiotherapy or chemotherapy. It can affect the nerves that control ejaculation of semen. This can cause the semen and sperm to flow back into the bladder, which is called a retrograde ejaculation. Having retrograde ejaculations is harmless, but orgasms will feel different.


Penectomy and penile reconstruction

Surgery to remove the penis is called a penectomy. This may be a partial penectomy (where part of the penis is removed) or a total penectomy (where the whole penis is removed). Your surgeon will try to remove as little of the penis as possible. They may also be able to reconstruct it if necessary, although your penis is likely to be smaller than before and may have scars.

Your surgeon or specialist nurse will discuss the surgery with you and answer any questions you have.


Stoma

Sometimes surgery for bowel or bladder cancer involves having an opening made in the abdominal wall. This is called a stoma. A stoma allows waste from your body (either urine or bowel motions) to drain into a bag that covers the stoma.

A stoma and colostomy bag
A stoma and colostomy bag

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If you have a stoma, there’s a high chance of permanent damage to the blood supply and the nerves in your genital area. This may cause you to have problems getting and keeping an erection.


Laryngectomy

A laryngectomy is an operation to remove the voicebox (larynx). This can change the way you talk and breathe. It can have an effect on your sexuality by changing how you communicate before or during sex.


Facial surgery

Surgery for head and neck cancers can sometimes leave scars or be disfiguring. If you have surgery to the jaw or tongue, it may change the way you speak, which can affect the way you communicate. Surgery may also affect the way a person kisses or gives oral sex.

Newer surgical techniques and advances in plastic surgery are trying to improve any lasting problems.


Limb amputation

Very occasionally, when treating some types of cancer (such as primary bone cancer), a surgeon may need to amputate the affected arm or leg. The limb will often be replaced with an artificial arm or leg (a prosthesis).


Removal of lymph nodes

If you’ve had lymph nodes removed as part of your treatment, you may get swelling in a nearby area of the body. For example, when lymph nodes are removed from under the arm as part of treatment for breast cancer, the affected arm may swell. If lymph nodes are removed from the groin, this may cause swelling of the legs and pubic area. The swelling is called lymphoedema.


Mastectomy and lumpectomy

Breast cancer in men is rare. A mastectomy is an operation to remove the breast tissue, nipple and usually some lymph nodes in the armpit. A lumpectomy removes just the breast cancer and an area of surrounding tissue. It doesn’t remove the whole breast. A lumpectomy is also called a wide local excision.

After a mastectomy or lumpectomy, there will be a scar. It will be red at first, but this usually fades to a silvery white line over a few weeks or months. It’s common to have some swelling around the operation site to begin with.

Both operations can affect the sensations in your breast and nipple.

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The male body and sex

If changes to your body are affecting your sex life, it may help to remember the sexual areas of a man’s body.