Effects of surgery on men

Surgery can directly affect your sexual function. Your surgeon will talk to you about the operation and any effect it may have on your sex life before your surgery. Operations that may affect your ability to have sex include having your prostate gland removed, having the bladder and prostate removed, having one or both testicles removed and having part or all of the penis removed.

Some operations can affect a man’s ability to have or maintain an erection. This is called erectile dysfunction (ED) and can be caused by damage to nerves or blood vessels during surgery. Other effects of surgery can include changes to ejaculation or a change in the size of the penis. Having both testicles removed means you will not produce testosterone. This can cause you to lose interest in sex and be unable to have a natural erection.

There are different things that can help with these difficulties. It will depend on your situation. Your doctors and nurses will be able to tell you more.

Treatments that may directly affect sexual function

Certain cancer treatments may directly affect sexual function. It is important to remember that not everyone will have the side effects we mention in this section. Your cancer doctor or nurse can answer any questions you may have about your treatment, and how it might affect you.

Treatments for cancers in the pelvic area (area between the hips) are the most likely to affect sexual function. These can include treatment for cancers of the:


Surgery

Some operations may directly affect sexual function. These include:

  • prostatectomy – removal of the prostate gland
  • cystectomy – removal of the bladder and the prostate gland
  • abdominoperineal resection – removal of the anus, rectum and lower part of the colon
  • transanal resection – removing a tumour from the rectum through the anus
  • penectomy or partial penectomy – removal of the penis or part of the penis
  • orchidectomy – removal of one or both testicles.

Before any surgery your surgeon will talk to you about possible side effects, including any effects on your sex life.


Effects on erections

Some operations may damage nerves and blood vessels that control blood-flow to and from the penis.

They include:

  • prostatectomy
  • cystectomy
  • abdominoperineal resection
  • transanal resection.

Damage to these nerves or blood vessels can affect your ability to get or keep an erection. This is called erectile dysfunction (ED). It can be temporary or long-term. The risk of ED after these operations is higher for men who had erection difficulties before the surgery, and for older men. The older a man is, the greater the risk of long-term ED.

Surgeons cannot predict which men will have long-term erection problems. So, if you are having an operation that could cause ED, it is important that you’re fully aware of the risks. Your surgeon will discuss the operation, its possible side effects and other treatment options with you.

What can help

A type of surgery called nerve-sparing surgery can reduce the risk of long-term ED. But it isn’t suitable for all men. If the cancer is growing into or close to the nerves, it is not usually possible to protect the nerves with this type of surgery.

After nerve-sparing surgery, it may take time for the nerves to recover. Men may have ED for some time. It can take several months for erectile function to recover. Your surgeon can tell you more about nerve-sparing surgery.

After an operation that can cause ED, some men are put on to an ED recovery package. This is sometimes called penile rehabilitation. The aim is to increase blood-flow to the penis to keep it healthy.

There are several treatments that can help men with ED to have erections again. We have more information about managing erectile dysfunction.


Changes to ejaculation

Some types of surgery may cause changes in ejaculation. These include the following:

  • cystectomy
  • prostatectomy
  • retroperitoneal lymph node dissection. This is when lymph nodes are removed in the tummy area. Lymph nodes are small, bean-shaped structures that help the body fight infection. It is sometimes done during testicular surgery.

If you cannot ejaculate, it is not possible to father a child through sex. But you may be able to father a child with the help of fertility treatment. Your doctor can talk with you about fertility treatments if this is important to you.

Dry ejaculation

After prostatectomy or cystectomy, it is still possible to have an orgasm, but there will be no ejaculation. This is called a dry ejaculation or dry orgasm. It happens because the prostate gland has been removed. You still make sperm, but it is re-absorbed back into the body.

Leaking urine at orgasm

After prostatectomy, some men leak a small amount of urine at orgasm. This is called climacturia. Urine is sterile and won’t cause an infection for your partner.

If you have had a prostatectomy, you may also have leakage of urine (incontinence) at other times. We have more information on coping with incontinence.

Ejaculating into the bladder (retrograde ejaculation)

As part of treatment for testicular cancer, some men have an operation to remove lymph nodes in their lower abdomen. This surgery may affect nerves that control ejaculation of semen. At orgasm, semen and sperm go into the bladder instead of leaving the body through the penis. This is called a retrograde ejaculation. It is harmless but orgasms will feel different. You may notice urine you pass after ejaculation is cloudy. This is caused by semen in the urine.


Changes to penis size

Some men notice their penis is slightly smaller after prostatectomy. This may also happen after other operations that affect the nerve supply to the penis. There can be two causes:

  • Damage to the nerves that supply the penis. This can cause it to be pulled tighter to the body, so it looks smaller. This is similar to the effect that happens when the penis is exposed to cold temperatures. As the nerves recover in the months following surgery, the penis returns to its normal size.
  • Damage to tissue inside the penis. Men normally have erections during sleep. These help keep the penis healthy. If nerves to the penis are damaged, night-time erections do not happen. Over several months this can damage the penis, causing it to shrink.


Surgery for cancer of the penis

If you have surgery to remove cancer from the penis, your penis will be smaller and may have scars. Your surgeon will remove as little of the penis as possible. Most men can have a fulfilling sex life after this surgery. The head of the penis, which is the most sensitive part, will have been removed. But erections and orgasms are still possible.

If more of the penis needs to be removed, you may be able to have surgery to reconstruct the penis later. After penile reconstruction, you may be able to get an erection, but this will depend on the type of reconstructive surgery you have had. Your surgeon and specialist nurse will talk about this with you.

If your whole penis has been removed (penectomy), you will no longer be able to have penetrative sex or receive oral sex in the ways you did in the past. It may be possible for some men to have a new penis reconstructed. Your surgeon can talk about this with you.

Not having a penis can be very difficult to come to terms with. But you may find new ways to enjoy sexual activity. The areas around your scrotum and testicles will still be sensitive. You may still be able to have orgasms through stroking and other stimulation.

I can’t have sex as we all experience it, but it’s just as good in a different way.

Christopher


Removal of one or both testicles (orchidectomy)

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. In some men, the remaining testicle may not make enough testosterone. This is more common in men who are having chemotherapy. Testosterone levels usually get back to normal slowly once treatment is over.

Low testosterone levels can cause a loss of interest in sex or difficulty getting or keeping an erection.

A blood test can check testosterone levels. Men whose testosterone levels are too low may be prescribed testosterone replacement therapy. This can be given as gels, injections or capsules. While having this treatment, you will have regular blood tests to check your levels of testosterone are within normal limits.

Removal of both testicles

If you have both testicles removed, for example as treatment for prostate cancer, you will be infertile following the surgery. You may also lose interest in sex and be unable to have a natural erection, because of a lack of testosterone. Testosterone replacement treatment is not usually an option for men who have been treated for prostate cancer. This is because it increases the risk of the cancer coming back or growing more quickly.

Life after an orchidectomy

If you have had your testicle(s) removed, you may feel less masculine. However, neither the operation nor 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.

There is no reason whatsoever for you to feel any less of a man. And that is very, very important. Don’t ever feel any less of yourself because a small part of your body has been removed.

Michael

I don’t think my partner’s perception of me as a man has a great deal to do with appearance. I don’t think gender identity is about body shape anyway. It certainly isn’t purely about that.

Martin


Surgery to the anus and rectum

Surgery to remove an anal or rectal cancer may affect your sex life if you enjoy receptive anal sex or anal play.

If you have a type of operation called an abdominoperineal resection, the entrance to the anus will be surgically closed. This means anal sex is no longer possible. Bowel motions pass out of the body through an opening (stoma) in the tummy. We have more information about stomas.

After some types of surgery for bowel cancer, a stoma is made but the anus and part of the rectum are left in place. The remaining part of the rectum is surgically sealed and is no longer connected to the rest of the bowel. This leaves a ‘rectal stump’. It may be possible to have receptive anal sex or anal play after the wounds from your operation have fully healed. This depends on the depth of the stump. It is important to check with your surgeon before attempting this.


Emotional effects of surgery

If surgery changes how you look or how a part of your body works, this can have emotional as well as physical effects. Some types of surgery may not affect your physical ability to have sex, but could affect how you feel and think about yourself sexually. We have more information about sex and your feelings.

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The male body and sex

It may help to understand more about your body and how it becomes sexually aroused.