Coping with sexual difficulties in men

Cancer and its treatment may affect your sex life, both physically and emotionally.

You may not feel like having sex. You may be worried about it being painful. Trying relaxation techniques and different types of sexual touching may help.

After treatment, many men have problems getting or keeping an erection. There are a lot of options that may help, including:

  • medicines
  • pumps
  • implants.

If you have surgery to remove a testicle, you may be able to have a false testicle (prosthesis). Surgery can have an impact on your body image and self-confidence.

You may have bowel and bladder problems after cancer treatment. You may have a stoma. These changes can have a big impact on your sex life. Talk to your doctor or specialist. They may be able to treat the side effects with medicines or suggest ways to help you cope.

If you’re having sexual difficulties, it’s important to talk about them with someone. A sex therapist or counsellor may be able to help you with some of these issues.

If you don't feel like having sex

If you have a partner, it’s important to let them know if you don’t feel interested in sex. Explaining why you don’t feel like having sex can reassure them that it isn’t because you no longer find them attractive. You can show your partner how much you care about them in other physically affectionate ways. Being more relaxed and intimate with your partner may gradually lead to more sexual contact.

If your partner is feeling frustrated, it may be helpful for them to reduce the frustration through masturbation, either with you or alone.

If you have fatigue and don’t have much energy, it might help to have sex in different ways. Less energetic sexual positions, where your weight is well supported, can reduce strain. You may also prefer quicker sexual contact rather than longer sessions. These are things you can talk about together.

If tension is building between you, it may be helpful to get support from a counsellor or sex and relationship therapist. They specialise in offering people help in these circumstances.

Tips to help you communicate

Lead Cancer Nurse Lynne Dodson discusses the importance of communicating any sexual issues you may have as a result of cancer.

About our cancer information videos

Tips to help you communicate

Lead Cancer Nurse Lynne Dodson discusses the importance of communicating any sexual issues you may have as a result of cancer.

About our cancer information videos


Pain during sex

Pain can reduce sexual feelings and desire. Pain often leads to a fear of pain, and this can cause tension. Tension can be distracting and stop you becoming aroused. It can also cause further pain.

There are many reasons for pain during sex. It’s important to let your partner know what’s painful so you can find other positions or ways of having sex.

The cause of the pain can often be treated simply. If you have pain during sex, tell your doctor or nurse. They can examine you to find out why and suggest possible solutions.

If you have pain or are worried about pain, it may be helpful to:

  • have sex after taking painkillers and waiting a short time for them to work
  • learn some relaxation techniques to use before having sex
  • take control of the depth and speed of penetration
  • try to ensure you and/or your partner are close to orgasm before penetration
  • try different types of sexual contact that you don’t find painful – this could be sexual contact without penetration
  • use pillows and cushions to help you feel more comfortable and supported
  • have sex side by side, to reduce body weight on a sore area.


Erection changes

After surgery or radiotherapy to the pelvic area, many men have erection difficulties. But the treatment may not be the only cause. Studies have found that it’s common for men to have sexual problems after treatment that have nothing to do with their genital area. So if you’re having sexual difficulties, it may not be because of your cancer treatment. There may be psychological factors involved that you aren’t consciously aware of. It’s also important to be honest about any difficulties you had before treatment.

You may find you can have full erections with time. Even if you can’t, you can still have intercourse with a semi-erect penis. The positioning for this may be better with your partner on top guiding the penis inside. You can also enjoy other forms of sexual activity with a partial erection.

It is important to remember that you don’t need to have an erection to have an ejaculation or orgasm.

If you’ve had an operation that’s damaged the nerves that control erections, you may need to think of different ways to satisfy yourself and your partner. You don’t need to have a hard penis to give your partner pleasure. You may find it helpful to increase your range of sexual activity, to increase the pleasure for you and your partner. For example, your sexual activity could include oral sex, mutual touching, increased masturbation, or using sex toys, such as a dildo or vibrator.

Medicines and injections

If you have problems getting or keeping an erection, there are lots of options that can help you. Remember that although these may give you a hard penis, they won’t necessarily make you feel more aroused. It’s worth trying different methods, as some may work better than others.

Sildenafil (Viagra®) can help produce an erection by increasing and sustaining the blood supply in the penis. It’s usually taken 30–60 minutes before sex, on an empty stomach. Then after direct sexual stimulation, an erection can occur.

Viagra should be prescribed by your GP. It may not be recommended for you if you have certain heart problems or are taking certain drugs, such as nitrates. It can cause side effects for some people, including heartburn, headaches, dizziness and visual changes.

Tadalafil (Cialis®) tablets can help to produce an erection. Cialis works by increasing the effects of one of the chemicals produced in the body during sexual arousal. It shouldn’t be taken by people who are taking certain heart medicines. Your doctor can prescribe you Cialis in two different ways. They will explain the differences between the two:

  • You can take Cialis once a day. In this case, it takes about 5–7 days to build up in the body. Once you’ve started taking it, you need to take it every day for it to work.
  • You can take Cialis just when needed. In this case, you take it between 30 minutes and two hours before sexual activity. The medicine stays active for about 36 hours.

Vardenafil (Levitra®) tablets are similar to Viagra. They normally work within 25–60 minutes. The most common side effects are headaches and facial flushing.

Alprostadil (MUSE®) pellets can be inserted into the penis. The pellet melts into the urethra, and after some rubbing to distribute it into the nearby tissues, it produces an erection. The pellets are usually kept in the fridge, but they work better if they’re at room temperature before you insert them. Try to pass urine before inserting the pellets. Some men find the side effects of the pellets uncomfortable at first, but not the insertion of them. Side effects can include a burning feeling in the urethra. The first dose of MUSE is given in hospital.

Alprostadil (Caverject®, Viridal®) can be injected directly into the shaft of the penis, using a small needle. This causes an erection in 5–20 minutes. The drugs restrict blood flow and trap blood in the penis. You often need to experiment at first to get the dose right. You should start with a low dose and gradually increase it to prevent the risk of priapism.

Some men who use these injections say the head of the penis isn’t as hard as the shaft.

The injections are prescribed by your GP. The first doses will be given by a trained healthcare professional, and in time you will be shown how to do it yourself. It’s recommend that the injections are only used once in 24 hours and no more than three times a week. You should also change the site of the injections regularly.

Priapism

This is a rare side effect of the injections, and sometimes the tablets, where the erection lasts for several hours. This can damage the tissues of the penis. If your erection lasts longer than two hours, you should get medical help as soon as possible. This is called priapism. The person who prescribes your injections or tablets will explain the risks and treatments for priapism to you.

Pumps

Vacuum pumps can also be used to produce an erection. They are sometimes called vacuum constriction devices or vacuum erection devices (VEDs).

The pump is a hollow tube that you put your penis into. The pump makes the penis fill with blood by creating a vacuum. A rubber constriction ring is then put around the base of the penis to hold the erection. The erection can be maintained for a maximum of 30 minutes. Once you have had sex, the ring is taken off and the blood flows normally again. The pump can be used as many times as you want, as long as you leave half an hour between each use.

The advantage of the pump is that it doesn’t involve any medication, so it doesn’t interact with other medicines you are taking. You may need to try it a few times before you get used to using it. The pump may make your penis slightly bigger but colder than usual. The pumps are available on the NHS.

Your doctor or nurse may encourage you to use a VED routinely, and not just for intercourse. This is so that when you are ready to start sexual activity, you will have a better chance of getting an erection.

Most men who have erection problems after pelvic surgery or radiotherapy will probably have some benefit from the treatments described above. But everyone is different. Specialist advice and counselling can also be useful. You can ask your doctor to refer you. Asking for help early might help prevent changes to the penis that might be more difficult to treat later on. Any medical treatment for sexual problems caused by prostate cancer is available on the NHS.

Implants

Penile implants are sometimes used after all other methods have been tried. There are two main types, which have to be inserted during an operation:

  • The first type uses semi-rigid rods that keep the penis fairly rigid all the time. They allow the penis to be bent down when an erection isn’t needed.
  • The second type is an inflatable device. When it’s activated, it causes an erection.

Your doctor can discuss penile implants with you.

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos


Changes in testicles

After an operation to remove your testicles, you may need to avoid sexual positions that put pressure on the area. Some men say orgasms feel different, and the normal contractions of the scrotum at orgasm may feel uncomfortable. Men usually ejaculate less semen than they did before.

Your doctors can prescribe testosterone replacement therapy. This helps improve your libido and makes it easier to get erections. It can be given as tablets, injections, or patches or gels that are applied to your skin. You may find it helpful to talk to your doctor or specialist nurse about this.

Testicle replacement

Your surgeon may insert a false testicle (prosthesis) into the scrotum. This looks and feels like a normal testicle. However, although it looks normal, you may still feel different about your body. Some men say they feel less masculine, and they need time to talk through this body image change.


Penile reconstruction

Penile surgery can have a significant impact on your body image and self-confidence.

After surgery, most men are able to have a fulfilling sex life. If you’ve had part of your penis removed, you should still be able to have erections and orgasms. If your whole penis has been removed, you will no longer be able to have penetrative sex or receive oral sex in the ways you were used to. You will need to find new ways to have sex. The areas around your scrotum and testicles will still be sensitive and you may still be able to have orgasms.

If you’ve had a penile reconstruction, you may be able to get an erection, but this will depend on the type of reconstructive surgery you’ve had.


Urinary problems

After cancer treatment, people occasionally have problems with leaking urine (incontinence) or having difficulty passing urine.

You may have to wear incontinence pads or have a urinary catheter, which can lead to feelings of embarrassment. You may feel unclean or unattractive, and you may avoid intimate contact.

Although it may seem embarrassing, it’s a good idea to discuss incontinence with your sexual partner. Be honest with them – tell them that a little urine may leak during sex. You may want to let them know that urine is sterile and it won’t cause an infection for them. It can also help to have towels and tissues nearby in case there’s any leakage. Good personal hygiene will help you feel more confident.

If you don’t have a catheter

Avoid drinking too many fluids for an hour or so before you have sex. Make sure you pass urine beforehand so your bladder is as empty as possible. It’s sometimes possible to make sure your bladder is empty by putting in a catheter – your nurse or a continence adviser can discuss this with you. You may also want to have a shower or bath before having sex, which you could do alone or with your partner.

After prostate surgery, some men find they lose a small amount of urine when they orgasm. This is known as climacturia. If this loss of urine is distressing to you or your partner, you may want to wear a condom to contain the urine. Pelvic floor exercises may help you increase urinary control, and a technique called bulbo-urethral massage can reduce the amount of urine you lose at orgasm.

Your doctor, specialist nurse or physiotherapist can give you advice on different ways of coping with incontinence. They can also refer you to a continence adviser for further support.

If you have a catheter

Sex is still possible if you have a urinary catheter in place. You can fold the catheter back along the penis using surgical tape and cover it with a condom to keep it in place. Extra lubrication may be needed during sex.

If you are producing semen, you may need to stop it blocking the catheter. You may need to flush out your bladder after sex.

In some situations, it may be possible to remove the catheter during sex. Your nurse or continence adviser can discuss all these options with you.


Bowel problems

Bowel problems can sometimes be a side effect of cancer treatment, especially pelvic radiotherapy. These problems include loose bowel motions (diarrhoea) and needing to open the bowels with very little or no warning (faecal incontinence). These effects may be temporary, but they can sometimes be permanent.

Having problems with your bowels can have a huge impact on your life. It may make you feel less interested in sex, and it can also make you feel embarrassed and affect your confidence. You may feel unclean or unattractive, and you may avoid intimate contact.

You can discuss any bowel problems with your doctor or specialist nurse, or with a dietitian. They may be able to reduce the side effects using a combination of medicines, dietary changes and exercises, and can help you cope with the way the problems are making you feel.

There are things you can do that may help the way your bowel problems affect your sex life:

  • Find out which foods cause the diarrhoea or make it worse, and avoid them for several hours before you have sex.
  • Empty your bowels just before you have sex.
  • Good personal hygiene will help boost your confidence.
  • Using scented candles may help if you’re concerned about smells.
  • Let your partner know that you may have to rush to the toilet.
  • Make sure you can get to the toilet quickly and easily.
  • Have tissues and towels nearby during sex.
  • You could use an anal plug. They’re available from the Bladder and Bowel Foundation.


Stomas

Having a stoma can make some sexual positions uncomfortable. It can affect your confidence and the way you feel about your body. You should reassure your partner that sex will not harm the stoma. It is not recommended that a stoma is used for penetrative sex, although in some situations this may be possible. Your doctor or specialist nurse can discuss this with you further.

Make sure the bag fits well and doesn’t leak. It’s a good idea to empty the bag before sex, although this can sometimes make it difficult to be spontaneous. Some foods can cause the bag to fill quickly, so avoid eating or drinking anything that usually causes you problems. You may also be able to plug the stoma or do a stoma washout so that a bag isn’t needed for a short time.

Stoma nurses can advise and help you with all the sexual effects a stoma may cause. Information is also available from the Ileostomy and Internal Pouch Support Group or the Sexual Advice Association.


Changes to your face and speech

Having facial surgery may change the way you feel about yourself and cause low self-esteem. There are a number of organisations that give help and advice to people trying to cope with a facial disfigurement. These include Let’s Face It and Changing Faces.

It’s usually possible to speak after a laryngectomy, using an aid or oesophageal speech. Oesophageal speech is a way of speaking that you can be taught if your voicebox has been removed.

However, speaking using an aid or oesophageal speech can sometimes be difficult or distracting during sex. Communication between partners is very important. It may help to discuss what you’d both like before starting sex, and to find ways of signaling messages to each other.


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).


Mastectomy and lumpectomy

If you’ve had a mastectomy or lumpectomy, you may have lost a nipple. There are ways of recreating the appearance of a nipple on the chest, which your surgeon or breast care nurse can discuss with you. For some men, this change in appearance won’t be a problem at all. But it can affect your confidence and how you feel about yourself as a man.

You may worry that a partner will be put off by your scars or a change in how your body looks. If you’re feeling self-conscious about how you look, talking to your partner or specialist nurse about how you feel can help you feel more confident.


Lymphoedema

Lymphoedema can affect your sex life and change the way you see and feel about your body. These things might make sex more comfortable and enjoyable:

  • Find sexual positions that don’t put weight on the area affected by lymphoedema.
  • Have sex at times when the swelling is better. For example, many people find their swelling is better in the morning or after they’ve worn a compression garment for a few hours.
  • If you have genital lymphoedema, use extra lubricant to reduce friction to the skin.
  • If you feel self-conscious, have sex while partly dressed or in dimmed light.

Back to Effects of treatment on a man's sexuality

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.