How treatment for prostate cancer can affect your sex life

Treatments for prostate cancer can cause sexual difficulties. Or you may have side effects that make you feel less interested in having sex. These can include:

We have included information about managing side effects in our information on individual treatments. As your side effects improve, you may feel more interested in having sex.

If cancer and its treatments affect your sex life, it can feel like a serious loss. You do not need to be in a relationship to feel this. But there are different ways to manage sexual difficulties.

Cancer and its treatments can also affect how you feel and think about your body. You may feel less sexually attractive. If you are having issues with your body image, ask your doctor or nurse for advice.

Certain lifestyle changes may help improve body image concerns, such as being more physically active, eating healthily and managing your weight. Ask your doctor or nurse for advice.

Sexual difficulties

Prostate cancer treatments can have a direct effect on your sex life.

Different cancer treatments may:

  • reduce your sex drive (libido)
  • cause difficulties getting or keeping an erection (called erectile dysfunction, or ED)
  • affect your ability to have an orgasm or to ejaculate
  • the penis and testicles to get smaller if you are taking hormonal therapy for a long time.

If you are having sexual difficulties, there are different treatments and types of support to help you.

Talking about sex and prostate cancer

You may find it difficult to talk about sex with your doctor or nurse. But doctors and nurses who treat men with prostate cancer are used to talking about these issues. They can give you advice and answer your questions. If you need more specialist advice, they can refer you to an erectile dysfunction (ED) clinic or a sex therapist.

If you have questions about sex during or after treatment, ask your doctor or nurse. Having sex will not affect how well your treatment works. In some situations, they may advise you to be cautious about sex during treatment or immediately after it finishes.

For example, after surgery you may be advised to wait until your wound has healed. Side effects of pelvic radiotherapy, such as skin changes or tiredness, may make having sex difficult or you may not feel up to it. You may decide to wait until your side effects improve.

If you identify as LGBT+

If you identify as gay, bisexual, transgender or LGBT+, you may worry about being treated insensitively by your healthcare team. Many sexual difficulties caused by prostate cancer are similar whatever your sexuality, but you may have some specific questions. Having your sexual or gender identity acknowledged may help you feel better supported. It also means your healthcare team can give you the right information and advice. Prostate Cancer UK has specific information for gay and bisexual men.

Pelvic radiotherapy and brachytherapy can affect the back passage (rectum). This can cause different side effects. If you receive anal sex, it is best to wait until these side effects have improved. It is important not to injure the tissues of the rectum. Radiotherapy may cause long-term changes to the rectum that may make receiving anal sex difficult. You can talk to your doctor or nurse for more advice.

If you feel unable to talk to your healthcare team about your sexuality, the LGBT Foundation has a helpline that can give you confidential advice and support – call 03453 30 30 30.

Managing sexual difficulties

There are practical ways to help manage sexual difficulties. Your doctor or nurse will give you information about these.

Most men with advanced prostate cancer have hormonal therapy. Loss of sex drive and erection difficulties are common side effects of most of these drugs.

There are no treatments that increase sexual desire while you are on hormonal therapy. When you stop taking hormonal therapy, many side effects gradually go away. It is sometimes possible to have breaks in hormonal therapy (called intermittent hormonal therapy). This may help some men.

Treatments for erectile dysfunction (ED) may help some men get an erection. But they will not increase desire. Your doctor or nurse will give you information about these.

Most treatments aim to increase the blood supply to the penis. You may need to try a treatment a few times to start with. Some men may use more than one method.

Erectile dysfunction (ED) recovery after treatment

Some men are offered an ED recovery package soon after treatment. This is usually called penile rehabilitation. You regularly use one or more treatments, such as tablets or a pump, to encourage blood flow to the penis after surgery or radiotherapy. This is to help the penis recover – it is not just for sex. When you are ready to start having sex, you should have a better chance of getting an erection. Your doctor or nurse can tell you more about this.

We have more information on managing ED.

Infertility

Most treatments for prostate cancer are likely to cause infertility. This means you will no longer be able to father a child. If you want to have children, this can be very upsetting.

If your fertility is a concern for you, talk to your specialist before treatment. It is usually possible to store sperm before your treatment starts. The sperm may then be used later as part of fertility treatment.

Relationships

If you have a partner

If you have a partner, talking openly with them can help you feel closer. It can also help you make changes to your sex life together. Talking about things can help you avoid misunderstandings and find ways to cope with problems.

There are different ways you can show your partner you care about them. This can include spending time together and showing affection through touching, holding hands or putting an arm around their shoulder. You may also find new ways to share sexual pleasure.

Talking to a counsellor or sex therapist may help you and your partner adapt to changes in your sex life. You can ask your partner to come to appointments with you. This will help them understand the issues you are dealing with.

If you are single

If you are not in a relationship, it is natural to worry about meeting a new partner or about your sex life. You may need some time to come to terms with what has happened.

It may help to talk to a counsellor or sex therapist. The College of Sexual and Relationship Therapists (COSRT) has a list of nationwide counsellors and therapists who can offer advice and support.

About our information

  • References

    Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    European Association of Urologists. Guidelines on Prostate Cancer. 2016.

    European Society for Medical Oncology. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2015.

    National Institute for Health and Care Excellence (NICE). Prostate cancer overview. Available from: pathways.nice.org.uk/pathways/prostate-cancer (accessed from March 2017 to November 2017).

    National Institute for Health and Care Excellence (NICE). Surveillance report 2016. Prostate cancer: diagnosis and management (2014). NICE guideline CG175. 2016.



  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Lisa Pickering, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.