Sex life and prostate cancer
Treatments for prostate cancer can cause sexual difficulties. You may have side effects that make having sex difficult or make you feel less interested in sex.
How prostate cancer treatment can affect your sex life
Treatments for prostate cancer can cause sexual difficulties and make you feel less interested in sex. These side effects can include:
- tiredness (fatigue)
- feeling less interested in sex (loss of libido)
- changes to your bladder or bowel
- hormonal effects, such as weight gain or breast swelling.
As side effects improve, you may feel more interested in sex.
If prostate cancer and its treatments are affecting your sexual wellbeing, it can feel very difficult to cope with. 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 (body image). You may feel less sexually attractive. If you are having issues with your body image, ask your GP, cancer doctor or specialist 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 GP, cancer doctor or specialist nurse for advice.
Sexual difficulties
Prostate cancer treatments can have a direct effect on your sexual wellbeing. For example, they can cause difficulty with getting or keeping an erection. This is called erectile dysfunction (ED).
You may already have had sexual difficulties before your diagnosis. These become more common as you get older. ED is also linked with conditions such as high blood pressure and raised cholesterol.
After a radical prostatectomy, ED may happen soon after treatment.
With radiotherapy, you may not have ED problems immediately after treatment, but it may develop over years. Hormonal therapy may also lower your ability to get and maintain an erection. Your erections may improve slowly over a few months after stopping hormonal therapy.
Treatment can also affect your ability to have an orgasm or to ejaculate. After a radical prostatectomy, you will not ejaculate semen but can still have an orgasm. After having external radiotherapy or brachytherapy, you do not usually produce much semen but can still orgasm.
Some treatments can reduce your sex drive (libido). Hormonal therapy, which you may have with radiotherapy, lowers your libido.
If you have ED, there are different treatments to help you
Talking about sex and prostate cancer
You may find it difficult to talk about sex with your GP, urologist, cancer doctor or specialist nurse. But it is important to have your questions answered and to get the help you need. They should make you feel comfortable during conversations about sex. You do not need to use medical words. Use the words you normally use. This can help the professionals understand how to best support you.
You may want to think about if there is someone in your healthcare team you feel more comfortable talking to. To help you feel prepared, plan what you want to say in advance and write down your questions. If you have a partner, you may want them with you at these discussions. Or you may prefer to talk confidentially with your doctor or nurse. If you need more specialist advice your GP, urologist, cancer doctor or specialist nurse can refer you to an ED clinic or a sex therapist.
If you find it difficult talking to your healthcare team or getting information, there is other support available. You can talk in confidence to a cancer information nurse specialist on our Macmillan Support Line or through email. Prostate Cancer UK also has a helpline where you can talk or chat online to a specialist prostate nurse.
Sex and treatment
If you have questions about sex during or after treatment, ask your urologist, cancer doctor or specialist 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 just might not feel ready. You may decide to wait until your side effects improve.
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If you identify as LGBTQ+
Your healthcare team is there to support you and treat you in a way you feel comfortable with. There may be times when it helps the team know how you identify your gender or sexual orientation. It may help you feel better supported. And your healthcare team can give the right information and support to you and your partner, if you have one.
The impact of cancer and cancer treatment are often the same whatever your sexual orientation or gender. But you may have some specific questions about how these will affect your sexual wellbeing.
If you are trans (transgender) or non-binary, talking to a healthcare professional about sex can sometimes be especially difficult and complicated. Some of the information you need may involve parts of the body that do not reflect your gender identity. You may find this uncomfortable or upsetting to talk about. You may also have specific questions about sex and cancer if you take hormones or have had gender realignment surgeries.
If you do not feel you can talk to your healthcare team, you could talk to:
- your local sexual health service
- a transgender sexual health service.
Prostate Cancer UK has more information for gay and bisexual men and transgender women.
If your healthcare team cannot help, they can refer you to a sex therapist or another specialist who can. If you want to talk things through, you can call the LGBT Foundation on 03453 30 30 30. They can give you confidential advice and support.
Prostate cancer treatment and anal sex
Pelvic radiotherapy can affect the lower bowel (rectum) and cause side effects. If you receive anal sex, your healthcare team may advise you to wait until 8 weeks after treatment. This avoids making side effect worse or causing longer term problems. Your cancer doctor, radiographer or specialist nurse can explain when it should be safe to receive anal sex. You can talk to them about long term changes to the rectum that may make receiving anal sex difficult.
After a radical prostatectomy, you are usually advised to wait for 6 weeks before you receive anal sex. Your urologist or specialist nurse can talk to you about when it should be safe.
When you feel ready to try, start slowly and gently. Use lubricant to help protect the anus and rectum. Take your time and build up to full penetration slowly.
Managing erectile dysfunction (ED)
There are practical ways to help manage ED. Your urologist, cancer doctor or specialist nurse can give you information about these.
If you are having hormonal therapy, it is likely to lower your sex drive. Treatments for ED do not increase sex drive, but you may still want to try them.
Penile rehabilitation
Penile rehabilitation means using erectile dysfunction (ED) treatments to reduce the risk of long term erection problems after pelvic surgery or radiotherapy. Because a radical prostatectomy can cause ED problems quickly, you may be offered penile rehabilitation soon after treatment.
After cancer treatment, you have ED treatments and use a vacuum pump regularly. You do this even if you do not want an erection or to have sex. This is to exercise the muscles and tissues needed for erections. This may improve the chance of being able to have erections.
Using ED treatments in this way is not always available through the NHS. There is not enough evidence to show how effective it is yet.
Your urologist, cancer doctor or specialist nurse can tell you more about this.
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Treatments for erectile dysfunction (ED)
Most ED treatments aim to increase the blood supply to the penis. You may need to try a treatment a few times to start with. You may want to try more than 1 method. Your urologist, cancer doctor or specialist nurse can give you advice and support.
Treatments for ED include:
- tablets
- injections
- pellets or creams
- pumps.
These all work by improving the blood flow to the penis. Your healthcare team can tell you more about these methods if they are suitable for you. They can explain how to use them and about any side effects.
If other treatments do not work for you, your healthcare team may talk to you about penile implants. These are not always available through the NHS.
You may also be able to improve erections with lifestyle changes such as keeping to a healthy weight and being physically active. Other things that can help are finding ways to cope with stress, stopping smoking, drinking less alcohol and not taking recreational drugs.
We have information about these methods online. You can also listen to stories from people who have had a radical prostatectomy and the effect on their sex life.
Fertility
Most treatments for prostate cancer are likely to cause infertility. This means you will no longer be able to get someone pregnant naturally.
If fertility is a concern for you, talk to your specialist before treatment. It is usually possible to store sperm before treatment starts, but you may need to pay for this. The sperm may then be used later as part of fertility treatment.
Relationships and sex
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 them.
Remember, there are lots of ways to give and receive pleasure. You do not need to be able to have penetrative sex to make a partner feel good. And you do not always need to have an erection to ejaculate or have an orgasm.
You could try other types of touching, such as oral sex or using sex toys. Take time to try new things and experiment to find what feels good now. A sex therapist may be able to help you cope or find different ways to enjoy sex or improve your sexual wellbeing.
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. Lovehoney supports people to increase their understanding of sex and cancer, and suggests ways to maintain a healthy sexual relationship during and after cancer treatment.
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About our information
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.
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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 informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. NICE Guideline [NG131]. Published: 09 May 2019. Last updated: 15 December 2021. Available from: www.nice.org.uk/guidance/ng131 [accessed March 2024].
Castro E, Fizazi K, Heidenreich A, Ost P, Parker C, Procopio G, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020; 31(9): 1119–1134. Available from: www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext [accessed March 2024].
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
University College Hospitals, London
Date reviewed
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