Male pelvic or hormone changes and sex

Side effects of cancer treatment can affect your sex life. This page is about side effects that may happen if cancer treatment directly affects your pelvic area or hormone levels.

You may find our information about the body and sex helpful when reading this page.

Not everyone will have the side effects we mention here. You may have side effects or questions that we do not cover. It is also important to remember your sexual well-being and relationships can be affected by more than just these physical changes.We have more information about cancer and relationships and the emotional effects of cancer. We also have information about:

Your cancer team can answer any questions you have about your treatment.

Erection problems (erectile dysfunction)

You may find you have problems getting or keeping an erection during cancer treatment. This is called erectile dysfunction (ED).

The cancer treatments below can cause changes that make it physically difficult to get or keep an erection. These changes may be short-term, but they are sometimes permanent. If there is a risk of ED, your cancer doctor will explain this before you decide about the treatment.

Erection problems can also happen because you are feeling tired or sick. Or they can happen because you are worried or coping with difficult feelings. This is a common response to what you are going through. It is often temporary and usually goes back to normal after treatment ends.

If you are worried about ED, you can talk to your cancer doctor, specialist nurse or GP before, during or after your treatment. They can give you advice about support or treatments that may help. Long-term erection problems may have a big impact on the type of sexual activity you usually enjoy. A sex therapist or counsellor may be able to help you cope or find different ways to have sex.

Pelvic surgery

Some types of surgery can damage the nerves and blood vessels that make the penis hard when you are aroused. This includes surgery to the:

  • prostate
  • bladder
  • anus, rectum or lower part of the colon.

After one of these operations, you may have difficulties getting or keeping an erection. This may not be permanent, but it can be a long-term problem. The risk of problems is higher if you had erection problems before the surgery, and if you are older. The older you are, the bigger the risk of long-term problems.

Sometimes a type of surgery called nerve-sparing surgery can reduce the risk of long-term erection problems. Your surgeon can explain if this is suitable for you. If the cancer is growing into or close to the nerves, nerve-sparing surgery may not be possible.

Your body needs time to recover after surgery. It may be several months or sometimes years before your erections start to improve.

Pelvic radiotherapy

Pelvic radiotherapy can narrow the blood vessels that make the penis hard when you are aroused. This may permanently affect your ability to get or keep an erection.

If erection problems develop, this usually happens slowly a few months after treatment. It may continue to get worse for up to 3 years.

Hormonal therapy

Some cancer treatments are used to reduce levels of hormones that are helping cancer cells grow. These treatments are often used to treat prostate cancer by reducing testosterone levels. They include:

  • hormonal therapy tablets and injections
  • surgery to remove both testicles.

Low levels of the hormone testosterone can reduce your interest in sex and make it difficult to get an erection.

Hormone tablets and injections may be used for months or even years at a time. Some people will be on this treatment for the rest of their life. Sometimes it is possible to take breaks from treatment to reduce side effects for a time. This is called intermittent hormonal therapy. Your cancer doctor can explain if this is suitable for you.

Your erections may improve slowly over a few months after stopping hormone tablets or injections. This can depend on whether you have also had other treatments, such as pelvic radiotherapy or surgery. Your cancer doctor can give you more information.

Chemotherapy

Chemotherapy does not usually physically affect your ability to get or keep an erection.

Rarely, some types of chemotherapy drug may affect the nerves that make the penis hard. The drug most likely to do this is called vincristine. Other drugs that might do this include cisplatin and doxorubicin. This is usually a short-term side effect. It usually improves a few weeks after you have your last chemotherapy treatment.

Sometimes high doses of chemotherapy can affect your testosterone levels. Having low levels of this hormone can reduce your interest in sex. It can also make it difficult to get an erection. Your testosterone levels usually recover slowly after your treatment ends.

Treating erection problems

If you have problems getting or keeping an erection, there are treatments that may help. These include:

  • tablets taken before sex
  • vacuum pumps that pull blood into the penis
  • injections into the penis
  • a pellet or cream you put into the opening of the penis (the urethra)
  • penile implants
  • sex therapy.

A treatment may not always work the first time you use it. As long as you do not have side effects, you may need to try a few times before you know how well it works for you. If you have had nerve-sparing surgery, your nerves can take a few months or longer to heal. If a treatment does not work at first, you may get better results with it a few months later.

It is often worth trying different treatments for erection problems. Some may work better for you than others. Or you may find a combination of treatments gives you the best result. Give yourself time to experiment with different types of treatment and try to be patient.

You may also need time to practice using some of the treatments. Some only work with sexual stimulation. If you have a partner, it may help to involve them. You may want to bring them to any appointments, so they understand a treatment before you try it at home.

Treatments for erection problems may not feel very sexy to use. You may worry you will lose your interest in sex while you wait for a treatment to work. If you are with a partner, you could use the treatment as part of your foreplay. Or it can be helpful to talk to a sex therapist as you both get used to these changes to your sex life.

Penile rehabilitation

This means using ED treatments to reduce your risk of long-term erection problems after pelvic surgery or radiotherapy. It is also called an ED recovery package.

After your cancer treatment, you take ED treatments such as tablets and use a vacuum pump regularly. You do this even if you do not want an erection or to have sex. The aim is to exercise the muscles and tissue needed for erections. This may improve your chances 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.

Tablets

Some drugs can help you get an erection. These tablets work by improving the blood supply to the penis:

  • Sildenafil (Viagra®)
    You should take this about 60 minutes before you want an erection.
  • Vardenafil (Levitra®)
    You should take this 30 to 60 minutes before you want an erection.
  • Avanafil (Spedra®)
    You should take this 15 to 30 minutes before you want an erection.
  • Tadalafil (Cialis®)
    You should take this 30 minutes to 2 hours before you want an erection. Tadalafil can also be taken regularly, so the drug builds up in the body. You take a lower dose once a day, every day. This means you can get an erection without having to plan to take a tablet first.

The tablets only work with sexual stimulation. Your GP, cancer doctor, specialist nurse or sex therapist can explain how to take these drugs and the possible side effects. They may not be safe for you if you have heart problems or if you are taking certain other types of drug, such as nitrates. They should not be taken with recreational drugs such as amyl nitrate (poppers). Ask your doctor if you are not sure about other drugs you are taking.

Priapism

A possible side effect of these drugs is having an erection that lasts for a few hours. This is called priapism. It is a serious side effect, as it can damage the tissues of the penis. If your erection lasts longer than 2 hours, you should always get medical help as soon as possible.

Injections

This treatment may be more effective than tablets if you have erection problems caused by nerve damage.

You inject a drug called alprostadil (Caverject®, Viridal®) into the penis, using a small needle. This improves blood flow in the penis and usually causes an erection in 5 to 20 minutes.

A healthcare professional will explain how to take alprostadil and possible side effects. They will give you the first injection and teach you how to do this yourself. Your dose will be adjusted to find what works best for you.

Priapism is a possible side effect of this treatment. If you have priapism, you should always get medical help as soon as possible.

Pellets or cream

You can also use the drug alprostadil as pellets (MUSE®) or a cream (Vitaros®). You put this into the opening of the penis to cause an erection.

You need to pass urine (pee) before using the pellets. This wets the urethra and helps the pellet dissolve. Inserting the pellet or cream is not usually painful. But the drug may cause a burning feeling or pain in the penis as it starts working.

A healthcare professional will explain how to take alprostadil and the possible side effects. They will give you the first dose and teach you how to do this yourself. It can be adjusted to find the right dose for you. This treatment can cause priapism, but this is rare.

Pumps

Vacuum pumps can be used to pull blood into the penis and cause an erection. They are also called vacuum erection devices (VEDs).

You put your penis in the pump. The pump creates a vacuum that makes the penis fill with blood. You put a stretchy band around the base of the penis to hold the erection. This is called a constriction band. You should not wear the band for more than 30 minutes.

You can orgasm while wearing the band. But it presses on the urethra and this may stop semen coming out if you ejaculate. When you take the band off, the blood flows normally again. You will lose any remaining erection and semen may come out.

You can use a pump as many times as you want, but you should leave 30 minutes between each use. Using a pump may make your penis slightly bigger and colder than usual. You may need to try it a few times before you get used to using it.

There are different types of pump and different constriction bands. They are sometimes available on the NHS or you can buy them. Your GP, cancer doctor, specialist nurse or sex therapist can give you more information.

Penile implants

This is sometimes used if other erection treatments have not worked. You have an operation to place implants inside the penis. There are two main types of implant:

  • Semi-rigid rods
    Semi-rigid rods keep the penis firm all the time. You bend the penis down when an erection is not needed.
  • Inflatable rods
    Inflatable rods make the penis erect when they are filled. During the operation to place the rods, a pump is put into the scrotum and a small balloon filled with water is put into the tummy (abdomen). When you want an erection, you use the pump to fill the rods with water.

Your doctor can give you more information about penile implants. This treatment is not always available on the NHS.

Lifestyle changes and other tips

Depending on the cancer treatment you have had, you may also improve erection problems by making changes to your lifestyle. We have more information about making changes to your lifestyle.

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 out what feels good now. A sex therapist may be able to help you cope or find different ways to enjoy sex.

Changes to ejaculation or orgasm

Pelvic radiotherapy and some types of surgery may change how you ejaculate or how your orgasms feel. Often it can help to know what to expect. But if these changes affect your relationships or how you feel about having sex, it may help to talk to a sex therapist.

Painful ejaculation

Pelvic radiotherapy can irritate the urethra. You may have a sharp pain when you ejaculate during treatment and for a few weeks afterwards. This should improve as your body recovers after treatment.

Dry ejaculation

Some treatments affect the prostate’s ability to make fluid to carry sperm down the urethra. When you orgasm it may feel different. Less or no fluid may come out. This is called a dry ejaculation or dry orgasm.

If you have had surgery to remove the prostate, you will have dry ejaculations. The testicles still make sperm, but it is safely re-absorbed back into the body.

Dry ejaculation can also happen after pelvic radiotherapy. It may happen slowly after external radiotherapy. After internal radiotherapy (brachytherapy) for prostate cancer, it happens soon after treatment.

Ejaculating into the bladder (retrograde ejaculation)

Surgery for testicular cancer may involve removing lymph nodes in the lower tummy. Lymph nodes are small glands that help the body’s immune system fight infection and disease. This can affect the nerves that control ejaculation.

This means when you orgasm, the fluid containing sperm (semen) goes into the bladder instead of out through the penis. This is called a retrograde ejaculation. It may make your orgasms feel different. After ejaculation, you may notice your urine is cloudy. This is caused by semen in the urine. It is not harmful.

Leaking urine at orgasm

Surgery to remove the prostate can sometimes cause a small amount of urine to leak at orgasm. This is called climacturia. Urine is sterile and will not cause an infection for your partner. But some people find it embarrassing or difficult to cope with.

Prostate massage and orgasm

Some cancer treatments can affect the prostate. This may change whether you can orgasm by having your prostate touched when you receive anal sex. This includes using fingers, a hand or sex toys inside the back passage.

Radiotherapy to the prostate can make the prostate and back passage tender or painful to touch. Longer-term, you may find anal sex feels different or that it is harder to orgasm this way.

If your prostate has been removed, you may find receiving anal sex feels different and you will not be able to have prostate orgasms.

This may be a big change in your sex life and relationships. A sex therapist or counsellor may be able to help you come to terms with this and find different ways to enjoy sex.

Changes to the penis

Some cancer treatments can make the penis smaller or look smaller.

If pelvic surgery has affected nerves near the penis, it may pull tighter to the body and look smaller. As the nerves recover in the months after surgery, the penis should return to its normal size.

Treatments that reduce your testosterone levels can also make the penis smaller. For example, this may happen if you are on hormonal therapy drugs for a long time. It can also happen if you have surgery to remove both testicles.

Low testosterone levels mean you are less likely to have erections or be interested in sex. This means the tissues and muscles in the penis are not exercised in the usual way. Eventually, it can affect the size of the penis and your ability to get or keep an erection.

Your cancer team may suggest you use erectile dysfunction (ED) treatments to reduce your risk of changes to the penis. This is called penile rehabilitation. 

Treatment for cancer of the penis

Any treatment for cancer of the penis can be difficult to cope with. Most treatments will not affect your ability to get an erection or orgasm. But they can still affect how you feel about your body and affect your confidence sexually.

Surgery to remove cancer from the penis may cause scars. Your surgeon will remove as little of the penis as possible. But after surgery, your penis may be smaller or a slightly different shape. Depending on the areas removed, the sensation in your penis may be different after surgery. You should still be able to have erections and orgasms.

If more of the penis needs to be removed, you may be able to have surgery to reconstruct the penis later. Depending on the type of reconstruction you have, you may still be able to get an erection.

Your surgeon and specialist nurse can explain your operation and what to expect. You should give yourself time to adjust to any changes. If the sensation in your penis is different, you may want to take time by yourself or with a partner to find out what feels good now. It may help to talk to a sex therapist if you are finding sex difficult in any way.

Rarely, the surgeon needs to remove the whole penis. This operation is called a total penectomy. It may be possible to have reconstruction surgery to make a new penis.

If the penis must be removed completely, this can be very difficult to adjust to. The areas around the scrotum and testicles will still be sensitive. With time and patience, you may find other types of touch that you enjoy or that cause orgasm.

Low testosterone

Some cancer treatments may affect your levels of the hormone testosterone. Low testosterone levels can cause symptoms including:

  • less interest in sex
  • erection problems
  • muscle loss
  • bone thinning
  • mood changes
  • tiredness. 

Treatment for prostate cancer

Treatment for prostate cancer often involves reducing testosterone levels to shrink the cancer or stop it growing. Usually, testosterone is reduced with drugs called hormonal therapies. Sometimes it is reduced by using surgery to remove both testicles.

Both types of treatment can cause symptoms of low testosterone levels. If you find hormonal symptoms hard to manage, we have information about managing hormonal symptoms that may help.

Hormone tablets and injections may be used for months or even years at a time. Some people will be on this treatment for the rest of their life. You may find the effects of low testosterone get easier to manage. Sometimes it is possible to take breaks from treatment to reduce side effects for a time. This is called intermittent hormonal therapy. Your cancer doctor can explain if this is suitable for you.

Your erections may start to improve a few months after stopping hormone tablets or injections. This can depend on whether you have also had other treatments, such as pelvic radiotherapy or surgery.

If you are worried about the effect of low testosterone on your sex life, it may help to talk to someone. There are treatments for erection problems that may help.

Other cancer treatments

Other treatments that may cause low testosterone include:

Usually your testosterone levels slowly return to normal after these treatments. But low testosterone is sometimes a long-term or late effect of treatment and may cause symptoms. Your cancer doctor will explain if this is likely for you.

You can have a blood test to check your testosterone levels. Sometimes your doctor can give you testosterone replacement therapy (TRT) to help. You usually take this as a gel on your skin or as an injection. This treatment is not suitable for everyone and should not be used if you are trying to start a pregnancy. Your doctor can give you more information.

Changes in sexual sensation

Some cancer treatments cause changes that affect how sex feels. After pelvic radiotherapy or surgery, you may have changes to the skin or nerves. This can affect your sensations in the pelvic area. You may find it harder to get aroused by touching these areas. If your prostate has been removed, you may find receiving anal sex feels different and you will not be able to have prostate orgasms.

You may want to take time by yourself or with a partner to find out what feels good now. Do not put pressure on yourself to have the same sensations you had before treatment. A sex therapist or counsellor may be able to help if you are worried or having problems.

Bladder problems

Some cancer treatments can cause bladder side effects, such as leaking pee (incontinence) or difficulty peeing (passing urine). These can be short-term problems, but they can sometimes be permanent. They may make you feel self-conscious or embarrassed about being physically close with someone. They may also make you less interested in sex.

There are often ways to manage bladder problems. Talk to your GP, cancer doctor or specialist nurse, or with a physiotherapist. They may give you medicines, or advice about pelvic floor muscle exercises that can help. They can arrange for you to see a specialist for treatment or more support if you need it.

We have more information about bladder problems

Climacturia

If you leak urine during sex (climacturia), a technique called bulbo-urethral massage may help reduce this. Your GP, cancer doctor or specialist nurse can give you more information about this.

You can also use a constriction band around the base of the penis when you have an erection. The band presses down on the urethra and stops urine coming out. You can keep this type of band on for up to 30 minutes. You can orgasm while wearing the band. But because it presses on the urethra, this may stop semen coming out if you ejaculate. You should not keep it on for longer than 30 minutes, because this can damage the tissues in the penis. You may need to experiment to find the right tightness, so it stops urine and is still comfortable for you.

It can be embarrassing, but it is also a good idea to be honest about bladder problems with sexual partners. It may help them to know a little urine may leak during sex. Urine is sterile and will not harm them or cause infections.

These tips may also help:

  • Try to avoid drinking lots of fluid for about an hour before you have sex.
  • Go to the toilet just before you have sex.
  • Wear a condom.
  • Have tissues and towels nearby during sex.
  • Try having sex in the shower.

If you have a catheter

Sex is still possible if you have a urinary catheter (a tube in the bladder and penis that drains urine out of the body). It should not affect your ability to get an erection or ejaculate. You can fold the catheter back along the penis using surgical tape and cover it with a condom to keep it in place. You may need to use a lubricant during sex.

After sex, you should always wash around the catheter. Sometimes it may be possible to remove the catheter before sex. Your nurse, or a continence adviser, can show you how to remove your catheter.

Changes to the anus or rectum

How changes may affect anal sex

Changes to the anus or rectum (back passage) may affect your sex life if you are the receptive partner for anal sex. This includes using fingers, a hand or sex toys inside the back passage.

Changes can be caused by some types of:

If you want to receive anal sex, your cancer team may advise you to wait for a time after treatment before you try. Your body needs time to recover and heal. It is important to ask them for advice. They can explain how long you should wait and if it is safe for you to receive anal sex.

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.

Long-term changes and anal sex

Sometimes changes are longer-term and can mean anal sex is no longer possible or safe. A sex therapist may be able to help you cope and find different ways to enjoy sex. Your risk of having long-term changes depends on the treatment you had.

Radiotherapy to the rectum may make it less stretchy, more fragile and less able to heal. Your cancer team may suggest you avoid receiving anal sex to prevent damage to the rectum. Damage can become a serious problem if the tissues cannot repair.

Surgery can also cause long-term changes. If the anal opening was surgically closed as part of your operation, you will not be able to receive anal sex. If the rectum was surgically closed further inside your body, you may still be able to receive anal sex. But you will still need to wait until all the wounds have healed.

If receiving anal sex is part of your usual sexual activity, these changes can have a big impact on your sex life and relationships. It is important to get the right information from your cancer team about your treatment and how it may affect you.