Sex and relationships

Prostate cancer treatments can have a direct effect on your sex life. They can reduce your sex drive (libido) and cause difficulties getting an erection (called erectile dysfunction or ED).

Talk to your doctor or nurse about sexual difficulties or concerns. They will be used to talking about these issues. They can give you advice, or refer you to an ED clinic.

There are practical ways that may help some men manage sexual difficulties. But they do not increase sexual desire. Tablets, such as sildenafil (Viagra®), that you take before sex are the most common treatment for ED. There are also other methods that can be used to produce an erection. These include injecting a drug into the penis, using pellets or a cream, or a vacuum pump.

Many sexual difficulties caused by prostate cancer are similar whatever your sexuality. But having your sexual or gender or identity acknowledged may help you feel better supported.

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.

Sex and relationships

Treatments for prostate cancer can affect your sex life and your relationships. Treatments may have a direct effect on your sex life. Symptoms of the cancer or its treatments, such as tiredness or discomfort, can make it difficult to have sex. Feelings such as anxiety or sadness can also affect how you feel about 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. It 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 doctor or nurse for advice.

Being more physically active, eating healthily, and managing your weight may help to improve body image concerns. Ask your doctor or nurse for advice.


Sexual difficulties

The difficulties you have will depend on the treatment you have. Some men may already have sexual difficulties because of previous prostate treatments, other medical conditions, or their age.

Your doctor or nurse will explain the effects of your treatment on your sex life. For some men, this may be an important factor in making treatment decisions.

Effects of treatments may cause:

  • a reduced or loss of interest in sex
  • difficulties getting or keeping an erection (erectile dysfunction, or ED)
  • difficulties having an orgasm or ejaculating
  • the penis and testicles to get smaller if you are taking hormonal therapy for a long time.

Talking about sex

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 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 also 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.

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 0345 3 30 30 30.


Managing sexual difficulties

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. Many treatments work by increasing the blood supply to the penis.

If you need support coping with sexual difficulties, your nurse or doctor can give you information. They can also refer you to specialist support services.

Tablets

Tablets you take before sex are a common treatment for ED. You need to be sexually stimulated to get an erection first. If you have heart problems or are taking certain drugs, these tablets may not be recommended for you. Your GP will explain their side effects. Tablets include sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®), and avanafil (Spedra®).

Injections

You use a small needle to inject a drug called alprostadil (MUSE®) directly into the shaft of the penis. The drug restricts blood flow out of the penis causing an erection in 5 to 20 minutes. A healthcare professional will give you the first dose and teach you how to do this yourself.

Pumps

Vacuum pumps can also be used to produce an erection. They pull blood into the penis by creating a vacuum. You put a stretchy ring around the base of the penis to hold the erection. It can be maintained for up to 30 minutes.

Pellets or creams

Pellets or creams can be put into the opening of the penis with an applicator. The cream or pellet is absorbed into the penis and produces an erection.

My loss of sex drive has been restored but not to the same level before treatment. But I’ve discovered that mutual affection and love do not decrease like sexual urge.

Percy


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.

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