Pelvic radiotherapy: sex life and fertility for men

Pelvic radiotherapy may affect your sex life, or your ability to make someone pregnant (your fertility). Your radiotherapy team can give advice and support. If you are worried about fertility, talk to them before you start treatment. There may be ways they can protect, or preserve your fertility.

Your team may tell you to use contraception during radiotherapy and for a time after. This is to:

  • prevent pregnancy, because some treatments can harm an unborn baby
  • protect your partner, if you have seed brachytherapy for prostate cancer.

Ask your team to explain which type of contraception you should use. They may also advise you to wait a few weeks after radiotherapy before having sex. This allows any irritation and side effects to improve.

Side effects may:

  • mean you do not feel like having sex
  • make having penetrative sex uncomfortable or painful
  • make it difficult to get, or keep, an erection.

It is normal to feel nervous about having sex after pelvic radiotherapy. Take your time and make sure you are relaxed. If you have problems that do not improve, talk to your cancer doctor or nurse.

Effects on your sex life

It can be difficult to talk about your sex life. But if you have any problems during or after your treatment, there are usually things that can help. You may have side effects that:

  • mean you do not feel like having sex
  • make having penetrative sex uncomfortable or painful
  • make it difficult to get, or keep, an erection.

Do not let embarrassment stop you from getting information that can help. Your team can give advice and support. If you need expert advice, they can often arrange this for you.

If you identify as gay, bisexual, transgender or LGBT+, you may worry about your healthcare team treating you insensitively. Many sexual difficulties caused by pelvic radiotherapy are similar whatever your sexuality. But you may have some specific questions. Having your sexual or gender identity acknowledged may help you feel more supported. It also means your healthcare team can give you the right information and advice.

If you feel unable to talk to your healthcare team about your sexuality, contact the LGBT Foundation. They have a helpline that can give you confidential advice and support.

I can experience sex but it’s different. I went to see a nurse who deals with sexual problems. I wouldn’t have spoken openly about before, but it was quite helpful.

Christopher


Having sex after treatment

Your team may advise you to wait a few weeks after radiotherapy before having sex. This is to allow any irritation and side effects to improve. Ask your doctor or nurse for advice about this, as it can depend on the treatment you are having.

It is normal to feel nervous about having sex after pelvic radiotherapy. You may have ongoing side effects. Or you may be coping with changes that affect your feelings about your body. If you are ready to have sex, take your time and make sure you are relaxed. If you have any problems that do not improve, talk to your cancer doctor or nurse.

We have more information about cancer and your sex life.

Sex and cancer - tips for men

Sex therapist, Lorraine Grover, demonstrates the tools available for men to help with possible sexual side effects of cancer treatment.

About our cancer information videos

Sex and cancer - tips for men

Sex therapist, Lorraine Grover, demonstrates the tools available for men to help with possible sexual side effects of cancer treatment.

About our cancer information videos


Protecting your partner

You may have had brachytherapy, with radioactive seeds placed in the prostate gland as part of your treatment. After having this treatment, you should use condoms during sex for the first few weeks. This is in case a radioactive seed moves from the prostate into the semen. But it is very rare for this to happen.


Contraception

It may be important that you do not make someone pregnant during radiotherapy, and for a few months after it has finished. Some treatments can be harmful to an unborn baby.

Your radiotherapy team can give you more information about this. They may tell you to use contraception to prevent a pregnancy during your treatment and for a time after. There are different types of contraception. Ask them to explain which type is best for you.

Preventing pregnancy may be important even if you have been told that radiotherapy might affect your fertility. It is difficult to know exactly when this will happen. You may still be able make someone pregnant.


Erection problems

Radiotherapy to the pelvic area can cause problems getting or keeping an erection. This is called erectile dysfunction or ED. You may find your erections are not as strong as they were before the treatment. You may get an erection, but then lose it. Or you may be unable to get an erection at all. Your radiotherapy team can explain what is likely to happen.

Although you may feel embarrassed, talk to your doctor if you are having problems. There are treatments for ED that may help.

It is natural to worry about how ED will affect your sex life. It may help to remember there are lots of ways to give and receive pleasure. Sex is not only about penetration. There are other ways to be intimate with your partner, such as oral sex, mutual masturbation or using sex toys. Sometimes, both you and your partner may enjoy just hugging and kissing as ways of being intimate during this time.


Changes in ejaculation

You may have a sharp pain when you ejaculate. This is because radiotherapy can irritate the tube that runs through the penis from the bladder (the urethra). The pain should get better a few weeks after treatment finishes.

After treatment, pelvic radiotherapy reduces the amount of semen you produce. This means when you ejaculate, you may only notice a small amount of fluid. Some men do not produce any semen at all. This is called a dry ejaculation. But you will still be able to orgasm (climax). You may find the sensation of an orgasm feels different from before.


Effects on fertility

Pelvic radiotherapy may make you unable to make someone pregnant (infertile). Before you decide to have treatment, your team will explain any risks to your fertility. For some people, radiotherapy causes changes that may get better with time. For others, the treatment they have to the pelvic area causes permanent infertility.

Your team may talk to you about persevering your fertility, if this is possible for you. For men, preserving fertility usually means collecting and freezing sperm.

Preserving fertility is not always possible. But it may mean some people who lose their fertility are still able to have a baby in the future. We have more information about fertility preservation for men.

Losing your fertility can be hard to cope with, especially if you had planned to have children. It can help to get the right support. If you have a partner, it may be a good idea to include them in this too.

Your doctor or nurse can usually arrange for you to talk to a fertility counsellor or therapist. Talking to other people who are in a similar position may be helpful. Organisations such as the British Infertility Counselling Association (BICA) can offer support and counselling. If you are not sure where to start or just want to talk, you can contact our cancer support specialists

I had to give a sperm sample, so if one day I wanted to have children, I could. It’s something I’ve only just come to terms with and been able to talk about.

Paul

Back to Pelvic radiotherapy explained

What is pelvic radiotherapy?

The pelvis is the lower part of the tummy between the hips. Radiotherapy to this area is called pelvic radiotherapy.

Side effects during treatment

You may have side effects during and shortly after your treatment. The healthcare team will help you manage these.

After pelvic radiotherapy

Your radiotherapy team will explain any follow-up you need, how they can help and how you can help yourself.