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If you or someone you care about has been treated for prostate cancer, you may have noticed changes in your sex life. Prostate cancer itself can affect sexual activity, but most often, sexual concerns show up as side effects of prostate cancer treatment.
Many different factors can influence the degree of sexual changes after treatment, and most people experience some form of sexual side effect. Even though these changes are common, it’s often hard to talk about them.
This article will explain how prostate cancer and its treatments can affect your sex life. Knowing what to expect can help you feel more prepared for treatment. After you finish treatment, there are many ways to manage side effects and improve your sexual health. Talking openly with your doctor is an important step in finding the support and solutions you need.
Erectile dysfunction (ED) means having trouble getting or keeping an erection that’s firm enough for sex. ED is a common experience after prostate cancer treatment. When ED starts and how long it lasts can depend on which treatment you have.
ED symptoms often begin soon after prostate surgery. Some people may see improvement over time, but recovery can take up to 18 to 24 months. In some cases, erections may not return. Surgeries that try to protect the nerves responsible for erections (called nerve-sparing procedures) may improve your chances of regaining erections, but there are no guarantees.
ED symptoms after radiation therapy usually develop more slowly. Symptoms may show up about six to 18 months after treatment and can sometimes worsen as time passes.
Hormone therapy lowers the body’s sex hormones, including testosterone, which can lead to ED. After stopping hormone therapy, some people find their ability to get erections improves within a few months.
High-intensity focused ultrasound (HIFU) treatment uses high-frequency sound waves to heat and destroy cancer cells. ED can happen after HIFU, but some people notice their erections improve over time.
Cryotherapy freezes cancer cells to destroy them. ED is a common side effect, but for some, erectile function may get better over time.
With treatment, many people with ED after prostate cancer can have erections again. Options include:
Lifestyle changes — like quitting smoking, maintaining a healthy weight, and being physically active — can also help manage ED and improve sexual function.
Decreased libido (low sex drive) is a common experience for people with prostate cancer and a side effect of some treatments. Following are some reasons your sex drive might decrease.
Fatigue (extreme tiredness that doesn’t go away with rest) can happen with any prostate cancer treatment. Feeling very tired may make you less interested in having sex.
Some treatments, such as radiation therapy, can cause bowel changes like diarrhea, trouble controlling bowel movements, or rectal bleeding. Prostate cancer surgery can sometimes cause urine leakage during sexual arousal or orgasm. These side effects may lower your desire for sex.
Hormone therapy — also called androgen deprivation therapy (ADT) — reduces the amount of testosterone and (to a lesser extent) other sex hormones in the body. Lower testosterone can decrease sex drive. Hormone therapy can also cause changes like:
These physical changes may also affect your libido.
It’s common to feel anxious, depressed, or stressed after a cancer diagnosis. These feelings can lower your interest in sex.
Prostate cancer treatment and its side effects may change the way you feel about your body or yourself. Some people may feel less confident or worry about changes to their sense of masculinity. These feelings can affect your sexual desire.
If you have a partner, talking openly about sex and how you’re feeling can help you both adjust. For many people, the desire for sex returns after treatment and recovery. If it doesn’t come back right away, you can explore other ways to stay close. Physical touch, such as cuddling and kissing, can help you and your partner feel connected.
Depending on the type of prostate cancer treatment you receive, you may notice changes in your orgasms or ejaculation. These can include the following:
After a radical prostatectomy (surgery to remove the prostate), you can still have an orgasm — even if you don’t have an erection — but you will no longer ejaculate semen. This is called a dry orgasm. The intensity or feeling of orgasm may be stronger, weaker, or different than before.
Some treatments, including certain types of radiation therapy or surgery that affects the bladder neck, can cause retrograde ejaculation. This happens when semen flows backward into the bladder instead of out through the penis. Retrograde ejaculation is not harmful. The semen leaves the body the next time you urinate.
Prostate cancer surgery can sometimes cause urine leakage during sexual arousal or orgasm. This is called climacturia. Pelvic floor exercises (such as Kegel exercises) may help improve bladder control over time.
Some people experience pain or discomfort during orgasm after prostate surgery or radiation therapy. This usually improves with time, but if it continues, talk with your doctor about possible treatments.
Some treatments such as radiation therapy, brachytherapy (internal radiation), and HIFU may reduce the amount of semen you produce. You might also notice small amounts of blood in your semen, especially in the months after treatment. Hormone therapy can lower semen production and may change how intense orgasms feel.
Many prostate cancer treatments can affect fertility (the ability to have biological children). If you have surgery to remove the prostate, you’ll no longer be able to have a child naturally. After this surgery, you can still have an orgasm, but you will not ejaculate semen. This is known as a dry orgasm.
Other treatments for prostate cancer may lead to infertility as well, including:
With radiation therapy and chemotherapy, infertility may be temporary or permanent, depending on the dose and your age. In many cases, fertility does not return after prostate cancer treatment.
If you may want to have biological children in the future, talk with your doctor before starting treatment. Options such as sperm banking (sperm storage) can help preserve your ability to have children later. A fertility specialist can explain your choices and what to expect.
Prostate cancer surgery and hormone therapy can cause changes in the size or shape of the penis and testicles. These changes can be upsetting, but they are a known side effect of treatment.
After surgery to remove the prostate, some people notice a small decrease in penis length when the penis is flaccid (soft), erect, or both. The average decrease is about 1 centimeter, although this varies from person to person. Some may also notice curvature or narrowing of the penis after surgery. Although doctors don’t fully understand why this happens, possible causes include scar tissue, reduced blood flow, or nerve changes that affect erections.
Penile rehabilitation (treatments started soon after surgery to support erectile health) may focus on improving blood flow to the penis. Options can include vacuum erection devices and medications for ED. These treatments may help reduce further shortening and support recovery of erectile function.
Hormone therapy lowers testosterone levels in the body. ADT can be given with medications or, less commonly, through orchiectomy (surgery to remove the testicles). Lower testosterone can lead to shrinkage of the penis and testicles over time.
On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.
Which sexual changes have you experienced as a result of prostate cancer or its treatment? Let others know in the comments below.
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About 25 years or so when my prostate cancer really became an issue I never thought that it would affect my life as it has
Prior to the cancer fully manifested my wife and I had an active and… read more
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