Sex After Prostate Cancer

About 12.1 percent of men in the United States will be diagnosed with prostate cancer in their lifetime, according to the National Cancer Institute. The good news, though, is that the five-year relative survival rate is about 98 percent, thanks to the myriad treatments available.

While options to combat prostate cancer dramatically impact men’s lives for the better, they’re not without other consequences. Complications such as erectile dysfunction (ED) and decreased libido affect thousands of men annually and can place a great strain on daily life and personal relationships.

Treatment options for prostate cancer

So you’ve been diagnosed with prostate cancer—what now?

Watchful waiting, the most conservative treatment, involves repeat diagnostic testing and/or imaging at certain intervals. This method is considered for mild and low-risk cases. If surgery is recommended, it may necessitate removal of part or all of the prostate gland and subsequent radiation and/or hormone therapy.

A doctor’s recommendations will depend on your age, risk factors, stage of cancer, imaging and other considerations. Your physician will explain the pros and cons, and the best individual outcome. There is no perfect treatment, but you’ll have the opportunity to learn the risks and benefits of each option, and decide what’s best for you and your family.

Sexual health effects

Four main components of an erection can be impacted by treatments for prostate cancer: libido, mechanical ability, orgasm and ejaculation.

Changes in libido are associated primarily with hormone therapy; lowered testosterone levels, for example, can cause decreased desire. While this can be very stressful in the short term, it is a temporary issue that should resolve itself once the required hormone therapy has run its course.

Mechanical ability—that is, the ability to have a firm erection—is often impacted by radiation and surgical treatment. Depending on the type of treatment, up to 50 percent of men still struggle with ED as a side effect years later. Fortunately, innovations in surgical and radiation options—nerve-sparing prostatectomies, robotic surgeries and beyond—are improving outcomes.

Still, difficulty in orgasming and mechanical problems with achieving erection continue to be major issues for men post-prostate cancer treatment. Additionally, nerve issues can cause decreased sensation.

Finally, ejaculation is affected by the removal of the prostate and the seminal vesicles that produce sperm, because the man can no longer make semen. Obviously, this is a serious issue for anyone hoping to conceive. However, most cases of prostate cancer occur later in life, so this tends to be less of a concern for the majority of patients.

Coping with sexual health side effects

Inability to achieve an erection can cause some men to struggle with feelings of self-doubt or question their masculinity. Others have trouble in relationships, as decreased libido or the inability to have penetrative sex can be a stressful and frustrating issue between partners. But men have countless options to help.

Possibly the most important tool to deal with these concerns is your ability to communicate. Make sure you’re opening up to your physician(s), your family and your partner(s). Difficult as it may be, open up to everyone about all you’re going through.

There’s one other person you always want to be honest with, and that’s yourself. Burying your head in the sand may seem like a good idea some days, but you’ll be amazed how strong you can be if you face these problems head on, especially when you have the support of loved ones.

And in the bedroom...

If you’re in a long-term relationship, you and your partner can work together to achieve your sexual health goals.

For example, if you’re having problems with desire or trouble achieving orgasm, think about incorporating sex toys, videos or new positions and activities. External vacuums, implants and medical devices can also help.

Talk to your doctor and ask whether some medical solutions might work for you. Popular and effective medications such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) can be helpful if your penis has mechanical issues. If you’re really committed, penile injection therapy and intraurethral suppository medications are also options.

Consider lifestyle changes, too, including eating well, working out, abstaining from smoking, minimizing drinking, getting enough sleep, decreasing stress and practicing Kegel exercises. Don’t hesitate to consider working with a therapist or sexual health counselor, too.

And if getting hard just doesn’t seem possible right now, it’s time to get creative: There are many ways aside from penetrative sex to be intimate.

Prostate cancer may be the end of your prostate, but it doesn’t have to be the end of your sex life. Speak up, ask questions, explore options and be fearless.