Sexual side-effects for men and people assigned male at birth

It is natural for you to be concerned about the impact that cancer can have on your sex life. 

What are the possible sexual side-effects?

• Erectile dysfunction (ED). Finding it hard to get or keep an erection strong enough for sex. This can be caused by damage to nerves or blood vessels after surgery or radiotherapy. There are treatments to help with erectile dysfunction, so let your doctor know if it’s a problem for you. 
• ‘Dry’ orgasm. After some treatments, like pelvic radiotherapy or prostate surgery, you may find that an orgasm has less semen than usual or you may have a ‘dry’ orgasm, where no semen is ejaculated. If you have dry orgasms, you won’t be able to have a child, as there is no semen. 
• Orgasm changes. You may find that the sensation of orgasm is different to the orgasms you had before surgery. It may last longer or there may be some pain after orgasm in the early days. Or it may simply feel different. 
• Changes to your genitals. Up to a year after prostate surgery you may notice your penis has shortened. Hormone therapy may make your testicles smaller.

What can help?

Treatments that encourage blood flow into your penis, such as tablets or a vacuum pump, may help to prevent a shortened penis.  

Loss of sex drive (libido)

Losing interest in sex can be caused by physical or emotional changes. For example, if your hormone levels are affected by treatment or you are very fatigued, you may find you have less sex drive.

Emotions like anxiety, depression or sadness can make you less interested in sex too. You may also feel less confident about your physical appearance, if it has changed after treatment. 

What can help?

If low libido is caused by low testosterone, your doctor may prescribe testosterone for you. Or you may be too sore to have sex after surgery. 

Trying to find out the cause of fatigue and treating it can help. For example, you may need a blood transfusion if your fatigue is due to a low red blood cell count or dietary advice can help if you’re not eating well. Read more about fatigue and tips to help.

Pain and discomfort

It may be difficult to hold or hug your partner, especially if your wounds are still healing or if you have scarring after surgery. And areas treated with radiotherapy may be tender and painful to touch if it has been treated with radiotherapy. 

What can help?

• Taking painkillers before sex
• Changing position during sex so there is less direct pressure on the affected area.

Treatment for erectile dysfunction (ED)

Getting the best from treatment 

Don’t expect too much the first few times you try a treatment. It can take time to get used to everything, so don’t put too much pressure on yourself. Don’t give up. You might need to try a few different things or use 2 treatments together to find what works for you. Go back to the doctor if you feel a treatment isn’t helping.

Getting early treatment for ED

Taking medication or using a vacuum pump for erectile dysfunction soon after prostate surgery can improve your chance of having erections again. Even if you’re not interested in sex, taking the tablets or using a vacuum pump at an early stage may improve your chances of having erections and sex again in the future. Discuss this with your surgeon, nurse or your GP.

Types of treatment for erection problems (erectile dysfunction)

• Tablets. These help you to get an erection. They only work if you are interested in having sex and you need to get sexually aroused for them to work. It’s quite common for tablets not to work on their own. Many men have more success with another treatment or combination of treatments.
• Vacuum pump. A tube is placed over your penis and a pump creates a vacuum, which causes an erection. A rubber ring is placed at the base of your penis to keep it hard while you have sex. The tube is removed.
  
  Some people prefer the pump because it avoids the use of drugs. Another advantage is that the cost of the pump is a once-off payment. It can take some practice to get the technique right. You can use the pump as often as you like.
  
  It can also be used together with tablets or injections. You may be advised to use the pump to encourage blood flow to your penis after surgery or radiation treatments, even if you are not ready to have sex.
• Urethral pellets. These contain drugs to help you get an erection. They are put into the opening or ‘eye’ of your penis. Then the pellet is massaged into the penis to help it melt. Standing or walking around can help your erection develop better. You should get an erection in 5-15 minutes. Some men get some pain, redness or a burning sensation in the penis or testicles after using the pellets.
• Penile injections. You inject a drug into the base of your penis. You should get an erection within about 15 minutes. The erection lasts from 30 minutes to 2 hours. The first dose is given by your doctor in the hospital so that they can see how well you respond and decide the best dose for you. Then you or your partner will be taught how to give the injection at home. The injection does not hurt, as the needle is very fine. You should not inject more than 2 or 3 times a week.
• Penile implants (surgery). This is where tubes, a reservoir (container) and a pump are put inside your body during an operation. The implant means you can press on the pump to make your penis fill with fluid and get hard. Most men and their partners are very satisfied with these devices. Possible side-effects include infection and pain.

Hints and tips – sex after cancer treatment

• Give yourself time to recover and don’t rush into sex if you don’t feel ready. 
• It may help to talk openly to your partner or a counsellor about how you’re feeling. 
• Talk to your specialist nurse if you’re worried about your sex life or sexual side-effects. You don’t need to feel embarrassed. They will be happy to talk to you and give you advice.