How to return to sexual life after prostate cancer treatment

Regardless of cancer, treatments often cause side effects that affect patients’ quality of life. But with prostate cancer, potential side effects can be of particular concern to men trying to figure out which method is right for them. Surgery, radiotherapy, and other treatments can affect a patient’s sex life, causing challenges such as low sex drive, loss of penis length, dry orgasm, or low sperm count. Despite the distress these problems can cause, experts say that most of these side effects are manageable and that many men have a good chance of returning to a full sex life after prostate cancer treatment.

“Unfortunately, impotence is a possibility for nearly all prostate cancer treatment options, including surgery,” says Scott Shelfo, MD, FACS, medical director of urology at our hospital near Atlanta. “The degree of dysfunction depends on several factors, including the patient’s general health, coexisting medical problems, as well as the patient’s level of sexual function and ability prior to treatment.”

Cancer and sexual dysfunction treatments

After surgery, many men experience erectile dysfunction (ED), but for many, the interruption is temporary. Nerves damaged during surgery can lead to erectile dysfunction. A nerve-conserving prostatectomy can reduce the chances of nerve damage. “Another factor is the surgeon’s skill level to perform the nerve-retention technique, which, if done correctly, can improve the likelihood of patients retaining erectile function,” Dr. Chilvo says.

Prostate cancer can also be treated with several types of radiotherapy: brachytherapy, external beam radiotherapy, or stereotaxic body radiotherapy. Each type of treatment causes somewhat different side effects. About half of prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology .

“When you compare surgery to radiation, both can affect erections,” says Dr. Chilvo. “Surgery is usually more immediate and ED has the potential to improve over time. With radiation, erections are generally less affected at first, but over time (months or sometimes years) sexual dysfunction can develop. Both treatments can affect the sexual function, resulting in a lack of ejaculation or the ability to achieve an erection.”

The goal of hormone therapy is to lower the level of male hormones in the body or prevent them from feeding prostate cancer cells. Hormone therapy can cause a loss of sexual desire (libido) in some, but not all, patients. Some men find that they maintain their sexual desire but cannot achieve an erection or cannot reach an orgasm. Hormone therapy can also reduce the amount of semen released during ejaculation.

Chemotherapy drugs are used to kill cancer cells or limit their growth. Some patients may lose their sex drive and have difficulty getting an erection after chemotherapy. With all prostate cancer treatments, the patient’s age and general health will affect their ability to return to an active sexual life after treatment. The younger you are, the more likely you are to restore sexual function.

“Most of the men we see are in their 40s, 50s, and 60s and still have a healthy sex life,” says Dr. Chilvo. “So we’re not just talking about the right way to treat your cancer, but we’re trying to limit the side effects of treatment so you can maintain your quality of life.”

Ask your doctor for solutions

Patients should not be shy about discussing privacy issues with their physician. He or she may be able to prescribe medication to help you. Some medications, such as sildenafil ( ^Viagra® ), tadalafil (Cialis® ) or vardenafil (Levitra® ^{) :} are usually tried first. But these medications may not help men get an erection if the responsible nerves are unhealthy. In fact, the drugs only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health .

“In addition to oral medications for erectile dysfunction, there are other options available for men with erectile dysfunction after treatment for prostate cancer,” Dr. Chilvo says. These treatments include penile injections, which involve injecting a small amount of medication directly into the base of the penis. This has helped many men achieve erections. Another option is an intraurethral suppository, a vacuum external erection device, or surgery to implant a penile prosthesis.

While not all men who are treated for prostate cancer can regain erectile function, it is important to remember that erections are only one aspect of a satisfying sex life. Intimacy is another important component, which may become even more important as sex becomes more difficult after cancer treatment.

Learn four steps to resuming a healthy sex life after cancer.