How does prostate cancer affect sex?

Men having treatment for cancer of the prostate gland can have problems with sex. These include loss of interest in sex, and an inability to get an erection.

About 1 out of every 7 men will be diagnosed with prostate cancer in his lifetime, making it the most common cancer in men. Prostate cancer affects the walnut-shaped gland that wraps around a man’s urethra.

Treatments like surgery, radiation, and hormone therapy remove or destroy the cancer. However, all of these treatments can have sexual side effects. This can include trouble getting an erection, having an orgasm, and fathering children.

1. The removal of the prostate can cause changes during orgasm: your entire prostate gland is removed along with the seminal vesicles. It is important to understand that after surgery you will have a ‘dry’ orgasm because semen is no longer produced. There is no ejaculate during orgasm but you will still feel the muscular spasms and pleasure that produce the orgasm. The lack of semen and sperm means that you will not be able to conceive children naturally in the future. Other changes could include painful orgasm and leaking urine on orgasm.

2. Treatment for prostate cancer will mean that you cannot father children in the future: this is called infertility. This can be very hard to accept, especially if you were hoping to have children. You and your partner need to discuss this with your doctor before you start treatment, particularly hormone treatment or radiotherapy. Some men may want to collect and store sperm before they start treatment.

3. Erection difficulties can be very difficult to come to terms with: after surgery men are very likely to have erection problems. This may be temporary, but if you have had the prostate gland removed, it is more likely to be permanent. Hormone therapy can also affect men ability to have an erection. If you stop the injections or tablets, the erections may improve. With radiotherapy, erection problems may start up to 2 years after your treatment because of nerve damage. It can take that long for nerve damage to show up after any radiotherapy. If you have erection problems, medicines such as sildenafil citrate (Viagra), vardenafil (Levitra) or tardenafil may help. If these treatments are started early they can sometimes help to prevent erection problems developing.

4. Change in penis size: A possible side effect of surgery is a reduced length and width of the penis, while erect and/or flaccid/soft. ‘A side effect, if you have a radical prostatectomy, is the size of your penis [can] shrink and that’s not a side effect that anybody talks about.’
Many men report penile shortening and shrinkage following surgery. It is thought there are a number of factors that may contribute to this, including scar tissue formation, reconnecting of the urethra to the bladder, and damage or interruption to the blood supply of the nerves. The reasons for penile shortening and shrinkage are not yet fully understood.

5. Incontinence: the removal of the prostate gland may affect your ability to control the flow of urine from the bladder. This is because the urethra runs through the prostate gland. The mechanisms for urinary control are located very close to the prostate and can be affected during the surgery. Many men experience some degree of urinary incontinence in the short term following surgery. This usually resolves over time. When the urinary sphincter is affected, people can experience stress urinary incontinence – losing control of the bladder during physical activities or strain. All men will have a temporary urinary catheter for a short period after surgery. This is a thin, soft plastic tube that runs from inside the bladder to a bag outside of your body to collect the urine. Men normally need a catheter for a week after surgery, but sometimes up to three weeks. After the catheter is removed, it is not unusual to have some mild urinary incontinence. Improvement can occur quickly, but if you are still troubled after 6 months, then further treatments can help. Talk to members of your healthcare team who are supporting you if you are concerned.

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