How prostate cancer may affect your sex life

Jul 2022

Our psychosexual therapist Lynn Buckley answers all the questions you’re too afraid to ask about prostate cancer and your sex life

Will I still be able to masturbate?’ ‘Can I really hope to regain my sex life after surgery?’

These are some of the most pressing worries men have about prostate cancer – and often feature in the top searched questions about the disease online.

To answers these concerns NowWhat’s psychosexual therapist Lynn Buckley has collated her top ten questions that men want answered on this topic but are often too afraid to ask.

Can I do anything to protect my future sex life before I have prostate cancer treatment?

Over and above the normal pre-surgical recommendations of getting fit, losing weight and stopping smoking, yes there is! One of the main factors that determine your erection recovery is how good your pre-treatment erectile function is. That’s why prehabilitation – that’s therapy before treatment – can make your sexual organs more resilient, so they are better able to withstand the effects of treatment.

What that means practically is having regular erections – by which I mean a few times a week, ideally in the months running up to treatment. Regular erections encourage increased blood flow to the penis which helps keep the erectile tissues healthy.

Your medical team may suggest taking medication (PDE5 inhibitors such as sildenafil, brand name Viagra) in the weeks before your surgery if you are having nerve-sparing surgery as this also encourages blood flow to the penis.

The sexual organs are controlled and supported by muscle, and like any muscle they strengthen through regular use – so erections will help this way too.

Your medical team may also suggest strengthening your pelvic floor muscles – the band of muscles that acts like a hammock, from your pubic bone at the front to your spine at the back, as these too can play a part in maintaining erections.

Can my partner and I expect to have a good sex life once my erections have returned after my prostate cancer treatment?

Your chances of replicating the sex life you had before very much depends on the type of treatment you had and the stage of your cancer.

But even if your sex life isn’t the carbon copy of what it was, that doesn’t mean to say it’s going to be worse.

What is helpful is to talk to your partner about what sex means to you as a couple.

While you wait for your erections to return discover new ways of touching each other.

It could be that your sex life ends up being better than before.

Can I masturbate if I have prostate cancer?

Many men are curious about this – in fact it crops up among the most frequently searched questions online about prostate cancer.

The answer is that there is nothing about the cancer itself that will prevent you from masturbating, and nor is there any risk involved – you won’t spread or encourage the cancer to grow.

However if you have had treatment that interferes with your ability to have an erection then it will be a different kind of experience – although one, which may still feel pleasurable. 

What is a dry orgasm and what does it feel like?

A dry orgasm is when you have an orgasm but you don’t ejaculate any fluid – or only a very small amount.

There are various causes of dry orgasm – it occurs in men who have had their prostate gland removed because during the surgery the seminal vesicles are also removed – and it is here that the seminal fluid is made which mixes with sperm (made in your testicles) to produce semen. In the absence of seminal fluid and a prostate gland the sperm cells are simple reabsorbed into the testicles.

Dry orgasm may also result from hormone therapy or from radiotherapy as this can reduce the amount of semen made.

A dry orgasm can also stem from a retrograde ejaculation, when semen shoots back into the bladder during an orgasm rather than out of the penis. It might sound alarming but it is actually not harmful, nor is it painful.

It occurs because of damage to the urinary sphincter muscle, which normally holds the bladder shut during orgasm. The orgasm will be dry and you may notice your urine looks cloudy afterwards.

How dry orgasm feel varies form person to person – some men find it feels very different, while others find it makes little if any difference.

In most cases the feeling of pleasure that accompanies an orgasm should still occur as the pelvic muscles will contract rhythmically and spasm as they normally would and this will still stimulate the production of brain chemicals that bring that ‘organismic’ emotional state.

I’m gay. Will I still be able to enjoy sex after my prostate cancer treatment?

If you are the recipient of anal sex then there maybe some differences if you have had your prostate removed as orgasm often occurs as a result of the sensation of the penis rubbing on the prostate gland.

So sex will feel different. But that’s not to say it still can’t be fun – you may need to find other ways to make it pleasurable.

Anal penetration can require a stronger erection and if you find that yours aren’t as hard as usual than you may want to consider using medication, such as the PDE5 inhibitor drugs sildenafil (brand name Viagra), tadalafil (brand name Cialis) vardenafil (brand name Levitra), which encourages blood flow to the penis to make a stronger erection. Using this together with a constriction ring that helps keep the blood in the penis and using a lubricant might also be helpful.

If you have external beam radiotherapy then check with your medical team about when it might be safe to start having sex again as the treatment can make the tissues around the anus more fragile than normal.

I’ve had nerve-sparing surgery to remove my prostate gland. Will I have strong erections after I recover?

It depends what your erections were like prior to having surgery. This type of surgery aims to preserve the function that is there – but won’t improve on it.

If your erection is weaker after your treatment then it maybe that medication, PDE5 inhibitors, can help as these encourage blood flow to the penis. That alongside a masturbation programme – regular erections help improve the health of the penile tissue – may also be beneficial to improve the health of the tissue in your penis as you recover from the surgery. 

How can I make foreplay fun while relying on a pump or other erection aids?

A pump or erection aid might be given post surgery or radiotherapy to help you achieve an erection and they take effect relatively quickly – in the case of a pump or an injection, for example within minutes.

Some men worry that using these will interrupt the flow of intimacy – but rather than breaking away to use your aids I always suggest trying to include it as part of the foreplay.

The absolute key to this is communication with your partner. Discuss how you use it and even the words you feel comfortable using to describe the aid so you know what you are both talking about.

Also remember there is no reason why your partner can’t learn to use the aid. This can make it more of a shared experience rather than administering it alone and so can reduce any embarrassment you feel.

Is it dangerous to have sex with my partner if I’m having radiotherapy?

If you are having pelvic radiotherapy there is no risk to your partner during this time, so if you feel like it, by all means go ahead and have sex without fear.

The problem is that it might dampen your desire and it may lead to side effects that make it harder to have sex.

If you do have sex while undergoing radiotherapy do wear a condom to protect against pregnancy as the treatment can damage sperm and this could lead to birth defects.

Also if you’re having brachytherapy the radioactive seeds that are implanted into the prostate can become displaced and may be in your semen. So wearing condoms, especially during the first few months, can protect your partner from possible exposure to them. Your medical team will discuss with you when it is safe to have sex and what precautions need to be taken. 

I’m on hormone therapy. What can I do to increase my libido?

The effects of the hormones can lead to a lack of spontaneous desire, but you can experience good sex without spontaneous desire.

The key is don’t wait to feel aroused and don’t shy away from making the first move.

Equally try and maintain a willingness to be receptive to intimacy and sexual touch. I tell clients that if your partner kisses or touches you, don’t expect to feel instantly aroused – you may need to try and go with it for a few minutes. Once you allow yourself to be touched and kissed – or as you start to touch and kiss your partner – then your desire will build.

I’m due to have prostate cancer surgery and I’m told my erections may take a year or so to return. Will aids help me in the meantime?

They might well do.

Your medical team will probably have suggested a rehabilitation program which may include aids (as well as pelvic floor exercises). Those aids available include:

Vacuum erection device pumps: you put your penis in the pump and the vacuum draws blood in and creates an erection, which you keep in place with a constriction ring. Alternatively, you may be advised to use it daily as an exercise without the ring.

One benefit of the pump is that it can be good for maintaining the shape and length of the penis after surgery – in some cases it can shrink slightly.

Tablets (PDE5 inhibitors): such as aildenafil (brand name Viagra), tadalafil (brand name Cialis) and vardenafil (brand name Levitra) help to improve blood flow to the penis and can be given daily or used on demand (or both). They may also be used alongside the vacuum device. They work within 30 minutes and their effects can last hours.

If the above don’t help then the second line treatments would be considered. These include:

Penile injections: for this you self-inject a drug called alprostadil into the base of your penis, using a small needle. You may feel a sharp prick – although some men feel nothing – as you put the needle in the process becomes easier in time and an erection follows in roughly five minutes. There is a very low risk of priapism (prolonged painful erection). If this does happen you may need to seek medical help.

Pellets or creams: these can be a good option for those men who don’t like the idea of self-injection, however they might not be as effective. The pellet or cream, contain the drug alprostadil. The pellet is inserted into the urethra from the tip of the penis and the cream is applied to the glans or tip and works in 5-10 minutes.