People who are having or have had treatment for prostate cancer sometimes have problems with sexual intercourse. These include a loss of interest in sex, inability to get an erection, and fertility issues.

Prostate cancer is the most common non-skin cancer in men in the United States. It affects around 13 in every 100 American men, according to the Centers for Disease Control and Prevention (CDC).

While prostate cancer may not directly affect a person’s sexual ability, treatments, including radiation therapy, surgery, or hormone therapy, can often cause sexual dysfunction. For example, hormone therapy can reduce sexual desire and increase the risk of erectile dysfunction.

In this article, we explain how prostate cancer can affect sex and provide some tips on how to maintain a healthy sex life during this time.

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It is not unusual to feel anxious and depressed following a cancer diagnosis and during treatment. Anxiety can also lead to relationship stress.

Prostate cancer causes several physical changes that can affect a person’s sexual confidence. These may include:

These issues can affect sexual desire and performance.

Sometimes, surgery is necessary to remove cancerous tissue or the entire prostate gland.

Nerves that help control an erection run close to the prostate gland. During surgery, the surgeon will try to protect the nerves from damage while treating the nearby prostate gland. However, erectile dysfunction is one of the main potential side effects of prostate cancer surgery.

Surgeons may reduce the risk of surgery-induced erectile dysfunction through several measures.

  • Nerve-sparing prostatectomy: This aims to preserve the nerves that control erections.
  • Biopsy: This can help a doctor determine if cancer is present on only one side of the prostate. If this is the case, surgery may spare the nerves on the other side.
  • Cryotherapy: This is a less invasive procedure in which doctors use probes to freeze prostate cancer cells. However, there is also a risk of nerve damage with this type of treatment.

Learn more about prostate cancer surgery here.

Radiation therapy kills cancer cells, but can also affect the surrounding healthy tissue and possibly the rest of the body. Radiation therapy may help treat cancer cells in the prostate but can affect other sexual organs. This can potentially lead to nerve damage and erectile dysfunction, among other side effects.

A more focused type of radiation therapy called brachytherapy may have a lower risk. This treatment involves implanting radioactive seeds into the prostate, and it is less likely to affect other parts of the body. However, this is typically only applicable to those with early-stage prostate cancer.

Androgens, such as testosterone, are necessary for reproductive and sexual function, but they also encourage the growth of cancer cells in a person with prostate cancer.

One way of treating prostate cancer is to block or reduce the production and use of these hormones. It might be possible to do this using various drugs or surgically removing one or both testicles.

However, hormonal therapy can also have some side effects, including the risk of erection problems, loss of libido, and reduced fertility.

Different cancer treatments, including medications, chemotherapy, radiation therapy, and hormone therapy, can affect fertility.

Sperm production may fall or stop with radiation treatment. It usually returns, although the individual may still produce a smaller quantity of sperm.

For those who wish to have children in the future, one option is to store sperm in a sperm bank before starting prostate treatment.

If loss of sexual function occurs after prostate cancer treatment, several options can help a person find pleasure in sex again or return to previous sexual function.

Manage expectations

One choice to make is whether to pursue an active sex life or if the individual and their partner are happy to pursue new forms of intimacy.

This could involve experimenting with:

  • massage
  • new ways of touching
  • vibrators and other aids
  • the use of videos

Those in a relationship may find their partner happy to enjoy nonsexual intimacy. Open communication with a partner makes it easier to agree on expectations and share concerns. In some cases, a lower sex drive will not bother the partner. Others may enjoy finding new ways to be intimate.

Explore new sexual techniques

A partner who is usually insertive, or top, during sex may want to consider changing to receive anal penetration, as sex may be difficult without a full erection.

In the case of a prostatectomy, a partner who usually receives penetration may find that sex is less pleasurable, as the prostate gland usually contributes to the sensation.

Make time

Set aside time for physical stimulation. It may take extra physical and mental stimulation to get and sustain an erection.

Penile rehabilitation

Several treatments can help a person achieve an erection, including:

  • oral drugs, such as avanafil (Spedra), sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra)
  • cream to apply to the penis, such as alprostadil (Vitaros)
  • other drugs that come in injection or pellet form
  • vacuum pumps that can draw blood into the penis before sex
  • an inflatable implant may be an option if medications or other treatments are not effective

Learn more about the medications for erectile dysfunction here.

Keep healthy

Getting enough exercise may help boost a person’s sex life and reduce the risk of erectile dysfunction. Studies show that people with prostate cancer who exercise are more likely to return to an active sex life.

Learn more about specific exercises to reduce erectile dysfunction here.

A 2016 study assessing whether frequent ejaculation protects against prostate cancer concluded that ejaculating more often lowers the chances of prostate cancer.

However, the authors called for further research because other factors, aside from ejaculation, could account for the results. They could not confirm that ejaculation protects against prostate cancer.

Can you still get an erection without a prostate?

People’s experiences vary, but it is still possible to get an erection after prostate removal. However, surgery may damage the nerves, blood cells, and muscles necessary for an erection.

Can you climax without a prostate?

Orgasm is still possible after prostate removal, but it is likely to feel different. Without a prostate, there is no semen to ejaculate upon climaxing. This is called a dry orgasm or anejaculation. Some people say orgasms feel better after prostate removal, and others report them feeling less good.

Where does sperm go after prostatectomy?

After prostate removal, the body still makes sperm cells, but the sperm cannot exit the body. Instead, the body reabsorbs the sperm cells.

There are several links between prostate cancer and sexual function. For example, prostate cancer and erectile dysfunction are more common in older adults.

Prostate cancer and erectile dysfunction carry similar risk factors, and some studies show that the risk of prostate cancer is higher in people who already experience erectile dysfunction.

Treatments for prostate cancer, including surgery and radiation therapy, can also affect sexual function. Following treatment, some will retain or regain their sexual function, but others will find that the changes do not reverse.