Sex life and prostate cancer

Treatments for prostate cancer can cause sexual difficulties. You may have side effects that make having sex difficult or make you feel less interested in sex.

How prostate cancer treatment can affect your sex life

Treatments for prostate cancer may cause erection problems. Their side effects may also make you feel less interested in having sex.

 As your side effects improve, you may feel more interested in having sex.

If cancer and its treatments affect your sex life, it can feel very difficult to cope with. But there are different ways to manage sexual difficulties.

We have included information about managing side effects in our information on individual treatments. As your side effects improve, you may feel more interested in having sex.

Cancer and its treatments can also affect your body image. Some lifestyle changes may help improve body image concerns.

Sexual difficulties

Prostate cancer treatments can have a direct effect on your sex life. For example, they can cause:

  • Erection problems (erectile dysfunction)

    Cancer treatments may cause difficulties getting or keeping an erection. This is called erectile dysfunction (ED). After a prostatectomy, this may happen soon after treatment. With radiotherapy, ED problems may not happen immediately but they may develop over many years.

  • Changes to ejaculation or orgasm

    Treatment can affect the ability to have an orgasm or to ejaculate. After a prostatectomy, it is not possible to ejaculate, but it is possible to have an orgasm. After external radiotherapy or brachytherapy, it is common to not produce much semen but still orgasm.

  • Changes to sex drive (libido)

    Some treatments can reduce your sex drive (libido). Hormonal therapy, which you may have with radiotherapy, lowers your desire to have sex (libido). It may also lower the ability to get and maintain an erection.

Other things that may increase the risk of erectile dysfunction (ED)

There are different things that can increase your risk of ED. These include:

  • being older
  • having had sexual difficulties before treatment
  • having other medical conditions, which are more common with getting older, such as diabetes or heart disease
  • taking medicines that affect ED, for example, tablets for high blood pressure.

If you are having sexual difficulties, there are different ED treatments to help you.

Talking about sex and prostate cancer

You may find it difficult to talk about sex with your doctor or nurse. But it is important to have your questions answered and to get the help you need. Your doctor, specialist nurse or GP should make you feel comfortable during conversations about sex.

You may want to think about whether there is someone in your healthcare team you feel more comfortable talking to. We have more information about talking about sex with your healthcare team.

If you need more specialist advice your doctor or nurse can refer you to an erectile dysfunction (ED) clinic or a sex therapist.

Sex and treatment

If you have questions about sex during or after treatment, ask your doctor or nurse. Having sex will not affect how well your treatment works. In some situations, they may advise you to be cautious about sex during treatment or immediately after it finishes.

For example, after surgery you may be advised to wait until your wound has healed.

Side effects of pelvic radiotherapy, such as skin changes or tiredness, may make having sex difficult or you may not feel up to it. You may decide to wait until your side effects improve.

If you are LGBT+

There may be times when it helps your healthcare team to know how you identify your gender or sexual orientation. It may help you feel better supported. They can give the right information and support to you and your partner if you have one.

The impact of cancer and cancer treatment are often the same whatever your sexual orientation or gender. But you may have some specific questions about how these will affect your sexual well-being.

Prostate Cancer UK has more information for gay and bisexual men and trans (transgender) women.

Prostate treatment and anal sex

Pelvic radiotherapy can affect the back passage (rectum) and cause side effects. If you receive anal sex, your radiotherapy team may advise you to wait until 8 weeks after treatment. This avoids making side effect worse or causing longer term problems. Your doctor or nurse can explain when it should be safe to receive anal sex. You can talk to them about long-term changes to the rectum that may make receiving anal sex difficult.

After a prostatectomy, you are usually advised to wait for 6 weeks before you receive anal sex.

If your healthcare team cannot help, they can refer you to a sex therapist or another specialist who can. If you want to talk things through, call the LGBT Foundation for confidential advice and support.

Managing sexual difficulties

There are practical ways to help manage sexual difficulties. Your doctor or nurse will give you information about these.

If you are taking hormonal therapy, it is likely to lower your sex drive. Treatments for erectile dysfunction (ED) do not increase sex drive, but some people may still want to try them.

Most ED treatments aim to increase the blood supply to the penis. Some people may need to try a treatment a few times to start with, or to use more than one method.

Erectile dysfunction (ED) recovery after treatment

Because a prostatectomy can cause ED problems quickly, some people may be offered penile rehabilitation soon after treatment. This is called an ED recovery package. 

It means regularly using one or more treatments, such as tablets or a pump, to encourage blood flow to the penis. This is to help the penis recover – it is not just for sex. 

When you are ready to start having sex, you should have a better chance of getting an erection. Your doctor or nurse can tell you more about this.

We have more information on managing ED.

Infertility

Most treatments for prostate cancer are likely to cause infertility. If your fertility is a concern for you, talk to your specialist before treatment. It is usually possible to store sperm before treatment starts.

Relationships

If you have a partner

If you have a partner, talking openly with them can help you feel closer. It can also help you make changes to your sex life together. Talking about things can help you avoid misunderstandings and find ways to cope with problems. Talking to a counsellor or sex therapist may help you and your partner adapt to changes in your sex life.

If you are single

If you are not in a relationship, it is natural to worry about meeting a new partner or about your sex life. You may need some time to come to terms with what has happened. It may help to talk to a counsellor or sex therapist. The College of Sexual and Relationship Therapists (COSRT) has a list of counsellors and therapists on their website.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.