Sex and prostate cancer

• A quick guide to what's on this page
• Effects of prostate cancer treatment
• Diarrhoea
• Tiredness
• Urinary incontinence
• Less interest in sex
• Hot flushes and sweats
• Difficulty in getting an erection (impotence)
• Infertility

Treatment for prostate cancer can cause a variety of side effects. Any of these can affect your sex life, some more than others. You will not have all the side effects mentioned on this page. The effects you have will depend on the treatment you have had.

Some men worry that the cancer could be passed on to a partner in their semen. But cancer cannot be passed on in this way. It is not infectious.

You may not feel like sex at all while you are having your treatment, or for some time after you are diagnosed. Many people feel very low after they have been told they have cancer and don't feel interested in sex. But some people react to their diagnosis by feeling they should be packing in as much 'life' as possible. If you feel like this, and treatment has caused erection problems, this may be hard to bear.

Whatever happens at first, remember that things will change. To see how your sex life will be affected permanently, you will need to wait until at least the end of your treatment. And until you are feeling more 'back to normal'.

Some of the side effects listed here are temporary - for example, tiredness and diarrhoea due to radiotherapy will wear off some weeks after your treatment has finished.

Some men get diarrhoea during radiotherapy and for some time afterwards. This can be unpleasant and tiring and may put you off wanting to have sex. It will gradually go back to normal after a few weeks though.

You may feel too tired to want sex for some time after prostate cancer treatment. There is information about coping with tiredness in the section on coping physically with cancer of CancerHelp UK.

If you have incontinence or a urinary catheter, you may feel embarrassed and that may put you off sex. You can get help with incontinence from an incontinence advisor or your specialist nurse. Or some of the incontinence organisations on our prostate organisations page.

Being less interested in sex can be a side effect of

• Surgery to remove the testicles (orchidectomy)
• Hormone treatment

Unfortunately, a lower interest in sex cannot be treated with testosterone injections or patches as it normally would. This is because the testosterone could encourage the cancer to grow or come back.

Lack of interest in sex and impotence are both less likely with anti-androgens like bicalutamide, so changing your hormone treatment may help. You would need to discuss this with your specialist.

These side effects on your sex life can be difficult to live with. The way that the side effects affect you will depend on your own individual circumstances. It will also depend on your partner (if you have one) and how your sexual relationship has been in the past. It will help to talk things over with your partner and discuss the changes in your lives.

These symptoms can be a side effect of hormone therapy or removal of the testicles (orchidectomy). Hot flushes and sweats may be at their worst when you have just started your hormone treatment, or have just had your testicles removed. The flushes and sweats may get better with time. They may become less frequent or stop altogether. Or you may not be troubled by them at all. Everyone reacts to cancer treatment in different ways, both emotionally and physically. If you are having problems with sweats and flushes talk to your doctor, who may be able to prescribe medicines to help.

There is more information about hot flushes in the section on hormone therapy for prostate cancer. There is also information about dealing with sweating in our section on coping physically with cancer.

Difficulty in getting an erection can be caused by

• Radiotherapy to the prostate
• Prostate surgery
• Having both testicles removed
• Most types of hormone therapy

Erection difficulties can be very difficult to come to terms with. After surgery you are likely to have impotence. This may be temporary, but if you have had the prostate gland removed (radical prostatectomy), it is more likely to be permanent.

Hormone therapy can also affect your ability to have an erection. If you stop the injections or tablets, erections may improve.

With radiotherapy, erection problems may start up to two years after your treatment because of nerve damage. (It can take that long for nerve damage to show up after any radiotherapy.)

There is information about ways of managing erection problems in the CancerHelp UK sex and cancer for men section.

Talking about your erection problems

Erectile difficulties can be permanent or temporary. And they can be affected by your mood and feelings. If you are having problems, they may be caused by anxiety and not your treatment at all. You may find it difficult to talk about this both with your doctor and with your partner. But if you can talk to your doctor or specialist nurse they can help you or can refer you to a specialist counsellor or sex therapist. Treatments such as Viagra may help, especially if you get partial erections.

Remember that your doctor is likely to have treated many other men with the same problem so there is no need to feel embarrassed.

If you would like to talk to someone outside your own friends and family, look at our list of prostate cancer organisations for organisations you can contact. To find out more about counselling look in the what is counselling section.

If you are worried about talking to your partner, it may be because you are afraid they might reject you, or be angry with you in some way. But you are probably more worried about this than you need to be. Your partner will probably be relieved that you want to talk things over. They may have been trying to find the right time to raise the subject themselves.

Treatment for prostate cancer will cause infertility. This can be very hard to accept, especially if you were hoping to have children. You and your partner should discuss this with your doctor before you start treatment, particularly hormone treatment or radiotherapy.

If you have had a TURP operation, you will probably have retrograde ejaculation after surgery. Retrograde ejaculation means that when you orgasm, your sperm goes backwards into your bladder, rather than out through your penis. This is because there is a valve that normally shuts off the route to the bladder when you climax, and this is damaged in the TURP operation. If you want to have children, it may be possible to harvest sperm directly from your testicles. The sperm can be used to fertilise your partner directly or with the “test tube baby” technique (in vitro fertilization or IVF).

There is detailed information about infertility in the section about sex and fertility for men in the general radiotherapy side effects section.