Sex after Prostate Cancer

Strategies for Success

Depending on which prostate cancer treatments you have, there are likely to be changes to get used to. It is normal to have feelings and concerns regarding your sexual performance and how it will impact your sex life. Honesty is the best policy. You need to be open with your partner about your fears and what you need to do to feel comfortable during sex. Issues you might want to address include:

FAQ

Am I satisfied with my level of erection and ability to maintain an erection?

If you’ve undergone nerve-sparing surgery, you will still be able to have an erection, but it might not be as strong as before the surgery. It is important that you begin to work on the strength of your erections soon after surgery. If your prostate has been removed, you will no longer ejaculate because the prostate gland creates semen. This doesn’t mean you will not have an erection or an orgasm. It’s hard to imagine an orgasm without ejaculation, but the orgasm can be just as pleasurable. Some men indicate the orgasm feels “different”, and in some cases “better”.

It is likely your surgeon will prescribe a medication to help with erections (Viagra, Cialis, Levitra) if you don’t have other health issues that would contradict taking these medications. Studies show that you have to work to strengthen erections right from the start to avoid problems down the road with the quality of your erections. If medications are not as effective as you like, you can try other options (see Treatments to Enhance Erections). Speak with your surgeon for suggestions that will best work for you. It may take as long as 18 – 24 months to return to maximum erections after surgery. The strength of your erections before surgery will impact your function afterward.

What if I have performance anxiety?

Initially, you might have concerns about your sexual performance and the ability to achieve an erection. You might feel pressured to the point where you can’t achieve an erection. It’s important to realize that it might take awhile to achieve what you think is a strong enough erection. Communicate your fears and anxiety with your partner. Now is the time to focus on sexual sensations. Work on pleasuring each other without the expectation of intercourse as the end result. This might mean new forms of sexual expression such as oral stimulation. Sexuality is more than just erectile function. Now is the time to make new adjustments in your sex life that will hopefully be long-lasting.

To help relieve performance pressure, try creating a calm, sexy, loving environment prior to relations. Dim the lights, play your favorite music, or light some candles. Aromatherapy can help create a soothing environment. A diffuser can be used with your favorite scents, or a candle can be lit. Massaging each other using scented oils can relax you, provide physical stimulation, and create intimacy.

What if I can’t perform like I used to be able to?

You can experience varying degrees of pelvic nerve damage as a result of the surgical procedure. The effects of nerve damage can vary. Your surgeon can best explain what was done during surgery and what you can realistically expect afterward. Damage to nerves can result in:

Decreased sensation in the penis and scrotum
Varying degrees of difficulty in achieving and maintaining an erection
Difficulty achieving orgasm

See Treatments to Enhance Erections.

What if my erection is weak or I can’t have one at all?

Even if your erection is not what you would like, and may not be enough for vaginal intercourse, you can still enjoy sexual pleasure. You can also reach an orgasm without a full erection just through physical stimulation.

During surgery, if it was necessary to remove or interrupt the nerves controlling erections, you will be unable to have an erection. In this case, adaptations will have to be made to create a new expression of sexuality and intimacy with your partner. Sexuality is much more than erectile function. Finding new ways of sexual expression can create a bond between you and your partner that is new and exciting. Physical stimulation, holding and fondling, masturbation by both partners, and oral stimulation can all be explored. Sexual enhancers such as vibrators and artificial penises can be considered as well. Approach it as a change in your sex life, not an end to intimacy.

What can I do for my partner to assure she is satisfied with our sexual relationship?

Keep in mind that your partner is also going through adjustments in your sex life. As much as she’s trying to be supportive of you, she is sensitive to your issues as you recover  and it impacts her sexual response and behaviors. It’s important to be open about what both of you are feeling. She may feel as much pressure as you do that the sexual experience is a good one. Share what is working for both of you and what aspects of intimacy are challenging. Talking about strategies, new ideas to incorporate into your sex life, and how you can both find pleasure will create opportunities to enrich and improve your relationship.

If your prostate has been surgically removed, you will no longer ejaculate. This might cause intercourse to be “drier” than it was previously. If your partner has gone through menopause, dryness can particularly be an issue. Lubricants such as KY Jelly, Astroglide, or plain vegetable oil can be used to ease dryness and prevent painful intercourse. These products can be purchased at drugstore chains.

What are the effects of hormone treatments?

If you are treated with hormones for your cancer, they depress testosterone production in your body which can lead to many side effects. You may find your desire for sex is lacking and your erections to be weaker than prior to treatment. You can suffer anxiety, depression, breast enlargement, and hot flashes. Talk to your doctor about medications (Tamoxifen) to counteract these side effects. Consider ways to enhance your erections (see Treatments to Enhance Erections). Erectile dysfunction can start shortly after beginning hormone treatments and can be long-lasting.

What if I am incontinent of urine?

A frequent side effect of surgical prostatectomy can be urinary incontinence (leakage of urine).  Incontinence occurs less frequently with brachytherapy and radiation therapy. Many men fear leakage of urine more than impotence. Sometimes the incontinence resolves completely. At other times, it can be a continued problem. Fear of urinary leakage can be a major obstacle to sex. It doesn’t have to be the end of your sexual relationship! If you are burdened with this problem, get into a regular bathroom schedule. Empty your bladder every 3 hours, more if you’re drinking increased fluid volumes. Avoid alcohol, spicy foods, and caffeine prior to sex. These can stimulate your bladder. Try pelvic floor exercises (Kegel exercises). Practice stopping your flow of urine to get the feel of the exercises. Once you have the feel, do the exercises 20 times a day. If you have ongoing issues with urinary incontinence, seek the advice of your surgeon. There can be several causes of incontinence related to surgery, radiation, and brachytherapy. There are many treatment options to help you.

If dating, how will my new partner react to difficulties with erections?

It can be awkward to approach the topic of erectile dysfunction (ED) when you are dating and exploring intimacy. Honesty is the best policy. When you feel comfortable with your partner, explain that you have had prostate cancer and how it has affected your sexual function. Discuss the changes you have made to improve your sex performance and how your new partner can participate in what you’ve found helpful. You are who you are, and if you are comfortable and confident about your sexuality, your new partner will be too.

If I want to, can I have children in the future?

If you have a radical prostatectomy, you will be unable to produce semen and therefore will not ejaculate. Radiation treatments, chemotherapy, and hormone treatments might also affect your sperm count, making it difficult to conceive a child. If you’d like to have a child in the future, speak to your surgeon or physician prior to starting treatments. You may be able to donate your own sperm for future use.

What if I'm too tired to have sex?

Many of the treatments for prostate cancer can result in fatigue. As soon as you are able, return to a regular exercise program. Exercise will help energize you, help keep your weight in check, and promote a healthy sleep schedule. It can also help reduce anxiety and depression. Plan sex during the time of day when you feel the best. Eat a healthy, balanced diet to restore your nutrients and return your sense of well-being.

What if, no matter what I try, I'm unsuccessful?

If you find, after trying many different things, you are unable to achieve a satisfactory erection, seek the help of your surgeon or other health professional who may offer helpful suggestions. Don’t give up! There are many resources and new developments happening every day. If you feel your relationship can use some help, seek the assistance of a psychotherapist or sexual therapist. If you are anxious or sad and can’t seem to move forward, talk to your doctor. You may need an antidepressant to get you back on track to feeling yourself.

Section

Strategies for Success

It’s important to work on strong erections early in the treatment process. There are several options available to enhance erections.

Medications

Oral pills such as Viagra, Cialis, and Levitra are often used early during various treatments for prostate cancer to strengthen erections. The medications have to be accompanied by stimulation such as sexual thoughts or physical touching in order to be effective. The medications are usually taken 30 to 90 minutes prior to sex. Research studies support early use of medications, especially after a surgical prostatectomy, to improve the return of erectile function. The medications also stimulate nocturnal (nighttime)  erections which are helpful in regaining normal function. The medications must be prescribed by your physician. If you have a history of heart or kidney problems, you may be unable to take the medications.

Suppositories

A suppository, called Muse , can be inserted into the urethra (the opening that urine runs through when flowing out the penis) prior to sex. It dilates the blood vessels in the penis, making it erect. You must urinate prior to inserting the suppository to lubricate the urethra. If the suppository causes your partner to experience vaginal burning, a condom can be worn.

Vacuum Devices

The vacuum (Encore, Pos-T-Vac, Osbon) is applied to the penis and creates suction that draws blood into the penis, making it erect. A band is then placed at the base of the penis to help keep the erection. The band should not be used for more than 30 minutes at a time.

Penile Injections

Medication (Caverject or Trimix) can be injected into the side of the penis to create an erection. The thought of injecting the penis is not always pleasant, however, the effectiveness of the injections is high and this option should not be overlooked. An erection occurs in 10 to 20 minutes and can last approximately an hour. Occasionally, erections do not subside on their own. Erections lasting more than 3 to 6 hours can be harmful. Contact your physician for direction.

Penile Implant

Different types of penile implants can be surgically inserted in the penis to allow for an erection. A semi-rigid type is available where the penis can be moved into an erect position. There are also inflatable types of implants where a pump placed in the scrotum is used to inflate and deflate the penis.

Sexual Positions After Prostate Cancer

Face to Face

If you do not have a strong erection, using the face-to-face position with your partner will allow you to more easily participate in intercourse. You lie on your back with your partner sitting on top. Your penis can be more easily inserted into the vagina.

If you decide to use sex enhancers such as a vacuum device, penile ring, urethral suppositories, or penile injections, use them during foreplay. If willing, your partner can apply devices, insert suppositories, or give injections.

The journey through the diagnosis and treatment of prostate cancer can present challenges. Keep moving forward with hope and strength toward a new, healthy you!