Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.

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Sex and prostate cancer

In this fact sheet:

• How might prostate cancer • Dealing with prostate cancer
affect my sex life?
• Questions to ask your doctor or nurse
• Problems getting an erection
• More information
• Other sexual problems
• About us
• Sex and relationships

This fact sheet is for anyone who wants to

know how prostate cancer and its treatment Our sexual support service
can affect their sex lives and relationships. This is a chance for you, or your partner, to
It’s for anyone affected by prostate cancer, talk to one of our Specialist Nurses trained
whether you’re single or in a relationship, in sexual problems after treatment for
and whatever your sexuality. We describe prostate cancer. They can talk to you about
the possible sexual side effects, and the the impact of treatment on your sex life and
treatment and support available. relationships, and discuss possible treatments
or ways to deal with these changes.
Each hospital or GP practice will do things
differently. Use this fact sheet as a general
guide and ask your doctor, nurse or other
healthcare professional for more information.
How might prostate cancer affect my
You can also speak to our Specialist Nurses, sex life?
in confidence, on 0800 074 8383 or chat to Prostate cancer and its treatment can affect your
them online. sex life in different ways. It can affect your mind,
body and relationships.

Symbols Treatments for prostate cancer can affect:

These symbols appear in this fact sheet to • your ability to get an erection, ejaculate and
guide you to more information: have an orgasm
Speak to our Specialist Nurses • your desire to have sex (libido)
• your ability to have children naturally (fertility)
Read our publications • how you feel about yourself sexually
• how your body looks
• your relationships.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 2

What treatments are there for

Some common worries explained erection problems?
• You cannot pass on cancer through sex. There are a number of treatments available
which work in different ways. Treatments include:
• Having sex or masturbating will not affect • tablets
how well your treatment works. • vacuum pump
• injections
• Having sex or masturbating has no effect • pellets or cream
on your cancer or the chance of it coming • implants
back after treatment. • testosterone replacement therapy.
• It’s safe to have an erection if you have Because getting an erection also relies on your
a catheter in. thoughts and feelings, dealing with any worries
or relationship issues as well as having medical
treatment can work well.
Problems getting an erection How well each treatment works is different
Treatment for prostate cancer can cause for everyone. Your overall health, your ability
difficulty getting or keeping an erection. This is to get erections before cancer treatment, the
called erectile dysfunction (ED) or impotence. treatments you try and your age can all play a
Erection problems have many possible causes role. Try different things and stick with them for a
and become more common as we get older. while to find the best option for you.
But there are treatments and support available
which can help. Some treatments for erection problems can
seem artificial and you may feel like you lose the
Everyone is different. Some men will have moment. But people often get used to them.
temporary problems that improve with time. Some couples even use their treatment as part
Others will be able to get an erection with the of their foreplay, such as using the vacuum
help of treatment. But some might not be able to pump or rubbing in cream together. See page 7
get erections, even with medical help. for more information about sex and relationships.

What causes erection problems?

When you are sexually aroused (turned on) your What can I do to help myself?
brain sends signals to the nerves in your penis. Physical activity, staying a healthy weight,
The nerves then cause blood to flow to your stopping smoking and doing pelvic floor
penis, making it hard. Anything that interferes muscle exercises may help improve your sex
with your nerves, blood supply or your desire life and your erections.
for sex can make it difficult to get or keep
an erection. Read more in our fact sheets, Diet and
physical activity for men with prostate
Causes of erection problems include: cancer and Pelvic floor muscle exercises.
• treatments for prostate cancer
• other health problems such as diabetes or
heart disease
• certain medicines
• depression or anxiety
• being overweight
• smoking
• drinking too much alcohol.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 3

Tablets Vacuum pump

A group of drugs called PDE5 inhibitors A vacuum pump can be used to help treat
(phosphodiesterase type 5 inhibitors) could help erection problems. You use a pump and a plastic
you get an erection. These include: cylinder to create a vacuum, which makes
• sildenafil (generic sildenafil or Viagra®) blood flow into your penis to make it hard.
• tadalafil (generic tadalafil or Cialis®) You then slip a constriction ring from the end
• vardenafil (Levitra®) of the cylinder around the base of your penis.
• avanafil (Spedra®). This stops most of the blood escaping when
you remove the pump. You should not wear the
You need to be sexually aroused for the tablets constriction ring for longer than 30 minutes at
to work. They normally start to work about 30 a time.
minutes to an hour after taking them.

You can take sildenafil, vardenafil and avanafil pump

when you need to. They will keep working
for four to six hours, or up to eight hours for
vardenafil. So if they work you should be able to penis
get an erection if you’re sexually aroused during
that time.

Tadalafil can work for up to 36 hours so it lets

you be more spontaneous. Your doctor may cylinder
suggest you start by taking a 5mg dose of
tadalafil tablet every day. This may then be
reduced to a smaller dose of 2.5mg depending
on how your body responds.

PDE5 inhibitor tablets can cause problems if

you’re taking medicines to control your blood constriction
ring
pressure. However, if you’ve been taking blood
pressure tablets for six months or more and
your blood pressure is stable, you can usually
take PDE5 inhibitor without any problems. If you
take alpha blockers your doctor or nurse may
suggest taking the drugs at least four hours
apart or even longer in some cases. Talk to your
doctor for specific information about how long to
wait in between taking each medicine.

You should not take PDE5 inhibitor tablets if

you’re taking drugs called nitrates. These are With a little practice, the pump can help you
used to treat heart problems and are also used get an erection in two to three minutes. A lot of
in recreational drugs known as poppers. If men use the pump in combination with other
you have a heart problem or take nitrates, ask treatments such as tablets.
your doctor or nurse about other ways to treat
erection problems. You can also use the pump daily to get blood
flowing into the penis. This can help keep your
You may need to take tablets on an empty penis healthy in the long term and could help
stomach as some tablets do not work as well to maintain its size. You do not need to use a
after a big meal or with alcohol or grapefruit juice. constriction ring for this.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 4

Injections Pellets or cream

Erection problems can also be treated with The drug alprostadil is also available as a small
drugs using an injection that you give yourself. pellet called MUSE®, and as a cream called
These include alprostadil (Caverject®, Caverject® Vitaros®. These don’t tend to work as well as the
Dual Chamber or Viridal Duo®) and aviptadil with injections, but they’re an alternative if you don’t
phentolamine mesilate (Invicorp®). like the idea of an injection.

An injection may sound off-putting, but many You use an applicator to insert the pellet or
men find it isn’t that bad and doesn’t hurt. Your cream into the opening or ‘eye’ of the penis.
nurse or doctor will show you how to inject the You’ll get an erection within five to ten minutes,
side of your penis with a very thin needle. They which may last for up to an hour. The cream
will make sure you’re happy giving yourself the may take longer to work.
injection before you go home.

You’ll get an erection within five to 10 minutes,

which normally lasts for up to an hour. applicator
stem

spongy very fine

tissue needle
of penis

applicator

injection

applicator
plunger
opening or
‘eye’ of penis

applicator
If your erection doesn’t go down stem
All treatments for erection problems can
cause a painful erection that will not go
down. If this happens, try doing some
gentle exercises, such as walking, jogging pellet
or using an exercise bike. Having a warm
urethra
bath may also help. Try taking some mild
pain killers, such as paracetamol, to reduce
pain. If you’ve had an erection for more than Implants
four hours, go to your nearest accident and This involves an operation to put an implant
emergency (A&E) department straight away. inside your penis. It can be a good option if other
This is called priapism. It’s considered a treatments have not worked or you’re not happy
medical emergency, but it can be treated. with your erectile function.
It’s very rare, but slightly more common with
injections than with other treatments. There are two main types:
• Semi-rigid rods that keep your penis fairly
firm all the time but allow it to be bent down
when you don’t want an erection.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 5

• An inflatable implant in your penis and a It’s still possible to be intimate with your partner
pump in your scrotum (the skin around the and find new ways to be sexual, even if you’re
testicles). When you squeeze the pump the on hormone therapy.
implant fills with fluid (saline) to make the
penis hard. Your erection will last for as long How can I get treatment and support?
as the implant is inflated and you can deflate it Men with prostate cancer can get free treatment
when you want to. for erection problems and other sexual problems
on the NHS. Your GP, hospital doctor or nurse
can prescribe treatment if you want help getting
erections for masturbation or sex. There is no
fluid age limit for receiving treatment, but there may
be a limit on how much your GP can prescribe.
implant
Your doctor or nurse may also refer you to a
specialist service such as an ED clinic.

Many men avoid asking for help or trying

treatments – it can be a difficult thing to face and
to talk about. But there are trained professionals
pump in
scrotum who have experience managing sexual problems
and relationships. They can make you feel more
comfortable and talk you through the treatments
and ways of dealing with changes in your
relationship. If you have a partner, you can ask
them to go with you to your appointments.

Stick with it
Treatments for erection problems aren’t always
implant a ‘quick fix’. You often have to stick with them
when
inflated for a while or try different treatments to see what
works best for you.

If you’re taking tablets, they may not work the

first few times. It can take a while to get the
Testosterone replacement therapy timing right or find the right dose for you.
If you’ve been successfully treated for localised
prostate cancer and your erection problems are A combination of treatments, such as tablets
caused by low testosterone, then you may be and a vacuum pump, may work better than
able to have testosterone replacement therapy. one treatment on its own. Speak to your doctor
Talk to your doctor or nurse about whether about what might work best for you.
hormone replacement therapy is suitable for you.
What if I have other health problems?
Will the treatments work if I’m on Some treatments may not be suitable if you have
hormone therapy? a heart problem, sickle cell disease or Peyronie’s
Hormone therapy reduces your testosterone disease, or if you’re taking drugs called nitrates.
level, which lowers your desire for sex. Some Ask your doctor or nurse for advice if this
treatments, such as tablets, only work when you includes you. You should also let them know
have a desire for sex, so these are unlikely to be about any other medicines you’re taking. You’ll
the best option for you. But injections, pellets, find more information in the leaflet that comes
cream or a vacuum pump could still give you with your treatment. If you’re not sure, talk to
an erection. your doctor or nurse, or speak to a pharmacist.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 6

When should I start treatment? rehabilitation soon after surgery may improve
You can start treatment for erection problems your chance of getting and keeping an erection
whenever you feel ready. Starting treatment later on.
soon after your prostate cancer treatment, for
example with a low-dose tablet once a day Will I be able to orgasm and ejaculate after
or using a vacuum pump, may improve your prostate cancer treatment?
chance of getting and keeping an erection later After prostate cancer treatment you will still
on. If you already have erection problems, you have feeling in your penis. You should still
could try starting the treatments before your be able to have an orgasm but this may feel
prostate cancer treatment. different to before. However, some men may
lose the ability to orgasm, especially if they’re on
hormone therapy.
Other sexual problems
Some men leak urine or feel pain when they
Prostate cancer and its treatment can also affect
orgasm. Others find they don’t last as long
your sex life in a number of other ways.
during sex and reach orgasm quite quickly.
Will prostate cancer affect my desire for sex?
If you have had your prostate removed, you will
Prostate cancer and its treatment can affect your
not be able to ejaculate. This is because the
desire for sex. Hormone therapy lowers your
prostate and seminal vesicles, which make some
sex drive so that you feel less interested in sex.
of the fluid in the semen, are removed during the
This is because some types of hormone therapy
operation. Instead, you may have a dry orgasm
lower your levels of testosterone, which is what
– where you feel the sensation of orgasm but
gives you your sex drive.
don’t ejaculate.
If you’re on long-term hormone therapy,
If you’ve had radiotherapy, brachytherapy,
you could ask your doctor or nurse about
high-intensity focused ultrasound (HIFU) or
intermittent hormone therapy. This is where you
hormone therapy, you may produce less semen
stop hormone therapy when your PSA level is
during and after treatment. With radiotherapy,
low and steady, and start it again if it starts to
brachytherapy and HIFU, you may also notice a
rise. Your sex drive may improve while you’re
small amount of blood in the semen. This usually
not having hormone therapy, but this can take
isn’t a problem, but tell your doctor or nurse if it
several months. Read more in our booklet,
happens. Some men on hormone therapy say
Living with hormone therapy: A guide for men
their orgasms feel less intense.
with prostate cancer.
Retrograde ejaculation
Will prostate cancer treatment change the
If you’ve had radiotherapy for prostate cancer,
size or shape of my penis?
or an operation called a transurethral resection
Some men notice that their penis is a little
of the prostate (TURP) to help you urinate more
shorter after surgery (radical prostatectomy).
easily, you may get retrograde ejaculation. This
Some men notice other changes such as a
is where the semen travels backwards into
curve in their penis. Other treatments, such as
the bladder when you orgasm, rather than out
hormone therapy with radiotherapy, may also
through your penis. The semen is then passed
cause changes in the size of your penis.
out of the body when you next urinate. It isn’t
harmful and shouldn’t affect your enjoyment
Encouraging blood flow to the penis can help
of sex, but it may feel different to the orgasms
keep your penis healthy. Using a vacuum pump,
you’re used to.
either on its own or with tablets, could help
maintain your penis size and improve erections.
This is called penile rehabilitation. Starting penile
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 7

Will I be able to have children after prostate Sex therapy (sometimes called psychosexual
cancer treatment? therapy or sexual counselling) is available on the
After prostate cancer treatment you might not be NHS in some areas, or you can pay privately or
able to have children naturally. If your prostate is contact charities for financial support. For NHS
removed, you won’t ejaculate any semen. If you services you will need a referral from your GP
have radiotherapy or brachytherapy, the radiation or other health professional. Check that any sex
might affect your ability to produce sperm. therapist you see is registered with the College
of Sexual and Relationship Therapists, the British
Changes to your sperm during radiotherapy, Association for Counselling & Psychotherapy, or
brachytherapy and chemotherapy could affect the Institute of Psychosexual Medicine.
any children you conceive during or after
treatment. But the risk of this happening is very If you have a partner, you may want to tell them
low and has not been proven. But if there is a about our booklet, When you’re close to
chance of your partner becoming pregnant, you someone with prostate cancer: A guide for
should use contraception during treatment and partners and family.
for a while afterwards. This could be for up to a
year, but check with your doctor or nurse.
If you’re a gay or bisexual man
Storing sperm To be the penetrative (top) partner during
You may want to think about storing your sperm anal sex you normally need a strong erection,
before treatment, so that you can use it later so erection problems can be a particular
for fertility treatment. You can usually store issue. You could try using a constriction ring
your sperm for up to ten years, and sometimes around the base of your penis together with
longer. You can get information on fertility other treatments like PDE5 inhibitor tablets
treatments from your GP or specialist team, or or pellets, to help keep your erection hard
from Fertility Network UK. enough for anal sex. Penile injections may
also help to give you a firm injection.

Read more about ways to manage all these If you receive anal sex (bottom), a lot of the
issues in our booklet, Prostate cancer and pleasure comes from the penis rubbing
your sex life. It also contains information against the prostate. So some men find their
for you if you’re a partner of someone with experience of sex changes if their prostate
prostate cancer. is removed.

Bowel problems and sensitivity in the anus

can be an issue after radiotherapy. It’s best
Sex and relationships to wait until your symptoms have settled
If you have a partner, then coping with cancer before trying anal play or sex. If you have
and side effects may change your relationship permanent seed brachytherapy there is a
and the way you have sex. risk in the first few months that your partner
might be exposed to some radiation during
Even though your sex life is unlikely to be the sex. Your doctor may suggest you avoid
same as it was before, there are still many ways having anal sex in the first six months after
to have pleasure, closeness or fun together. having permanent seed brachytherapy. Talk
Being physically close can help to improve your to your doctor or nurse your own situation.
relationship. Some couples find it useful to see Read more in our booklet, Prostate cancer
a relationship counsellor. The charity Relate tests and treatment: A guide for gay and
provides relationship counselling and a range bisexual men.
of other relationship support services.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 8

Dealing with prostate cancer

Changes to your body and your sex life can have Trained counsellors
a big impact on you. They could make you feel Counsellors are trained to listen and can
worried, unsatisfied, or even angry. There is no help you find your own ways to deal with
right or wrong way to deal with these changes. things. Many hospitals have counsellors or
Some men will want to try different treatments psychologists who specialise in helping people
for erection problems, and some will prefer to with cancer – ask your doctor or nurse if this
find other ways to be close to their partner. is available. You can also refer yourself for
What’s important is that you find a solution that’s counselling on the NHS website, or you could
right for you, and ask for support if you want it. see a private counsellor. To find out more, visit
www.nhs.uk/counselling or contact the British
Association for Counselling & Psychotherapy.

Our one-to-one support service

Our sex life has improved in ways This is a chance to speak to someone who’s
been there. You could talk about erection
that are very fulfilling, despite problems, treatments, or how prostate cancer
the lack of penetration. has affected your relationships and sex life.
We’ll try to match you with someone with
A personal experience similar experiences.

Getting support Support groups

If you’re stressed or down about changes to At support groups, people affected by prostate
your sex life, finding some support may improve cancer get together to share their experiences
how you feel. You are not alone. A lot of men, of prostate cancer. Some groups also hold
with and without prostate cancer, have sexual meetings online. You can ask questions, share
problems. Talking to other men who’ve had worries and know that someone understands
similar experiences can help, or you may prefer what you’re going through.
to talk to a professional who is trained to listen.
Our fatigue support
Our Specialist Nurses Fatigue is a common symptom of prostate
Our Specialist Nurses can help with any cancer, and a side effect of some treatments.
questions and explain your options. They have Our Specialist Nurses can talk to you in depth
time to listen to any concerns you or those close about your experience of fatigue, and the impact
to you have. it’s having on your day-to-day life. They can also
discuss ways to help you better manage your
Our sexual support service fatigue, such as behaviour and lifestyle changes.
This is a chance for you, or your partner, to talk
to one of our Specialist Nurses trained in sexual
problems after treatment for prostate cancer. To find out more about any of the above, visit
They can talk to you about the impact on your prostatecanceruk.org/get-support or call
sex life and relationships, and discuss possible our Specialist Nurses on 0800 074 8383.
treatments or ways to deal with these changes.

Our online community

Our online community is a place to talk about
whatever’s on your mind – your questions, your
ups and your downs. Anyone can ask a question
or share an experience.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 9

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have
to take to your next appointment.

How could my prostate cancer treatment affect my sex life?

How soon after treatment can I masturbate or have sex?

Which treatments for erection problems are best for me? Can I get them on the NHS?

Is there anything I can do before I start my prostate cancer treatment to help reduce sexual
side effects?

What happens if the treatment doesn’t work? Are there others I could try?

What other support is available to me?

Can my partner also get support?

Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 10

More information Relationships Scotland

British Association for Counselling www.relationships-scotland.org.uk
& Psychotherapy Telephone: 0345 119 2020
www.bacp.co.uk Information, relationship counselling and sex
Telephone: 01455 883 300 therapy in Scotland.
Information about counselling and details of
therapists in your area. Samaritans
www.samaritans.org
College of Sexual and Telephone: 116 123
Relationship Therapists Confidential, judgement-free emotional support,
www.cosrt.org.uk 24 hours a day, by telephone, email, letter or
Telephone: 020 8106 9635 face to face.
Information about sexual and relationship
therapy, and details of therapists who meet Switchboard - LGBT+ helpline
national standards. www.switchboard.lgbt
Telephone: 0800 0119 100
Fertility Network UK Free and confidential support and information for
www.fertilitynetworkuk.org lesbian, gay, bisexual and trans people, including
Telephone: 01424 732 361 a telephone and online chat service.
Information and support for people with
fertility problems. UK Council for Psychotherapy
www.psychotherapy.org.uk
Macmillan Cancer Support Telephone: 020 7014 9955
www.macmillan.org.uk Information about types of psychotherapy and
Telephone: 0808 808 0000 details of therapists in your area.
Practical, financial and emotional support for
people with cancer, their family and friends.
Includes information on sex and relationships.

Mind
www.mind.org.uk
Telephone: 0300 123 3393
Information and support for mental health issues
such as depression or anxiety.

NHS website
www.nhs.uk
Information about conditions, treatments
and lifestyle, including information about
sexual problems.

Relate
www.relate.org.uk
Information, advice and relationship counselling
and sex therapy in England, Wales and
Northern Ireland.
Lifestyle Specialist Nurses 0800 074 8383 prostatecanceruk.org 11

About us
Prostate Cancer UK has a simple ambition:
to stop men dying from prostate cancer – by
driving improvements in prevention, diagnosis,
treatment and support.

This fact sheet is part of the Tool Kit. Download

and order our fact sheets and booklets from our
website at prostatecanceruk.org/publications
or call us on 0800 074 8383.

At Prostate Cancer UK, we take great care to

provide up-to-date, unbiased and accurate facts
about prostate cancer. We hope these will add
to the medical advice you have had and help you
to make decisions. Our services are not intended
to replace advice from your doctor.

References to sources of information used in the

production of this fact sheet are available at
prostatecanceruk.org

This publication was written and edited by

our Health Information team.

It was reviewed by:

• Lorraine Grover, Psychosexual Nurse
Specialist, The London Clinic, London, and
The Shelburne Hospital, Buckinghamshire
• Samantha McBeigh, Clinical Nurse Specialist,
Belfast Trust
• Sam Muter, Clinical Nurse Specialist,
University Hospitals of Derby and Burton
• Our Specialist Nurses
• Our volunteers.

Tell us what you think

If you have any comments about our
publications, you can email:
yourfeedback@prostatecanceruk.org
 Speak to our
Specialist Nurses
0800 074 8383*
prostatecanceruk.org

Donate today – help others like you

Did you find this information useful? Would you like to help others in your situation
access the facts they need? Every year, over 52,000 men face a prostate cancer
diagnosis. Thanks to our generous supporters, we offer information free to all
who need it. If you would like to help us continue this service, please consider
making a donation. Your gift could fund the following services:
• £10 could buy a Tool Kit – a set of fact sheets, tailored to the needs of
each man with vital information on diagnosis, treatment and lifestyle.
• £25 could give a man diagnosed with a prostate problem unlimited time
to talk over treatment options with one of our Specialist Nurses.

To make a donation of any amount, please call us on 0800 082 1616,

visit prostatecanceruk.org/donate or text PROSTATE to 70004†.
There are many other ways to support us. For more details please visit
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