Sex after prostate cancer

Sex after prostate cancer can be deeply satisfying, but it may be different than it was before. This section includes many articles (listed below) that can help you through all phases of your man's sexual recovery.

Sex and prostate cancer treatment recovery take time

From a physical standpoint, a lot depends on the type of treatment your man chooses (particularly whether one or both nerve bundles are removed or damaged), whether he had any erection problems (called erectile dysfunction) prior to treatment, and his age. In general, impotence can become more of an issue as men get older.

Following a nerve-sparing radical prostatectomy, recovery from impotence (if it's a problem) generally happens slowly over time. Try to be patient. When it comes to sex and prostate cancer, the recovery process may take as long as several years. In fact, a recent study showed that it can take up to 4 years for men to see the most improvement in their sexual function after surgery for prostate cancer. So don't stop trying, even if your man may continue to have problems getting or maintaining a “stuffable erection” for sexual intercourse on his own. Our article about penile rehabilitation explains why having regular sex after prostate cancer treatment is so important.

Following radiation therapy, if impotence becomes a problem, it typically develops over time. During hormone therapy, a man may lose his interest in sex, as well as have erection problems. This can be difficult for both men and their wives/partners. This article can help you understand what your man may be feeling about his loss of libido.

From a psychological standpoint, there are other issues that may come into play during sex after prostate cancer. Some men may fear they won’t be able to get an erection, or feel like a failure if they can’t perform. Impotence—even if temporary—can be a big blow to a man’s sense of manhood. Worry and stress only add to the problem.

If your loved one has just had surgery for prostate cancer, he may fear that he will leak urine during sex (this can happen sometimes, but it is harmless). He may also experience some pain or discomfort during lovemaking, which can be another distraction.

What may be different for you

If your loved one didn’t have any erection problems before treatment, he was probably able to become aroused without any touching or direct stimulation. That may change after treatment.

If his prostate was surgically removed, he will have dry orgasms (some call it dry sex). That’s because the prostate and seminal vesicles have been removed, and there’s no longer a pathway for seminal fluid.

It may be encouraging to know that a man does not need to have an erection to have an orgasm. And there are other ways to satisfy your partner other than intercourse. It may take some experimentation to find what works best for both of you. Here are some articles that may help:

• Helpful tips for when you first make love after prostate cancer treatment.
• Learn how your man may feel about his impotence by reading our interview with with Rhonda Fine, PhD, ARNP, MSN, Board Certified Clinical Sex Therapist.
• Learn about impotence and sexual intimacy from our interview with Ralph & Barbara Alterowitz, authors of the book Intimacy with Impotence.
• Dr. Jo-an Baldwin Peters shares some insights about the loss of the ability to have penetrative sex.
• Try these sensate focus exercises to explore a new kind of intimacy.
• Our interview with Alicia B. Saunders, PhD, Board Certified Sex Therapist and Clinical Sexologist, will tell you how self-pleasuring can re-engage sex after prostate cancer.
• Read this article if you are wondering if a man's orgasms are different after treatment for prostate cancer.

It may help to approach sex after prostate cancer without any expectations. This may also help lessen any pressure or apprehension you may be feeling. Keeping the lines of communication open (including discussing what’s working and what isn’t) is also important. If you don’t experience the results you hoped for right away when you have sex after prostate cancer treatment, try not to be discouraged. If you feel you may need professional help, read this article about how a certified sex therapist/sexologist can help.

Help is available in many forms

Fortunately, there are many options available to help improve a man’s ability to get and maintain an erection, including:

Erectile dysfunction (ED) drugs
Self-injected drugs
Vacuum pump devices
Urethral pellets
Penile implants
Natural remedies

Talk to your loved one’s doctor about the different options that are available to help with erectile dysfunction. If one doesn’t work, try another.

When erections are not possible

While there are many other ways to be intimate with your loved one when erections are not possible, if you are still searching for a way for you and your man to have sexual intercourse, you may want to read this article about a strap-on penile prosthesis.

Don't lose heart

While there are definitely challenges associated with sex and prostate cancer, many of them can be overcome with patience and persistence.

We realize, however, that you may need to take some time to grieve what you've lost. But we hope that you will try to keep an open mind and not give up on sex altogether.

Updated 10/09

Always discuss everything you read on this web site with a qualified medical professional.

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Walsh PC. Guide to Surviving Prostate Cancer. New York, NY: Time Warner Book Group; 2001.