While most men will face some issues in the bedroom after prostate cancer treatment, these problems are often temporary or treatable.
You might feel frustrated at first, but be patient. With time and the right treatments, you can likely have a fulfilling sex life after prostate cancer.
What to Expect
Your prostate is next to key nerves, blood vessels, and muscles that help you have an erection. Surgery and radiation to treat your cancer can damage these areas, making it more difficult to get an erection or have an orgasm. (If you were having trouble getting an erection before your treatment, you probably still will.)
Hormone therapy lowers the amount of testosterone in your body, which won't help your sex drive and performance.
The most common complaint after certain treatments -- for about 8 out of 10 men -- is erectile dysfunction (ED). This means you can't get or keep an erection that's hard enough for penetration. But even if you have ED after your treatment, you can still have an orgasm. In fact, most men can have one without an erection.
You may also have:
These issues may last several weeks or much longer. It depends on the type of treatment you have and how you feel. Up to half of men who have nerve-sparing prostate surgery or radiation therapy see improvement in having sex within a year after their treatment.
Penile rehabilitation is a way to get your penis back into shape after surgery or radiation. The idea is to use it so you don't lose it.
While there's not a lot of data behind the theory of penile rehabilitation, supporters say frequent erections can raise oxygen levels and improve blood flow, which can keep your penis healthy.
If you want to try this, you'll need to commit to regular penis stimulation. ED treatments can also help with this process. Ask your doctor if rehab might work for you.
Medications: Well-known drugs like sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn) are pills you can take to improve blood flow to your penis. These can help ED if you've had prostate cancer, but only when your nerves aren't damaged by surgery or radiation.
Another way to have an erection without sexual stimulation is by giving yourself a shot of medicine in the base of your penis.
Devices: A vacuum, or "penis pump," pulls blood into your penis. These tools work best for men who can get an erection but can't keep it.
Or a surgeon could place implants in your penis to help you have an erection.
Oxytocin: You put this medicine under your tongue about 10 minutes before sex to help you have an orgasm.
Supplements: Some men take herbs and other substances to improve sexual desire and function such as dehydroepiandrosterone (DHEA), L-arginine, ginkgo, ginseng, yohimbe, and zinc. Some of these can be dangerous, and others have no scientific studies to back up their claims, so be sure to check with your doctor before you take one.
If you smoke or drink heavily, it might be harder to get an erection.
Kegel exercises help strengthen your pelvic floor muscles. Building those muscles may also improve your ability to have an erection.
Your Approach to Sex
It might sound basic, but make sure you're aroused in the moment. Think about a sexual fantasy or feelings of pleasure. Let your partner delay your excitement if you feel like you might have an orgasm.
Try other forms of intimacy, too. Sex doesn't have to be just the usual sex. Kissing, touching, oral sex, and manual sex are some other things you might enjoy. You can also use a vibrator on the head of your penis to stimulate nerves and send more signals to your brain.
Your Emotions and Sex
Your prostate cancer and its treatment won’t just affect your body. They’ll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of having sex. The more you worry, the worse the struggle. If you’re in a relationship, your partner will be going through many of the same feelings.
One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don't assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate.
Talking with a mental health professional -- either one-on-one or with your partner -- can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.