Sex After Prostate Cancer Treatment: What Changes and What Helps

When you're diagnosed with prostate cancer, sex isn't usually the first thing you think about. Then, when the worst of the treatment's over, it can suddenly become one of the biggest things on your mind. Many men go through this, and many don't talk about it. It's a big change, and you're allowed to grieve it. You're also allowed to want your sex life back, in whatever form that takes. There's a lot that can help.

What can change

Effects depend on your treatment, your age and how things were before. Your specialist can tell you what to expect in your case. Here are some common ones:

• Erections. Surgery and radiotherapy can affect the nerves and blood vessels involved. Problems with erections are very common, and may improve over time, sometimes for two years or more. Some men won't get back to where they were.
• Dry orgasms. After a radical prostatectomy, you won't ejaculate any more, because the glands that make most of the fluid have been removed. You can still have an orgasm. Many men find that surprising, as nobody's told them. It can feel different, and takes some getting used to.
• Libido. Hormone therapy (androgen deprivation therapy) lowers testosterone, and this often reduces desire significantly, along with causing fatigue and body changes.
• Leaking. Some men leak urine during arousal or orgasm, called climacturia. It's common and it's harmless, although it can be embarrassing. Emptying your bladder first, using a condom or laying down a towel can all help.
• Penis size and shape. Some men notice some shortening or curving after treatment. Using treatments for erections early on may help.
• How you feel about yourself. Many men struggle with feeling less like themselves. Tiredness, low mood and grief are real parts of this. It helps to talk to someone.

Treatments for erections

Talk to your GP, urologist or a men's health physiotherapist early, as some men benefit from starting soon after treatment. Your doctor can tell you which of these is right for you.

• Tablets (PDE5 inhibitors) can help if the nerves are still working. They aren't suitable for everyone, particularly if you take nitrates for your heart.
• Injections or urethral treatments, which act directly on the penis, and can work when tablets don't.
• Vacuum pumps, which draw blood into the penis, with a ring at the base to keep it there. Some men use them as part of their recovery. Medical devices can have different safety features from novelty toys, so ask your specialist which is appropriate for you. Our guide to pumps explains how they work.
• Penile implants, a surgical option when other things haven't worked.

Don't use a cock ring or pump without checking first, especially if you've had recent surgery or you're on blood thinners. Pelvic floor exercises can help with leakage and erections, and a pelvic health physiotherapist can teach you how to do them correctly. Our pelvic floor guide explains more.

Sex doesn't have to mean an erection

For many men and couples, the turning point comes when they stop trying to get back to what they had, and begin looking at what's possible now. A soft penis can still feel a lot of pleasure, and you can have an orgasm without an erection. Our guide to soft penises explains how.

• Vibration. Strong, external vibration works on many men, even without an erection. A wand on the underside of the penis or the perineum can be very effective. The Adam & Eve Dew Drop is small and easy to hold, with 10 modes.
• Touch, kissing and massage. Sensual massage is a gentle way to reconnect, without pressure to go anywhere in particular.
• Oral sex, hands and non-penetrative sex can be as satisfying as anything else.
• Toys for your partner. You can give your partner pleasure in many ways. A hand, a mouth and a good toy all count. Our guide to couples' toys has some ideas. Strap-ons are also an option for men who want penetration to be part of sex.

If you have had your prostate removed, prostate-focused toys aren't relevant, and anal play can feel quite different. Check with your specialist, particularly after radiotherapy.

For partners

This affects you, too. You may have been a carer for months, and it's hard to go back to being a lover. You may miss what you had, feel guilty about that, or be afraid to touch them. Tell each other. Gay and bisexual men can have specific concerns, particularly around bottoming, and there's specialised support available for them too.

Where to get help in Australia

• Your urologist, GP or prostate cancer specialist nurse. Bring it up, and keep bringing it up. It's a medical issue, and it's a normal thing to ask about.
• Prostate Cancer Foundation of Australia has information, specialist nurses and support groups, on 1800 22 00 99.
• Cancer Council offers support on 13 11 20, including for sexuality and intimacy.
• A sex therapist or psychologist who's experienced in working with people with cancer. Here's what that involves.

Beyond Blue, on 1300 22 4636, is there if you're feeling low. It's very common after a cancer diagnosis, and you don't have to get through it alone.

Recovery isn't always a straight line, and your sex life may never be quite what it was. But many men and couples go on to find something that's good, and sometimes even better, because they've finally had to talk about what they want.

This is general information, not medical advice. Please talk to your treating team about your situation.