Dealing with ED & Other Sexual Issues

Reviewed by: HU Medical Review Board | Last reviewed: October 2017 | Last updated: March 2021

Erectile dysfunction (ED) and other sexual side effects can develop after many of prostate cancer’s common treatment options, including radiation therapy, surgery (such as radical prostatectomy), and hormone therapy. Different treatment options carry varying probabilities of developing ED, as well as different recovery times for resolution of these symptoms.

Common sexual side effects experienced by men with prostate cancer include the following:

  • Decreased sex drive
  • Pain during intercourse
  • Erectile dysfunction (inability to achieve or maintain an erection)
  • Dry orgasm (orgasm without semen discharge)
  • Fatigue
  • Body image concerns
  • Weaker orgasms
  • Loss of fertility1

While none of these symptoms are directly life-threatening, they do have the potential to substantially affect a man’s quality of life. Further, these issues can not only affect a man’s self-esteem and his relationship with himself, but also his relationships with any intimate partners. Sexual side effects will impact all men differently. It is possible for one man not to feel impacted by sexual side effects, while another may experience debilitating quality of life changes. Whatever way you deal with sexual side effects you experience is completely normal. Some men may pursue treatment or management options, while others may not.

Sexual side effects of treatment

Nearly all of the major treatment options for prostate cancer carry a risk of developing sexual side effects. In some of these cases, these side effects may be temporary, especially for those utilizing hormone therapy, while others may be potentially permanent, such as after surgery. If you haven’t started treatment yet, you can talk with your doctor about any concerns you may have regarding sexual side effects. If possible, they may be able to help tailor your treatment plan to your specific worries and goals. For example, if you are a younger man who would still like to have children, your doctor may recommend hormone therapy over external radiation that could permanently damage your sperm. What your options are and the side effects you are at risk for are dependent on your personal history and the extent of your cancer.

Erectile dysfunction is common after most treatment options, while loss of fertility is more of a concern with certain chemotherapy agents, post-external radiation, or post-surgery (for both radical prostatectomy and orchiectomy—the removal of the testicles). In some cases, you may still be able to have an erection as normal, and even climax during sexual encounters, but your ejaculation might be dry because of changes to your prostate gland (meaning no semen exits the penis). Again, the changes in sexual function you may experience, and how long these symptoms last, is completely dependent on the treatment options you undergo, the extent of your cancer, and your personal medical history. Your healthcare team will try to predict what your life may be like post-treatment, or how to better manage symptoms you’re already experiencing.1

Managing erectile dysfunction

Since the risk of developing erectile dysfunction can come along with nearly all treatment options, it is very common for men with prostate cancer, or survivors of prostate cancer, to struggle with this side effect. Fortunately, there are a variety of different options you can try to improve your erectile dysfunction. Several of these include:

  • Medications called vasodilators (Viagra, Levitra, Cialis, Stendra, and alprostadil)
  • Mechanical devices such as penile rings and vacuum pumps
  • Surgical penile implants

Medically managing erectile dysfunction may not be desired or feasible for everyone, however, it can provide relief and improve quality of life.2,3

Managing infertility

Chemotherapy, radiation therapy (specifically external beam radiation therapy), and surgery (specifically orchiectomy) can all impact a man’s fertility and healthy sperm production. The chances of a man’s fertility being impacted and for how long is dependent on the treatment experienced. In some cases, like after radiation therapy, a man may still be able to father a child, however, his sperm may be damaged by radiation and could severely impact a developing fetus.

Since prostate cancer needing invasive forms of treatment most commonly affects older men, there is often less of a need to preserve fertility. However, younger men or men who still desire to father children can be impacted as well. In cases where a man wants his fertility to be preserved or wants to still father a child, some of the following options, when possible, may be utilized:

  • Sperm banking: Storing sperm before treatment for use later on. While this is a fairly easy and common option, it can be expensive.
  • Radiation shielding: Shielding the testicles during radiation to other areas of the pelvis may be possible in some cases if a man wants to protect his sperm.
  • Sperm extraction and aspiration procedures: Invasive procedures in which semen is extracted from a man who still makes sperm but may not be able to ejaculate.
  • Use of a donor sperm: Sperm from a donor can be inseminated into a female partner or surrogate. Also called donor insemination.
  • Adoption

What fertility sparing or management options you’re eligible for is once again determined by your cancer and the treatment options pursued. Your healthcare team will be able to help you determine what options are the most realistic and safe for you and your partner or family.4,5

Managing other sexual side effects

How you manage other sexual side effects, such as decreased sex drive, pain during intercourse, body image issues, or fatigue will be dependent on what the underlying cause of these issues are and to what extent they are occurring. In some cases, psychological counseling may be necessary to address any mental health concerns that are contributing to a man’s decreased overall sex drive or perception of himself.

Communicating to your partner

Sexual side effects can be embarrassing and life changing. Because of this, it’s common for men to avoid talking about these struggles with their doctors or partners. By not talking about these issues, feelings of fear or inadequacy may build up and cause significant mental, emotional, or physical complications. This is why it is critical to talk with your doctor about potential treatment and management options that may be right for you, as well as to keep open lines of communication with your intimate partners.

Whatever amount you choose to share is up to you, however, enlisting support is a very healthful decision to make, especially when it’s from intimate partners or spouses. Whether your preferences or needs have changed or you need to back away from sexual activity for some time, communicating with your partner and establishing expectations and desires is critical to maintaining a healthy intimate life while managing any sexual side effect frustrations.

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