Erectile Dysfunction and Other Sexual Issues

After prostate cancer treatment, many people experience sexual side effects. For example, a common side effect of prostate cancer treatment is erectile dysfunction (ED). Different treatments have different risks of causing these side effects, as well as different recovery times.^1,2

What are the possible sexual side effects of prostate cancer treatment?

Common sexual side effects of treatment for prostate cancer include:^1,2

• Erectile dysfunction (inability to achieve or maintain an erection)
• Loss of fertility
• Decreased sexual desire (libido)
• Pain or fatigue during intercourse
• Dry orgasm (orgasm without semen discharge) or weak orgasm
• Body image concerns and loss of confidence
• Urine leakage during ejaculation

In some cases, side effects are temporary. In other cases, side effects can be permanent. They can have a serious impact on your quality of life. They may affect your self-esteem and relationships with intimate partners.^2-5

Sexual side effects impact all people differently, and there are many ways to manage them. Some people pursue treatment, while others do not.³

Which treatments can cause sexual side effects?

All major treatments for prostate cancer typically carry a risk of sexual side effects. Your risk of sexual side effects depends on many factors, including:^1,2,4,5

• The extent of your cancer
• The type of treatment
• The dose and duration of treatment
• Your age
• The amount of time since you had treatment
• Your other health problems
• Any history of smoking

Prostate cancer treatments that can cause sexual side effects include:^1,2,4,6,7

• Chemotherapy – may lower testosterone levels and libido
• Radiation therapy – may result in a dry orgasm or ED if there is damage to nearby areas
• Hormone therapy – may lower libido and cause ED
• Surgery (radical prostatectomy) – can affect the nerves, which can lead to ED

ED is common after most treatments. Loss of fertility is mostly a concern with certain chemotherapy drugs, radiation, or surgery.^2,4,5

Most men can be sexually active during treatment. However, some treatments can cause a higher risk of infection or bleeding. During these times, your doctor may suggest not having sex. They may also suggest using a condom and birth control.^1,5

Managing sexual side effects of prostate cancer treatments

Talk to your doctor about what to expect during treatment. Tell them about any concerns you have. Your doctor may be able to tailor your treatment plan to your priorities. If you would still like to have children, your doctor may suggest treatments that will not cause permanent damage to fertility.^1,3

Medicines can provide relief and improve quality of life. But not everyone wants or can access treatments for sexual side effects. Deciding how to manage them is a personal decision.²

Erectile dysfunction

Many people with prostate cancer still want to be sexually active. Because ED is so common, treatment is a priority for many of them. Several treatment options are available to help manage ED, including:^2,3

• Oral medicines (PDE-5 inhibitors) – Viagra® (sildenafil), Levitra® (vardenafil), Cialis® (tadalafil), and Stendra® (avanafil)
• Vasodilators injected into the penis or inserted into the urethra – includes certain forms of alprostadil
• Mechanical devices – penile rings or vacuum pumps
• Penile implants – devices inserted through surgery

Loss of fertility

People who need invasive treatments for prostate cancer tend to be older, so often there is no need to preserve fertility. However, prostate cancer also can affect those who want to have children. In these cases, a few options are available:⁸

• Sperm banking – storing sperm before treatment for use later
• Radiation shielding – shielding the testicles during radiation to other areas of the pelvis
• Sperm extraction and aspiration procedures – extracting semen if you can still make sperm but cannot ejaculate
• Using a donor sperm – sperm from a donor inseminated into a female partner or surrogate

Your eligibility for these options depends on your personal health factors. Talk to your doctor about what is possible and safe for you and your family.⁸

Other sexual side effects

Pain, fatigue, and body image concerns are common side effects of prostate cancer treatment. Managing these side effects often depends on their severity and underlying causes.^1,3

Psychological counseling can help with the mental health challenges posed by these side effects. Support groups and counselors can help you share your feelings and concerns. They can also teach you how to cope with your experiences.^1,3

Sexuality, gender identity, and sexual side effects

Gay and bisexual men and transgender women may be impacted differently by sexual side effects. Some doctors may not ask about sexuality or gender identity, so you may have to start this conversation yourself.⁹

Transgender people, in particular, may avoid or delay care because they fear medical mistreatment. They may have had negative experiences with healthcare providers in the past.⁹

But studies have shown that prostate cancer can have unique effects on sexual and gender minority groups. These groups include gay, bisexual, queer, asexual, intersex, transgender, and nonbinary people. Their differences may affect the type of care they need. For them, unique issues related to prostate cancer may include:⁹

• Pain during anal intercourse
• Needing to change sexual roles because of treatment
• More distress from sexual side effects due to a higher likelihood of being single
• Higher risk of mental health conditions
• Increased desire to try ED treatments
• Recreational use of certain drugs that can interfere with ED medicines

Find a doctor you trust and who considers your needs. Open communication can help you stay safe and healthy. It can get you the treatment and support that is right for you.⁹

Communicating with your partner

Sexual side effects can be life-changing. It is common to feel embarrassed and avoid talking about your struggles. But by staying silent about these issues, feelings of fear or failure may build. This can lead to serious mental, emotional, or physical problems.³

Keeping open lines of communication with your partner is critical. How much you choose to share is up to you. But talking to them early and often can improve your comfort, confidence, and health. Some things you may want to talk about include:³

• Changes in your sexual preferences, desires, or needs
• What intimacy looks like for you now
• Setting new expectations
• Whether you need to take a break from sexual activity
• Ways your partner can support you
• Decisions about therapies, treatments, and devices