Prostate Cancer and Your Sex Life

Prostate cancer

and your sex life

2 Prostate cancer and your sex lfe
About this booklet

This booklet is for men and their partners who want to know
how prostate cancer and its treatment can affect their sex
lives, how they feel about themselves, and their relationships.
We talk about the sexual side effects you may experience
and the treatment and support available.
Whether you’re single or in a relationship, and whatever your

sexuality, we hope you find this booklet helpful.
Some sections might be more helpful to you than others, so

use the contents to guide you. You might want to dip in and
out of this booklet rather than read it all in one go.
Each GP practice or hospital will do things slightly differently.

Use this booklet as a general guide to what to expect and ask
your doctor or nurse for more information about your care and
the support available. You can also speak to our Specialist
Nurses, in confidence, on 0800 074 8383 or chat to them online.
The following symbols appear throughout the booklet:
Our Specialist Nurses
Our publications
Sections for you to fill in
The photos in this booklet are of people personally affected by prostate cancer. The quotes are not
the words of the people in the photos.
Specialist Nurses 0800 074 8383 prostatecanceruk.org 3
Real life stories

At the back of this booklet is a DVD of six men talking about how
they deal with changes to their sex lives during and after their
prostate cancer treatment.
Their stories include experiences of sexual problems after

surgery and radiotherapy, and during hormone therapy. These
men all have different ways of dealing with the impact of these
changes on their lives and relationships. They have also tried
a variety of treatments for erection problems, like injections,
vacuum pumps and pellets.
This symbol appears throughout the booklet to guide you

to different men’s stories on the DVD. You can also watch
them online at prostatecanceruk.org/real-stories
For more help on managing sexual problems see our interactive

online guide: prostatecanceruk.org/guides
You might well have some jolly good sex

afterwards. I would never have believed
it. And yet it happens. Now that’s
something I wish someone had told me
way back.
A personal experience
Contents
About this booklet .............................................................................................................. 2
How might prostate cancer affect my sex life? .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Getting the right treatment and support .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Problems getting an erection .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Treatments for erection problems ...................................................................... 22
Your desire for sex (libido) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Changes in penis size and shape .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Changes to orgasm and ejaculation .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Having children .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Your thoughts and feelings ....................................................................................... 47
Sex and your relationships ........................................................................................ 51
Gay and bisexual men .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Sex when you’re single ................................................................................................. 61
Support for partners .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
More information from us ........................................................................................... 65
Other useful organisations .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
About us .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Prostate cancer and my sex life: Real life stories DVD ................ 70
How might prostate cancer affect

my sex life?
Sex is an important part of life for many of us. Dealing with prostate
cancer and living with the side effects of treatment can have an
impact on your sex life. Many men with prostate cancer say that
changes to their sex lives and relationships are some of the biggest
issues they have to deal with.
Feeling sexual is partly physical and partly about your thoughts

and feelings. It depends on how well your sex organs are working
and whether other parts of the body are helping them work, for
example, the blood supply, nerves, brain and hormones. The way
your body responds sexually also depends on your thoughts and
feelings – about yourself and others.
If you’re in a relationship, the sexual impact of prostate cancer

could affect both you and your partner and it’s important that
you both get support if you want it. If you’re a partner of a man
with prostate cancer, there’s information you might find helpful
on page 63.
Prostate cancer can affect your sex life in overlapping ways

– affecting your mind, body and relationships.
Body
Treatment can damage the
nerves and blood supply
needed for erections.
Hormone therapy can affect
your desire for sex.
Relationships Mind
Coping with cancer Finding out you have
can change your cancer can make you
close relationships, feel down or anxious,
or your thoughts changing your
about starting one. feelings about sex.
Treatments for prostate cancer can affect:

• how you feel about yourself sexually
• your desire to have sex (libido)
• your ability to get an erection, ejaculate and have an orgasm
• your ability to have children (fertility)
• how your body looks
• your relationships.
There are treatments and support that can provide some answers
and ways for you to work through any problems – whether
your prostate cancer affects your thoughts and feelings, your
relationships or your body.
It’s okay to talk about sex and ask for support

Many men avoid asking for help or trying treatments – it can
be a difficult thing to face and to talk about. There are trained
professionals who have experience of managing sexual problems
and relationships. They will be able to make you feel more
comfortable and talk you through the treatments and ways of
dealing with changes in your relationships. We talk more about
discussing sexual problems and getting treatment on page 14,
and list ways to get support on page 49.
Will I be able to have sex and masturbate?

Many men wonder if it will be possible to get an erection and have
sex after prostate cancer treatment. This will depend on a number
of things, including what type of treatment you’ve had, how you’re
feeling, and whether you already had sexual problems before you
started treatment.
Everyone is different. Some men will have temporary problems that

recover with time. Others will be able to get an erection with the
help of treatment. But some might not be able to get erections,
even with medical help.
On the following pages we cover the types of sexual problems

you may have after different treatments and talk about things that
can help.
What effects can prostate cancer treatments have?

If you’ve had surgery (radical prostatectomy)
This is an operation to remove the prostate and seminal vesicles.
When can I have sex or masturbate?

• It’s safe to have erections, including at night while you’re asleep,
and masturbate when you feel like it.
• After keyhole surgery, you can have sex or be sexually active
once your catheter is removed.
• After open surgery, wait until the wound has healed and it feels
comfortable before you try having sex.
What problems might I have?

• Surgery often causes problems getting an erection. Many men
find these problems improve with time, but not all men get their
erections back.
• Your penis may become a little shorter.
• You won’t ejaculate any semen but can still orgasm, although it’s
likely to feel different.
• You won’t be able to have a child naturally (infertility)
(see page 46).
If you’ve had external beam radiotherapy

This is where radiation is directed at the prostate from outside
the body.

• You can have sex or masturbate as soon as you feel like it.
• You may wish to use contraception during treatment and for
at least one year afterwards if there is a chance of your partner
becoming pregnant (see page 46).
• If you receive anal sex, wait until any bowel problems or
sensitivity in this area have passed.

• Erection problems can develop slowly after treatment.
• You may find ejaculation uncomfortable.
• You may produce less or no semen but can still orgasm.
• You may not be able to have a child naturally (infertility)
(see page 46).
If you’ve had permanent seed brachytherapy

This is a type of radiotherapy where tiny radioactive seeds are put
inside the prostate and left there permanently.

• After treatment, wait a few days before you try having sex
or masturbating.
• It’s rare for seeds to come out in your semen, but use a condom
the first five times you ejaculate.
• Use contraception during treatment if there is a chance of your
partner becoming pregnant. You may have to use contraception
for up to a year after having treatment but ask your doctor or
oncologist about this (see page 46).
• If you receive anal sex, wait until any bowel problems or

sensitivity in this area have passed. It’s possible that your partner
might be exposed to some radiation during sex for the first few
months after treatment. So it’s sensible to keep the length of
time you have sex for as short as possible for up to six months.

• Erection problems can develop slowly over time.
• You may produce less semen but can still orgasm.
• You might not be able to have a child naturally (infertility)
(see page 46).
If you’ve had high dose-rate brachytherapy

This is a type of radiotherapy where thin tubes are put into your
prostate. A source of radiation is passed down the tubes for a few
minutes to destroy the cancer cells, then the tubes are removed.

• After treatment, wait at least one week before you try having sex
or masturbating.
• Use contraception for a while after treatment if there is a chance
of your partner becoming pregnant. Speak to your doctor about
how long for.

• You may have erection problems, which can slowly get worse
over several years.
• You may produce less semen but can still orgasm.
(see page 46).
If you’ve had high-intensity focused ultrasound (HIFU)

This uses high-frequency ultrasound energy to heat and destroy
cancer cells.

• After HIFU, wait at least one to two weeks before you try having
sex or masturbating.

• You may have erection problems.
• You may produce less or no semen but can still orgasm.
(see page 46).
If you’ve had cryotherapy

This uses extreme cold to freeze and destroy cancer cells.

• After cryotherapy, wait at least one week before you try having
sex or masturbating.

• You may have erection problems.
(see page 46).
If you’re having hormone therapy

Hormone therapy stops the hormone testosterone from reaching
cancer cells, to stop them from growing. It can be given by
injection, implants, tablets or surgery.

• It’s safe to have sex or masturbate if you’re having injections,
implants or tablets.
• If you’ve had surgery (orchidectomy), wait until the wound has
healed and it feels comfortable before you try having sex.

• You may have erection problems and you may lose your desire
for sex.
• Your penis may become shorter and your testicles smaller.
• You may not be able to orgasm or you may have less
intense orgasms. And you may produce less semen.
• You may have changes to your body which can affect how you
feel about sex, such as weight gain or hot flushes.
Some worries about sex and prostate cancer explained

• You can’t pass on cancer through sex.
• Having sex won’t affect how well your treatment works.
• Having sex has no effect on your cancer or the chance of it
coming back after treatment.
• It’s safe to have an erection if you have a catheter in.
Getting the right treatment

and support
There is no right or wrong way to deal with changes to your sex
life. Some men will want to try treatments for erection problems
(see page 22), while some will prefer to find other ways to be close
to their partner. What’s important is that you find what’s right for
you and don’t be afraid to ask for support if you want it.
Getting treatment for erection problems

Your GP, hospital doctor or nurse can prescribe treatment for
erection problems for free on the NHS, whether it’s for sex or
masturbation. There may be a limit on how much treatment they
can prescribe, but there is no age limit. They can also refer you to
a specialist in sexual problems or an ED (erectile dysfunction) clinic.
It can take time and commitment before you see any results.
Follow the advice you’re given about how to use your treatment
and for how long. Try each treatment several times and if it still
doesn’t work, tell your doctor or nurse. They may review your
treatment or refer you to a specialist.
Use these guidelines to help you

We’ve created two guides for health professionals supporting
men with erection problems after surgery, radiotherapy and
hormone therapy. You could show them to your doctor, nurse
or other health professional to help you get the best possible
support. Download the guides at:
• prostatecanceruk.org/edsurgery
• prostatecanceruk.org/edradiotherapy
Talking about sex

It can be difficult talking about sex, but talking to your doctor,
nurse or another health professional will mean you can get
treatment and support. It can also help you feel more positive and
more in control.
You can ask about sexual problems at any stage – before, during
or after your prostate cancer treatment. Talking about it before your
treatment will mean you know what to expect and can help you to
prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during
your treatment for prostate cancer. But if they don’t then you may
need to bring it up yourself.
Be prepared to try again

Not everyone is used to talking about sex. Even your health
professional might not be used to talking about it. Don’t be put off.
You might need to bring it up more than once, or with a different
person in your team. You can also ask to be referred to an expert
in sexual problems or an ED clinic – they will be used to talking
about sexual problems.
Your health professional might not be

comfortable talking about this. Hang on in
there. Find someone else who is.
16 Title of publication
Questions to ask your doctor or nurse

How could my prostate cancer treatment affect my sex life?
How soon after treatment can I masturbate or have sex?
Which treatments for erection problems would be best for me?

Can I get them on the NHS?
Is there anything I can do to prepare myself before I start my

prostate cancer treatment?
What happens if the treatment doesn’t work? Are there others

I could try?
What other support is available to me?
Can my partner also get support?

What health professionals might I see?

We say you can speak to your doctor or nurse throughout this
booklet, but you may find other health professionals can help as
well. It could be those listed here, or others you see.
Urologist
A surgeon who specialises in problems with the urinary and
reproductive systems, including prostate cancer.
Specialist nurse or clinical nurse specialist (CNS)

A nurse who specialises in caring for men with prostate cancer.
They may be the health professional you see most. They can
support you and answer questions.
Andrologist
A doctor who specialises in the male reproductive system,
including fertility and problems with the penis, testicles or
sex hormones.
Sex therapist (or psychosexual therapist)

An expert with specialist training in the causes and treatment of
sexual problems. They may have a background in medicine, nursing,
psychology, or mental health. See page 57 for more information.
Physiotherapist
A health professional who can help with mobility and provide
exercises to help improve fitness, ease pain, or strengthen
muscles. You might see a physiotherapist to help you do pelvic
floor muscle exercises.
Problems getting an erection

Difficulty getting or keeping an erection is sometimes called erectile
dysfunction (ED) or impotence. In this section we talk about some
of the causes and possible treatment options.
Causes of erection problems

Erection problems have many possible causes, including treatment
for prostate cancer. Many men with prostate cancer may have
had sexual problems before their treatment. It’s normal for our sex
lives to slow down as we get older, and problems with erections
become more common. But that doesn’t mean there’s nothing you
can do about them.
When you are sexually aroused (turned on) your brain sends
signals to the nerves in your penis. The nerves then cause blood
to flow in to your penis, making it hard. Anything that interferes
with your nerves, blood supply or desire for sex (libido) can make it
difficult to get or keep an erection.
Treatment for prostate cancer

Some treatments for prostate cancer can damage the nerves and
blood vessels that are needed for an erection, including surgery,
external beam radiotherapy, brachytherapy, HIFU and cryotherapy.
Hormone therapy can also lower your desire for sex and the lack of
activity means your penis will stop working so well.
Other health problems

Other health problems can cause erection problems, including:
• high blood pressure
• diabetes
• heart disease
• high cholesterol
• neurological conditions such as epilepsy, stroke, multiple
sclerosis or Parkinson’s disease
• other prostate problems such as an enlarged prostate or
prostatitis, and their treatments
• hormone problems, such as low testosterone (see page 36).
Other medicines
Some medicines can also cause erection problems. These include
medicines for high blood pressure, high cholesterol, depression
and anxiety, ulcers, irregular heartbeat, epilepsy and an enlarged
prostate. Don’t stop taking any medications you’re on, but talk to
your doctor or nurse about whether they could be affecting your
ability to get an erection.
Depression and anxiety

Feeling low or anxious can affect your erections and your desire to
have sex.
Lifestyle
Smoking, drinking too much alcohol, lack of exercise and being
overweight can cause problems with erections.
Focus on…
what to expect at an ED clinic
Your doctor may refer you to a specialist service such as an ED
(erectile dysfunction) clinic, which offers treatment for erection
problems. You might see one or all of the health professionals
listed on page 17. They will be used to talking about sexual
problems and should help make you feel more comfortable
talking about them.
What happens at the appointment will vary, but you will probably
have a chat about your sex life, any concerns you have,
any other health problems and how you’re feeling generally.
If you have a partner, you can ask them to go with you to
the appointment.
A doctor or nurse will check your blood pressure and heart rate,
and may do a blood test. They might also check how you are
physically. They might check your penis and testicles – this will
be done in a private room or behind a curtain.
You’ll be able to find out more about the treatments available.

And you might be able to try some of the treatments during the
appointment to see whether they work.
To deal with erection problems

I needed an open mind, patience
and some resourcefulness.
But the positive results make
that so very worthwhile.
Treatments for erection problems

There are a number of treatments available which work in different
ways. Treatments include:
• tablets
• vacuum pump
• injections
• pellets or cream
• implant
• testosterone replacement therapy.
I didn’t think I was ever going to have an

erection again. That’s what worried me the
most. When I started injections and they
worked – it was a fantastic feeling.
How well each treatment works and whether your erections

recover varies from man to man. Your overall health, your ability to
get erections before cancer treatment, the treatments you try and
your age can all play a role. Try different things and stick with them
for a while to find the best option for you.
Your thoughts and feelings

Because getting an erection also relies on your thoughts and
feelings, tackling any worries or relationship issues as well as
having medical treatment can work well. There are lots of ways
to do this. It may be talking to someone close to you, speaking
to your nurse, or getting some counselling or sex therapy. See
page 49 for ways to get support.
Will the treatments work if I’m on hormone therapy?

Hormone therapy lowers your desire for sex. Some treatments,
such as tablets, only work when you have desire, so these are
unlikely to be the best option for you. But injections, pellets, cream
or a vacuum pump could still give you an erection.
Even if you don’t have a strong desire for sex, having regular erections
can help keep your penis healthy because it encourages blood flow to
the penis, so the cells have a good supply of oxygen. See page 25 for
information about keeping your penis healthy.
Stick with it
Treatments for erection problems aren’t always a ‘quick fix’. You
often have to stick with them for a while or try different treatments
to see what works best for you. Men who try more treatments for
erection problems are more likely to find one that works.
A combination of treatments, such as tablets and a vacuum pump,
may work better than one treatment on its own.
If you’ve had surgery, your erections may improve over time as

your nerves recover. So if treatments don’t work at first, it’s worth
trying them again in a few months.
Fitting treatments into your sex life

Some treatments for erection problems can seem artificial and you
may feel like you lose the moment. But people often find they get
used to them. Some couples even use their treatment as part of
their foreplay, such as using the vacuum pump or rubbing in cream.
Your partner could come with you to any appointments and,

if possible, you could try your treatment with your partner in the
room, as it may help if they know how it works.
What if I have other health problems?

Some treatments for erection problems may not be suitable if you
have a heart problem, sickle cell disease or Peyronie’s disease, or
you’re taking medicines called nitrates. Ask your doctor or nurse
for advice if this includes you, and let them know about any other
medicines you’re taking. You’ll find more information in the leaflet
that comes with your treatment.
Watch Paul’s story

Find out about trying different treatments for erection problems.
Focus on… keeping your penis

active after surgery
Although you may not be ready or recovered enough for sex,
you can still start treatment for erection problems in the weeks
immediately after surgery. It could be taking a low-dose tablet
once a day or using a vacuum pump, or both together. The
treatment, along with masturbation, encourages blood flow
to the penis. This can help keep your penis healthy because it
means the cells have a good supply of oxygen. You may hear
this called penile rehabilitation.
Think of it in the same way as having physiotherapy if you had

injured an arm or leg. Starting treatment soon after surgery may
improve your chance of getting and keeping an erection later on.
My nurse encouraged me to take the tablets

and to masturbate even if my penis was soft.
He said I shouldn’t give up as it was keeping
my penis active. I found that masturbating in
the shower was best as I was more relaxed.
Tablets
A group of drugs called PDE5 inhibitors (phosphodiesterase type
5 inhibitors) could help you get an erection. These include:
• sildenafil (generic sildenafil or Viagra®)
• tadalafil (generic tadalafil or Cialis®)
• vardenafil (Levitra®)
• avanafil (Spedra®).
How well do they work?

How well these drugs work varies from man to man. The tablets are
quick and easy to take and they don’t interfere with foreplay. It’s good
to start taking them soon after prostate cancer treatment as you may
get your erections back sooner. They could also help your recovery
so that in the future you can get erections without medical help.
There hasn’t been any research comparing how well the different
types of PDE5 inhibitor tablets work in men who have prostate
cancer treatment, so we can’t say if one drug is better than another.
How do they work?

You need to be sexually aroused for the tablets to work. If you have
a low sex drive or low testosterone level, for example if you’re on
hormone therapy, they might not work so well for you.
The tablets normally start to work about 30 minutes to an hour after

taking them. Make sure you allow enough time for them to work,
otherwise it might seem like they’re not working when in fact they are.
You can take sildenafil, avanafil and vardenafil when you need to.
They will keep working for four to six hours, or up to eight hours for
vardenafil. So if they work you should be able to get an erection if
you’re sexually aroused during that time.
You can take tadalafil when you need to. It can work for up to
36 hours so it lets you be more spontaneous. Or your doctor may
suggest you take a low-dose (5mg) tadalafil tablet every day. If you
have a choice of drug, think about which one fits in best with your
sex life.
The dose you have will vary. Some men start with a low dose but go
up to a higher dose if the drug isn’t working. If the maximum dose of
one drug doesn’t work, another drug may work better for you.
Don’t give up
The tablets may not work the first few times. It can take a while
to get the timing right. Try each tablet at least eight times before
changing to a different one. You may need to take your tablet on
an empty stomach as some tablets don’t work as well after a big
or fatty meal, or with alcohol or grapefruit juice. Read the leaflet
that comes with your tablets for more information.
If you had surgery and your surgeon was able to save the nerves
that help you get erections (nerve-sparing surgery), you’ll be
offered PDE5 inhibitors. It can take months or even years for
the nerves to fully recover. This means it can feel like a long time
before the tablets start working. It’s important to keep your penis
active with other treatments, such as injections or a vacuum
pump, during this time (see page 25).
If your surgeon wasn’t able to save the nerves, your doctor

might still suggest you try PDE5 inhibitors, as they can still
sometimes have an effect.
Side effects
PDE5 inhibitor tablets are generally safe to use, but they can cause
side effects. These are usually mild and don’t last long. They include:
• headaches
• indigestion
• a flushed face
• itchiness or swelling in your nose (rhinitis)
• back pain.
Things to be aware of
PDE5 inhibitor tablets can cause a drop in your blood pressure,
but this doesn’t cause problems for most men. Tell your doctor or
nurse if you’re taking medicines to control your blood pressure. If
you take alpha blockers they may suggest taking the drugs at least
four hours apart.
You shouldn’t take PDE5 inhibitor tablets if you’re taking drugs

called nitrates. Taking these treatments at the same time can
cause your blood pressure to drop dangerously low, which can be
fatal. Nitrates are usually used to treat heart problems. They are
also used in recreational drugs known as poppers. If you have a
heart problem or take nitrates, ask your doctor or specialist about
other ways to treat erection problems.
Buying tablets on the internet

Only use medicines that have been prescribed to you by a health
professional. Sildenafil is available for free on the NHS so you
shouldn’t have to buy your treatment. Buying tablets on the
internet is dangerous as they can be fake, it’s impossible to know
the dose, and they could contain ingredients that are harmful or
react with other drugs. If your GP doesn’t want to prescribe tablets
then ask to be referred to an ED clinic.
Herbal medicine
Herbal medicines for erection problems, like ‘herbal Viagra’ which
is sold in Chinese herbal medicine stores, can also be unsafe.
Speak to your doctor before taking any herbal remedies.
Vacuum pump
You use a pump and a plastic cylinder to create a vacuum which
makes the blood flow into your penis. This can give you an erection.
There are two reasons men use a vacuum pump. One is to get an
erection for sex or masturbation and the other is to keep the penis
healthy in the long term. It could also help to maintain its size.
pump
constriction
ring
penis
cylinder
How well does it work?

The vacuum pump can be an effective way to get an erection hard
enough for penetration. Satisfaction with the pump varies, but
men who have good results will often keep using it. A lot of men
use the pump in combination with other treatments such as tablets
(see page 26).
The vacuum pump may also help maintain the length and
thickness of the penis if used regularly and soon after surgery.
How does it work?

You put your penis into the cylinder and use the pump to draw air
out of the cylinder, creating a vacuum inside it. This makes blood
flow into your penis to make it hard. Your nurse or doctor will show
you how it works and they might give you an instruction DVD to
take home.
If you are using the pump for sex or masturbation

After using the pump to get an erection, you slip a constriction ring
from the end of the cylinder around the base of your penis. This
stops most of the blood escaping when you remove the pump.
You shouldn’t wear the ring for longer than 30 minutes at a time.
Some men find that because the base of their penis is still soft it
moves around, so it can be difficult to have sex at first. You or your
partner may need to guide the penis in.
Shaving the hairs around the base of your penis can make it easier
to use the pump.
Some men prefer the vacuum pump because you don’t need to
use tablets or injections and you can use it as often as you like.
With a little practice, the pump can help you get an erection in two
to three minutes.
The way the vacuum pump works doesn’t involve the nerves that
are usually needed for erections. So if your nerves were removed
or affected during your prostate cancer treatment, the vacuum
pump could be a good option for you.
If you are using the pump to keep your penis healthy

To keep your penis healthy, you could use the pump every day.
Use the pump to get an erection and hold the erection in the
cylinder for 20 seconds. Then release the pressure and pump
again to get another erection. Keep repeating this for no more
than 10 minutes, as more than that could become uncomfortable.
Check the instructions for details or speak to your doctor or nurse.
Don’t use a constriction ring – only use a ring when you want an
erection for sex or masturbation. This is because the ring stops
blood and oxygen from flowing into your penis, and your penis
needs oxygen to stay healthy.
Side effects
Vacuum pumps are very safe to use and you can use them
along with other treatments. You may notice your penis feels
slightly cooler than usual and you might not be able to ejaculate
if you’re using a constriction ring. Some men also find it painful or
uncomfortable or experience some bruising or numbness.
Things to be aware of
The vacuum pump might not be suitable if you have a bleeding
disorder, if you take drugs to thin your blood, or if you have
Peyronie’s disease (where the penis is curved). Speak to your
doctor or nurse about whether it’s suitable for you.
Buying vacuum pumps

Vacuum pumps are usually available on the NHS. If you choose
to buy one, ask your doctor, nurse or specialist for advice on
choosing one that’s suitable. The Sexual Advice Association also
has information on buying a vacuum pump.
Injections
Erection problems can also be treated with drugs using an injection
that you give yourself. These include:
• alprostadil (Caverject®, Caverject® Dual Chamber, Viridal Duo®)
• aviptadil with phentolamine mesilate (Invicorp®).
spongy very fine

tissue needle
of penis
injection
plunger
An injection may sound off-putting but many men find it isn’t that
bad and doesn’t hurt. Your nurse or doctor will show you how to
inject the side of your penis with a very thin needle. They will make
sure you’re happy giving yourself the injection before you go home.

Injections often work well. They work quickly because the drug
goes straight to where it’s needed, and they give a natural looking
erection. It helps if you start soon after your prostate cancer
treatment. Injections should work if you have little or no sexual
desire (libido), but they work better when you have some sexual
interest and stimulation.
How does it work?

The injection causes blood to flow into the penis, allowing it to
become hard. You’ll get an erection quickly, within five to 10 minutes,
and it lasts for up to an hour.
You need to be able to see your penis to use the injection – so if

you have sight problems, a big belly or a hidden penis it may not
be suitable for you. If you have any difficulties using your hands it
may also be harder to use the injection. Your doctor or specialist
could show your partner how to use the injection, or you can talk
about other possible treatments.
Side effects
Some men find their penis hurts or aches for a few hours afterwards.
If you have any other problems, tell your doctor or nurse.
If your erection doesn’t go down

With all treatments for erection problems some men find their
erection won’t go down and can be painful. If this happens, try
having sex or masturbating. Squatting, walking up and down the
stairs or urinating (peeing) may also help.
Go to your nearest accident and emergency (A&E) department

straightaway if your erection lasts more than four hours. This is
called priapism and it’s considered a medical emergency, but
it can be treated. It is very rare and less than one in 100 men
who use treatments for erection problems experience this. With
injections, the figure is slightly higher at about one in 100.
Don’t use injections and PDE5 inhibitor tablets together, as this

increases the risk of priapism.
Pellets or cream
The drug alprostadil, which is used in the injections described on
page 32, is also available as a small pellet called MUSE® and as a
cream called Vitaros®.
opening or
applicator
‘eye’ of penis
stem
applicator
stem
applicator
pellet
applicator
urethra
How well do they work?

These don’t tend to work as well as the injections, but they’re a good
alternative if you don’t like the idea of an injection. Pellets and creams
may work if you have little or no sexual desire (libido), but they work
better when you have some sexual interest and stimulation.
How do they work?

You use an applicator to insert the pellet or cream into the opening
or ‘eye’ of the penis. The applicator can be difficult to use at first
but it shouldn’t hurt.
With the pellet, it helps if your urethra, which is the tube you
urinate through, is already moist, so urinate first. With the cream,
you or your partner can rub in any cream that’s left on the tip and
massage your penis to help it absorb the drug.
If the pellet works you should get an erection very quickly – within
five to 10 minutes – which lasts for up to an hour. The cream may
take a little longer to work.
Side effects
The pellets and cream can sometimes cause dizziness or a
burning feeling or pain in the penis or testicles.
You should use a condom during sex as your partner could have
a reaction to the drug – but this is unusual. Use a condom if your
partner is pregnant.
Implants
This involves having an operation to put an implant inside your
penis. Although it sounds quite off-putting, it can be a good option
if other treatments haven’t worked.
fluid
implant
implant
when
inflated
pump in
scrotum

Most men who have an implant are satisfied with it. It allows you
to have an erection when you want one and it doesn’t prevent
urinating, feeling or orgasm.
How does it work?

There are two main types of implants.
• Semi-rigid rods that keep the penis fairly firm all the time but
allow it to be bent down when you don’t want an erection.
• An inflatable implant in the penis and a pump in the scrotum
(the skin around the testicles). When you squeeze the pump the
implant fills with fluid (saline) to make the penis hard. The fluid
is either contained in the pump in the scrotum, or in a separate
container that sits in your lower abdomen, just above your penis.
Your erection will last for as long as the implant is inflated and you
can deflate it when you want to. This type of implant gives a more
natural erection, although the tip of the penis may stay soft.
Side effects
These are generally safe, but about three out of 100 men
(three per cent) who have an implant get an infection which means
the implant has to be taken out. You will be given antibiotics after
surgery to help prevent this.
The inflatable implant usually lasts for at least 12 years. But up

to about five out of 100 men (five per cent) may need to have it
replaced after five years. The semi-rigid implant is less likely to
need replacing.
Testosterone replacement therapy

Testosterone is a hormone that controls the growth of the male
sex organs, including the prostate. It also controls other male
characteristics, such as erections and muscle strength. Most of
the testosterone in your body is made by the testicles.
Different things can affect your testosterone levels, including a

number of health problems. If you have very low testosterone,
you may have problems getting an erection or have low libido.
If your erection problems are caused by low testosterone, then
you may be able to have testosterone replacement therapy. It
works by increasing the levels of testosterone in your body to a
normal level. This may improve your orgasms, ejaculation and
erections. It may also make some treatments for erection problems
(including PDE5 inhibitor tablets) work more effectively.
If your doctor or nurse suggests trying testosterone replacement

therapy ask them about the risks and benefits. For example,
testosterone can make prostate cancer cells grow faster so isn’t
usually recommended if you still have prostate cancer. And you
won’t be able to have it if you’re having hormone therapy. Some
research has shown that testosterone replacement therapy is safe
for men who’ve been successfully treated for localised prostate
cancer, where all of their cancer has been removed or destroyed.
Your doctor will be able to explain more about whether this is
safe for you.
If you decide to have testosterone replacement therapy, it’s

important to see the doctor or medical team who treated your
prostate cancer, rather than going to another doctor. And if you
have it, you will need to have regular prostate specific antigen
(PSA) blood tests and digital rectal examinations to check for any
signs of your cancer returning.
Lifestyle changes
Lifestyle changes such as staying a healthy weight and being
physically active can help improve your sex life. Physical activity
can help you to stay a healthy weight and lowers the risk of some
health problems that can cause erection problems, such as type-2
diabetes. It can also improve your energy levels, lift your mood and
help with some of the side effects of treatment, such as fatigue.
For more information read our fact sheet, Diet and physical
activity for men with prostate cancer.
Some men also find pelvic floor muscle exercises help improve the
quality of their erections. Read about these exercises in our fact
sheet, Pelvic floor muscle exercises.
Quit smoking
Smoking may increase the risk of erection problems and
treatments may not work as well if you smoke. Stopping smoking
isn’t easy but there is help available. The NHS website has
information, advice and support for giving up smoking, including
quit kits and face-to-face guidance.
Your desire for sex (libido)

Prostate cancer and its treatment can affect your desire for sex.
We explain some of the reasons why this can happen and describe
things that can help below. If you have a partner, let them know
if you’re feeling less interested in sex and why, as it’s likely they’ll
notice the change and they could be feeling rejected. Read more
about sex and relationships on page 51.
What might affect my sex drive?

Hormone therapy
Hormone therapy for prostate cancer is likely to lower your sex
drive. This is because some types of hormone therapy lower your
testosterone levels, which is what gives you your sex drive.
If you’re on long-term hormone therapy, ask your doctor or nurse

about intermittent hormone therapy. This is where you stop hormone
therapy when your PSA level is low and steady, and start it again if
it starts to rise. Your sex drive may improve while you’re not having
hormone therapy but this can take several months and some
men don’t notice any improvement. Intermittent hormone therapy
isn’t suitable for everyone. Read more in our booklet, Living with
hormone therapy: A guide for men with prostate cancer.
If having sex is important to you, you can still try treatments if your
sex drive is low. Some of the treatments for erection problems may
still work for you (see page 22).
Watch Bruce’s story

Find out how he dealt with changes to his sex drive.

Some men with prostate cancer feel that they have lost their
self-esteem, self-confidence or sense of masculinity. Feeling down or
stressed can mean you have less interest in sex. If you feel like this
consider getting some support (see page 49). As well as helping you
to feel better about yourself it may help improve your sex life.
Tiredness
All treatments for prostate cancer can cause tiredness or fatigue
(extreme tiredness) during or after treatment. If you feel very tired,
you may lose interest in sex or not have enough energy for it.
Try to plan your day to make the most of when you have more
energy. Having sex in a position where you don’t have to move
around much and taking breaks may help. Being physically close
by hugging and holding each other can help you stay close
when you don’t feel like having sex. We talk more about sex and
relationships on page 51.
Other side effects

Other side effects of prostate cancer treatments, such as urinary
and bowel problems, can affect your sex life. If you’re on hormone
therapy, you might notice changes to your body, such as weight
gain, loss of muscle, breast swelling, changes to the size of your
penis and testicles, or hot flushes. These may make you feel
embarrassed and less interested in sex. Let your partner know
about any side effects and talk to your doctor or nurse about ways
to manage them.
Changes in penis size and shape

Some men notice that their penis is a little shorter after surgery
(radical prostatectomy). Some men notice other changes such as
a curve in their penis or a narrower area. We don’t know for certain
why these changes happen, but it could be because of low oxygen
levels in the penis caused by not having erections. Other prostate
cancer treatments, such as hormone therapy with radiotherapy,
may also cause changes in the size of your penis.
Encouraging blood flow to the penis after surgery may help prevent
this. In particular, using a vacuum pump, either on its own or with
PDE5 inhibitor tablets, could help maintain the size and improve
erections (see page 29).
Changes to your body can be difficult to deal with. See page 49 for
ways to get support.
Changes to orgasm and ejaculation

After prostate cancer treatment you will still have feeling in your
penis. You should still be able to have an orgasm but this may feel
different to before, and some men do lose the ability to orgasm,
especially if they’re on hormone therapy.
If you’ve had surgery (radical prostatectomy), you won’t be able

to ejaculate when you orgasm. This is because the prostate and
seminal vesicles, which make some of the fluid in semen, are
both removed during the operation. Instead, you may have a
dry orgasm – where you feel the sensation of orgasm but don’t
ejaculate. You might release a small amount of liquid from the tip of
your penis when you orgasm, which may be fluid from glands lining
the urethra.
If you’ve had radiotherapy, brachytherapy, HIFU or hormone

therapy, you may produce less semen during and after treatment.
With radiotherapy, brachytherapy and HIFU you may also notice a
small amount of blood in the semen. This usually isn’t a problem,
but tell your doctor or nurse if this happens. Some men on
hormone therapy say their orgasms feel less intense.
Retrograde ejaculation
If you’ve had radiotherapy for prostate cancer, or an operation
called a transurethral resection of the prostate (TURP) to help
you urinate more easily, you may get something called retrograde
ejaculation. This is where the semen travels backwards into the
bladder when you orgasm, rather than out through your penis.
The semen is then passed out of the body when you next urinate.
It isn’t harmful and shouldn’t affect your enjoyment of sex, but it
may feel different to the orgasms you’re used to.
Reaching orgasm quickly

Some men find they don’t last as long during sex and reach orgasm
sooner than they want to. If this happens, wearing a condom or
changing positions during sex might help. Or you could try stopping
when you feel like you’re getting close to orgasm, and starting again
a few moments later.
Leaking urine
If you’ve had surgery you might leak a small amount of urine
when you’re sexually aroused, for example when you’re hugging
or kissing. It can also happen when you orgasm. This is called
climacturia. Although it could be a shock at first, urine is germ-free
and safe. If it bothers you, you could try:
• urinating before you have sex
• wearing a condom
• having sex in the shower
• having sex on a towel, or keeping towels or tissues nearby.
Tip
Before sex, make sure your bladder and urethra are empty.
After you urinate, use your fingertips to press gently upwards at
the base of your scrotum. Keep pressing gently as you move
your fingers forward from the base of your penis to the tip. This
should squeeze out any urine that’s left in your urethra.
If leaking urine is still bothering you, your doctor or nurse can give
you further advice. Some men also find that pelvic floor muscle
exercises help. There’s more about managing leaking urine in our
fact sheets, Urinary problems after prostate cancer treatment
and Pelvic floor muscle exercises.
Pain during orgasm

Some men feel pain in their penis when they orgasm or find
ejaculation uncomfortable. This may happen every time or just
sometimes, and it can last less than a minute or it can last longer.
Let your doctor or nurse know about the pain, especially if it

doesn’t get better. You may have some scarring or a blockage in
your urethra that needs treatment.
I tried different tablets, with no effect

other than giving me headaches and a
red face. I then tried the injection, which
worked occasionally at first but after
sticking with it, it now works every time.
Having children
After prostate cancer treatment you might not be able to have
children naturally. If you have surgery (radical prostatectomy)
you won’t ejaculate any semen. And if you have radiotherapy or
brachytherapy, the radiation might affect your ability to produce
sperm, although this can be temporary.
With radiotherapy and brachytherapy you may produce less fluid

when you ejaculate but you may still be fertile.
Storing sperm
Whatever treatment you have, you may want to think about storing
your sperm before treatment so that you can use it for fertility
treatment later. Ask your doctor or nurse whether sperm storage
is available locally. Sperm can usually be stored for up to 10 years,
and sometimes longer.
Using contraception
Changes to your sperm during radiotherapy, brachytherapy and
chemotherapy could affect any children you conceive during or
after treatment. But the risk of this happening is very low and it
hasn’t been proven. If there is a chance of your partner becoming
pregnant you should use a condom or other form of contraception
during treatment and for a while afterwards to avoid fathering a
child. This could be up to a year, but speak to your doctor or nurse
about this.
If you and your partner are planning to have children, you can get
information on fertility and possible treatments from your GP or
specialist team, Macmillan Cancer Support and Fertility Network UK.

Sex or masturbation may be an important part of your life as an
individual and in your relationship with your partner. It may be a way
of having fun or relaxing, helping you cope with difficult times, or
boosting your self-esteem and happiness.
Changes to your body and your sex life can have a big impact on
you. They could make you feel unsatisfied, worried, or even angry.
Some men say they feel like they’ve lost a part of themselves and
feel a sense of sadness and loss. There are ways to tackle these
issues and it’s possible to find solutions that work for you.
You need to be open-minded about what

could help you. You also need to be
proactive in getting your needs met,
and even recognising what your needs are.
Feeling down or worried

If you have prostate cancer it’s not unusual to feel worried or down
and you may need to deal with these feelings before you can deal
with any sexual issues. If you are finding it difficult to cope, you
may find it helpful to speak to your nurse or GP, or to a counsellor
or therapist. You can also talk to our Specialist Nurses, and there
are other places you can get support (see page 49).
Your identity
Changes to your body and problems with erections after treatment
for prostate cancer can change how you feel about yourself and
affect your self-esteem. Some men say they feel old and unmanly,
or that they have lost a part of their identity.
If your sex life is important to you then these changes might be

harder to deal with. We explain some things that could help below.
Things you can do to help yourself

Try to go easy on yourself
Are you putting too much pressure on yourself? It can take time to
come to terms with being diagnosed with prostate cancer, having
treatment and living with the side effects – particularly sexual ones.
Getting some advice or support as soon as possible may stop
difficult feelings becoming too much.
Look after yourself and your body

Focus on the things you like about yourself, do activities or hobbies
you’re good at, or try something new. Being physically active can
lift your mood, give you more energy, keep your body in shape and
may help your sex life. Making changes to your diet can help you
lose weight and keep healthy. Cutting down on alcohol may also
help. Read our fact sheet, Diet and physical activity for men
with prostate cancer for more information.
Getting support
If you’re stressed or down about changes to your sex life, finding
some support may improve how you feel. Some men prefer to
cope on their own. This works for some people, but getting things
off your chest can also help. There are lots of different ways to get
support, including those listed below.
You are not alone. A lot of men, with and without prostate cancer,
have sexual problems. Talking to other men who’ve had similar
experiences can be useful.
Our Specialist Nurses

Our Specialist Nurses can answer your questions and explain your
treatment options. They’ve got time to listen, in confidence, to any
concerns you or those close to you have.
Trained counsellors
Counsellors are trained to listen and can help you find your own
ways to deal with things. Many hospitals have counsellors or
psychologists who specialise in helping people with cancer – ask
your doctor or nurse at the hospital if this is available. Your GP
may also be able to refer you, or you can see a private counsellor.
To find out more, contact the British Association for Counselling &
Psychotherapy or the UK Council for Psychotherapy.
Our one-to-one support service

Our one-to-one support service is a chance to speak to someone
who’s been there and understands what you’re going through.
They can share their experiences and listen to yours. You could
talk about erection problems, treatments and how prostate cancer
has affected your relationships and sex life – whatever’s important
to you. Our Specialist Nurses will try to match you with someone
with similar experiences. Family members can also speak to
partners of men with prostate cancer.
Our online community

Our free online community is a place to talk about whatever’s on
your mind. Anyone can ask a question or share an experience.
Local support groups

At local support groups, men get together to share their
experiences of living with prostate cancer. You can ask questions,
share worries and know that someone understands what you’re
going through. Some groups have been set up by local health
professionals, others by men themselves. Many also welcome
partners, friends and relatives.
Our fatigue support service

Our Specialist Nurses provide a fatigue support service for men.
They can give you information and ongoing support over the
telephone. They will encourage you to take practical steps to
manage your fatigue. You can speak to them, in confidence,
on 0800 074 8383.
To find out more about any of the above, visit

prostatecanceruk.org/get-support or call our Specialist
Nurses on 0800 074 8383.
Sex and your relationships

If you have a partner, then coping with cancer and side effects
may have changed your relationship and the way you have sex.
Some couples even find that dealing with cancer strengthens
their relationship and brings them closer together. But you may
experience some or all of the following.
• Your normal pattern of having sex might change. Some men will
avoid sex or any kind of closeness because of worries that their
partner will expect full (penetrative) sex.
• Dealing with cancer sometimes means relationships can change
from romantic or sexual to more like a close friendship, or patient
and carer.
• You may be facing other changes in your relationship, such as
changing priorities and plans for your life together.
Even though your sex life is unlikely to be the same as it was

before, there are still many ways of having pleasure, closeness or
fun together. Being physically close can protect or even improve
your relationship. Try to be realistic but flexible in your approach to
sex. It doesn’t have to be all about full penetrative sex.
Watch Ally’s story

Find out about communicating as a couple.
Practical tips
Give the treatments a go
If you’re having problems with erections, try the available
treatments (see page 22). They will work for some men but not for
everyone. You may need to stick with a treatment for a while before
you see results, and you might need to try different treatments or
a combination. Don’t be put off if you know a treatment hasn’t
worked for someone else – everyone is different.
We still have sex, but in different ways and

with a little bit of medical intervention.
Talk about it
If you have a partner, talking about sex and your thoughts and
feelings will help you both deal with any changes. Some men worry
about the effect that changes to their sex life are having on their
partner. Try not to guess how they feel about things, as guesses
can often be wrong. And encourage them to get support too.
It’s not always easy to talk about sex and relationships, even if
you’ve been together for a long time. Some men find it hard to talk
about their emotions, as they feel that being emotionally strong is
part of what makes them a man. And sometimes couples who are
struggling to cope with the changes in their relationship will put off
talking about it. They might think the other partner doesn’t mind
the changes, feel embarrassed, or not want to upset each other.
Talking to each other, even if you need help to do so, can help you
come to terms with the changes to your sex life. Communication
can even bring you closer together and make you feel more
confident about facing challenges. If you find it difficult to talk, it may
help to write a letter to your partner, or see a relationship counsellor.
Your nurse or GP can put you in touch with a counsellor. You could
also try contacting organisations such as Relate or the College of
Sexual and Relationship Therapists. A sex therapist can also help
you communicate about sex (see page 57).
It is life-changing. You and your partner are

both going to have to make changes.
Stay close
Try to experiment and find out what works for you, and try
different, non-sexual ways of being close. This could be as simple
as holding hands or going out and trying new hobbies and things
to do. Some couples try to have an evening out together every
few weeks. Some men say they just miss having a hug with their
partner – having a regular cuddle can keep you close.
You need to have time alone together, whatever your situation.

If you are in a hospital, hospice or have carers coming to your
house, make sure they know when you need private time.
Watch Kevin’s story

Find out how he accepted changes to his sex life.
Maybe we don’t want to have sex. Maybe

we want to go for a meal or to the pictures.
Maybe we just want to lie down and cuddle.
Focus on pleasure not erections

Take the spotlight off performance. Remember – having sex is
not just about having erections or penetrative sex. Men can have
orgasms without having an erection or ejaculating and some men
get pleasure from pleasuring their partner.
Find a space to be together that is warm and comfortable, and

take some time to be physically close. Try some mutual massage
sessions. You could start with a massage that avoids the sexual
parts of the body and then add some genital touching later or at
another time.
Take things slowly, and later add in a session when you spend
more time touching each other’s genitals. If you relax and use all
your senses, you may be able to have an orgasm with a soft penis.
Have fun and experiment

There’s no one way to have sex or experience sexual pleasure,
but people can get stuck in sexual habits. Think of this as an
opportunity to refresh your sex life.
Sex is more than just penetration. You could try alternatives

such as massage, mutual masturbation, oral sex, vibrators and
dildos, watching erotic films or reading erotic books. You can
buy lubricants and vibrators in pharmacies, chemists, high street
lingerie and sex shops, or online. You can also buy lubricants in
some supermarkets.
You can make changes gradually. Start off with holding hands or
kissing if you don’t normally do this, and move on to new sexual
activities when you feel comfortable.
Our love-making has improved in ways that

are very fulfilling, despite lack of penetration.
Get some advice

If you have questions or concerns about sex speak to your
doctor, nurse or other health professional as soon as possible.
Some couples need more than just medical treatment for erection
problems, and you can get specialist advice and counselling.
Trying both medical treatments and seeking advice and support at
the same time can help.
Sex therapy
Sex therapy (sometimes called psychosexual therapy or sexual
counselling) is available on the NHS in some areas, or you can pay
for it privately. For NHS services you will usually need a referral
from your GP or other health professional. Check that any sex
therapist you see is registered with the College of Sexual and
Relationship Therapists, the British Association for Counselling &
Psychotherapy, or the Institute of Psychosexual Medicine.
Focus on… sex therapy

Sex therapy normally involves a series of counselling sessions
and, if you have a partner, it’s best for them to be involved.
Sex (or psychosexual) therapists or counsellors may have a

background in medicine, nursing or psychology. They will have had
special training in the causes and treatment of sexual problems.
The first appointments will focus on the therapist getting to know

you and finding out about your sex life. You and your partner
may have joint and separate appointments.
You may find the conversations with the therapist uncomfortable

at first, but this should improve as you get more confident.
At the end of these first few sessions, the therapist will give you
some brief information and advice and talk to you about whether
further therapy might be useful. They may refer you for couples
counselling, or other psychological services or treatment.
If you have further sex therapy it will often involve more

discussion of sexual problems, and specific activities and ways
to work through them. You might have homework, such as a
series of exercises to help you and your partner get to know
each other’s bodies and how they respond sexually, find ways to
communicate more effectively, or experiment with different ways
of being close.
Helpline 0800 074 8383 prostatecanceruk.org 58
The therapist will work with you at your own speed to help you
find solutions that work for you. There are many different options
to try and only you and your partner can make those decisions.
Sometimes just having someone listen to how you are feeling
helps you find your own answers.
There are some myths about sex therapy. You will never be
asked to undress or do anything sexual in the therapy room.
I really started to push myself to explore

other possibilities. And I found that actually
there are other gay men out there who want
sensuality and not just sex.
Gay and bisexual men

Prostate cancer affects gay and bisexual men in many of the same
ways as heterosexual men, but there can be some other issues too.
Not all gay or bisexual men have anal sex – but if you do, then the
impact of erection problems will depend on whether you are a top,
bottom or either.
To be the active partner (top) during anal sex you normally need
a strong erection, so erection problems can be a particular issue.
You could try using a constriction ring around the base of your
penis together with another treatment like PDE5 inhibitor tablets,
to help keep your erection hard enough for anal sex. You can buy
constriction rings online or from most sex shops.
If you receive anal sex, then bowel problems or sensitivity in the

anus may be an issue after radiotherapy. It’s best to wait until your
symptoms have settled before trying anal play or sex. If you’ve
had permanent seed brachytherapy there is a risk in the first few
months that your partner might be exposed to some radiation
during sex. Talk to your doctor or nurse for further advice.
Try using a condom and extra lubrication. Cleaning yourself before

sex can make you feel more comfortable, but douching can
irritate the lining of your back passage, making it more likely to get
infections – so you may prefer to just clean the outside area.
If you are receiving anal sex, a lot of the pleasure comes from the
penis rubbing against the prostate. This is why the prostate is often
referred to as the male g-spot. Some men who receive anal sex
find that their experience of sex changes if they have their prostate
removed (radical prostatectomy). As with all sexual changes you
may be able to find ways to work through this, to give and receive
pleasure, and to remain close or intimate.
We have more information about living with prostate cancer and

the side effects of treatment if you’re gay or bisexual in our booklet,
Prostate cancer tests and treatment: A guide for gay and
bisexual men.
Talking to health professionals

Some men find that their doctor or nurse assumes they are
heterosexual. Health professionals don’t record people’s sexuality
as standard. But it can help to tell your doctor or nurse about your
sexuality, particularly if you have specific issues you want to talk
about. Seeing a counsellor or a sex therapist may help if you find it
difficult to talk to your nurse or doctor (see page 49).
Watch Martin’s story

For one gay man’s experience of dealing with the impact of
prostate cancer on sex and relationships.
Prostate Cancer UK’s services are open to everyone, whether

you are gay, bisexual, transgender, heterosexual, single or in a
relationship. Partners can also use our services. There are also
support groups in the UK for gay and bisexual men with prostate
cancer. Any man who has sex with men, and transgender
women with prostate cancer, are also encouraged to get in
touch. To find your nearest support group, visit our website at
prostatecanceruk.org/get-support
Sex when you’re single

Being sexually active and feeling attractive can be just as important
if you are single. All the treatments described here are available to
you if you’re single – whether you want to be able to masturbate,
have sex, or start a new relationship.
If you’re starting a new relationship, sexual problems and other

side effects like urinary or bowel problems could be a worry. Some
men worry that having problems with erections will affect their
chances of having a new relationship. Fear of rejection is natural
and everyone has their own worries, whether or not they’ve had
cancer. If you’re single, you may want time to accept any changes
prostate cancer has caused before you start having sex or dating.
Try talking about your worries with someone you feel comfortable
with. This could be a friend, or a counsellor or sex therapist if you’d
prefer talking to someone you don’t know.
If you’re sexually active but not in a relationship, or you want to

start dating or start a new relationship, these tips may help.
• Be upfront. Pick the right moment and talk about your sexual
problems – wait until you feel comfortable with the person and
trust them. Choose a time when you are on your own together
and are both relaxed.
• Take your time. You may not want to try full penetrative sex
with a new partner straightaway, especially if you have problems
with erections. You could wait for a while and focus on getting to
know each other first.
Rejection can happen, but many people will accept sexual

differences and some won’t think penetrative sex is essential
for a relationship.
Starting a new relationship was simple

and really good. As a man you think
relationships are based on sex, but trying
to understand relationships more has
changed my whole perspective on what a
relationship is about. And I am glad to say
it’s actually for the better.
Support for partners

If you’re a partner of a man with prostate cancer then it’s likely that
you will also be affected by changes to your relationship and sex life.
Some partners feel distressed and may become anxious and

depressed. You may go through:
• worries about the future, about what will happen if your
relationship breaks down or your partner dies
• changes to how you feel about yourself – if your partner has a
low sex drive this might make you feel less desirable or attractive
• feeling frustrated or unsatisfied if your sex drive is higher than
your partner’s or you are having less sexual contact
• anger or sadness at the loss of the old ways of being together
• guilt for still having sexual feelings.
Your own desire for sex may change after your partner’s diagnosis
and during treatment. For example, if you’re feeling anxious, you
may have less interest in sex. If your roles have changed in the
relationship, this might also affect how you feel about sex. You may
be dealing with your own health or sexual problems.
Some men may avoid being physically close because they feel
uncomfortable with changes to their bodies or their sex drive, or
because they feel under pressure to perform sexually. This doesn’t
mean they no longer care for you.
If your partner is using any treatment for problems with erections,

then finding out more about them yourself and how to use them can
make it easier to fit them into your sex life (see page 22).
The information about sex and relationships in this booklet may

help, and you could get some information and advice together if
you need it.
Many partners don’t talk about their own feelings because they
want to protect the person they love. But it’s also important to get
some support for yourself, perhaps without your partner. Talking
to other partners who are experiencing the same thing, or getting
some counselling, may help.
Getting support is important for your own well-being. Men often

worry about how changes to their sex lives are affecting their
partners, so it could also help your partner to know you’re getting
support for yourself.
The Sexual Advice Association has more information for partners.

Talking about sex can be difficult, even if you’ve been together for
a long time. If you or your partner find it difficult to talk about sex,
it may help to see a sex therapist (see page 57).
We’ve learnt to talk to each other about

absolutely anything and it’s made us
appreciate each other a little bit more as well.
More information from us

Leaflets and booklets
We have a range of leaflets and booklets about prostate cancer
and other prostate problems.
To order publications:
All our publications are free and available to order or download
online. To order them:
• call us on 0800 074 8383
• visit our website at prostatecanceruk.org/publications
Call our Specialist Nurses

If you want to talk about prostate cancer or other prostate
problems, call our Specialist Nurses in confidence. You can
also text NURSE to 70004, or you can email or chat online with our
nurses on our website. Visit prostatecanceruk.org/get-support
Speak to our
Specialist Nurses
0800 074 8383*
prostatecanceruk.org
* Calls are recorded for training purposes only. Confidentiality is maintained between callers
and Prostate Cancer UK.
Other useful organisations

British Association for Counselling & Psychotherapy
www.bacp.co.uk
Telephone: 01455 883 300
Information about counselling and details of therapists in your area.
College of Sexual and Relationship Therapists

www.cosrt.org.uk
Telephone: 020 8543 2707
Information about sexual and relationship therapy, and details of
therapists who meet national standards.
Fertility Network UK
www.fertilitynetworkuk.org
Telephone: 01424 732 361
Information and support for people with fertility problems.
Institute of Psychosexual Medicine

www.ipm.org.uk
Telephone: 020 7580 0631
Information about psychosexual medicine, and details of
specialists who are trained in the treatment of sexual problems.
Macmillan Cancer Support

www.macmillan.org.uk
Telephone: 0808 808 0000
Practical, financial and emotional support for people with cancer, their
family and friends. Includes information on sex and relationships.
Mind
www.mind.org.uk
Telephone: 0300 123 3393
Information and support for mental health issues such as
depression or anxiety.
NHS
www.nhs.uk
Information about conditions, treatments and lifestyle, including
sexual problems and advice on quitting smoking. Support for
carers and a directory of health services in England.
Relate
www.relate.org.uk
Telephone: 0300 100 1234
Information, advice and relationship counselling and sex therapy.
In Scotland, contact Relationships Scotland instead.
Relationships Scotland
www.relationships-scotland.org.uk
Telephone: 0345 119 2020
Information, relationship counselling and sex therapy in Scotland.
Samaritans
www.samaritans.org
Telephone: 116 123
Confidential, judgement-free emotional support, 24 hours a day,
by telephone, email, letter or face to face.
Sexual Advice Association

www.sexualadviceassociation.co.uk
Information about sexual problems and their treatments, including
a smartphone app that allows you to ask questions and get
information in confidence.
Switchboard - LGBT+ helpline

www.switchboard.lgbt
Telephone: 0300 330 0630
Free and confidential support and information for lesbian, gay,
bisexual and transgender people throughout the UK.
UK Council for Psychotherapy

www.psychotherapy.org.uk
Telephone: 020 7014 9955
Information about types of psychotherapy and details of therapists
in your area.
About us
Prostate Cancer UK has a simple ambition: to stop men dying
from prostate cancer – by driving improvements in prevention,
diagnosis, treatment and support.
At Prostate Cancer UK, we take great care to provide up-to-date,

unbiased and accurate facts about prostate diseases. We hope
these will add to the medical advice you have had and help you
to make decisions. Our services are not intended to replace advice
from your doctor.
References to sources of information used in the production of this

booklet are available at prostatecanceruk.org
This publication was written and edited by

our Health Information team.
It was reviewed by:

• Professor Kate Bullen, Professor of Psychology and Head of
The School of Applied Social Science, University of Brighton
• Mamoun Elmamoun, Consultant Urologist,
St James’s Hospital, Leeds
• Lorraine Grover, Psychosexual Nurse Specialist,
The London Clinic, London
• Netty Kinsella, Uro-Oncology Nurse Consultant,
The Royal Marsden NHS Foundation Trust
• Richard Towers, Clinical Nurse Specialist and Psychotherapist,
Royal Marsden Hospital, London
• Our Specialist Nurses
• Our Volunteers.
Prostate cancer and my sex life

Real life stories DVD
This DVD features six stories of men dealing with changes to their
sex life during and after treatment for prostate cancer.
Colin, 52 Paul, 64
Colin talks about how he Paul had surgery and tried
and his wife have dealt with different treatments for
changes to their sex life after erection problems, including
surgery, and his experience a vacuum pump.
of using a vacuum pump and
injections to help get erections. Kevin, 56
Kevin had surgery and
Bruce, 51 radiotherapy followed by
Bruce explains how hormone therapy. He talks about
radiotherapy and hormone the challenge of accepting the
therapy has affected his sex life, changes in his sex life.
what he has done to deal with
this, and how he has overcome Martin, 58
these challenges and started a Martin had surgery,
new relationship. radiotherapy and hormone
therapy which meant he
Ally, 62 couldn’t get an erection and
Ally has stayed close to his lost his desire for sex. He
wife, even though their sex tried different treatments for
life has changed whilst erections and changed his
having radiotherapy and approach to sex – discovering
hormone therapy. his more sensual side.
DISCLAIMER: These films feature men’s personal prostate cancer stories. Everyone’s experiences
will be different. The films are not intended to provide medical information.
Did you find this information useful?

Would you like to help others access the facts they need? To
help us continue providing free information, you could make a
donation of any amount. Please call us on 0800 082 1616, visit
prostatecanceruk.org/donate or text PROSTATE to 70004.
For more details please visit prostatecanceruk.org/get-involved
†
You can donate up to £10 via SMS and we will receive 100%
of your donation. Texts are charged at your standard rate.
For full terms and conditions and more information, please
visit prostatecanceruk.org/terms
Speak to our
Specialist Nurses
0800 074 8383*
prostatecanceruk.org
Like us on Facebook: Prostate Cancer UK

Follow us on Twitter: @ProstateUK
© Prostate Cancer UK June 2017

To be reviewed June 2020
Call our Specialist Nurses from Monday to Friday 9am - 6pm,

Wednesday 10am - 8pm
* Calls are recorded for training purposes only.
Confidentiality is maintained between callers and Prostate Cancer UK.
Prostate Cancer UK is a registered charity in England and Wales (1005541)

and in Scotland (SC039332). Registered company number 02653887.
5649 SEX/APR19

Prostate Cancer and Your Sex Life

Uploaded by

Copyright:

Available Formats

Prostate Cancer and Your Sex Life

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Prostate Cancer and Your Sex Life

Uploaded by

Copyright:

Available Formats

Prostate cancer

and your sex life

About this booklet

Whether you’re single or in a relationship, and whatever your

Some sections might be more helpful to you than others, so

Each GP practice or hospital will do things slightly differently.

The following symbols appear throughout the booklet:

Our Specialist Nurses

Sections for you to fill in

Real life stories

Their stories include experiences of sexual problems after

This symbol appears throughout the booklet to guide you

For more help on managing sexual problems see our interactive

You might well have some jolly good sex

How might prostate cancer affect

Feeling sexual is partly physical and partly about your thoughts

If you’re in a relationship, the sexual impact of prostate cancer

Prostate cancer can affect your sex life in overlapping ways

Treatments for prostate cancer can affect:

It’s okay to talk about sex and ask for support

Will I be able to have sex and masturbate?

Everyone is different. Some men will have temporary problems that

On the following pages we cover the types of sexual problems

What effects can prostate cancer treatments have?

When can I have sex or masturbate?

What problems might I have?

If you’ve had external beam radiotherapy

When can I have sex or masturbate?

What problems might I have?

If you’ve had permanent seed brachytherapy

When can I have sex or masturbate?

• If you receive anal sex, wait until any bowel problems or

What problems might I have?

If you’ve had high dose-rate brachytherapy

When can I have sex or masturbate?

What problems might I have?

If you’ve had high-intensity focused ultrasound (HIFU)

When can I have sex or masturbate?

What problems might I have?

If you’ve had cryotherapy

When can I have sex or masturbate?

What problems might I have?

If you’re having hormone therapy

When can I have sex or masturbate?

What problems might I have?

Some worries about sex and prostate cancer explained

Getting the right treatment

Getting treatment for erection problems

Use these guidelines to help you

Talking about sex

Be prepared to try again

Your health professional might not be

Questions to ask your doctor or nurse

How soon after treatment can I masturbate or have sex?

Which treatments for erection problems would be best for me?

Is there anything I can do to prepare myself before I start my

What happens if the treatment doesn’t work? Are there others

What other support is available to me?

Can my partner also get support?

What health professionals might I see?