Prostate Cancer

How Does Prostate Cancer Affect Your Sex Life?

Written by Sarah Gupta, MD | Reviewed by Sophie Vergnaud, MD

Published on December 20, 2021

Geber86/iStock via Getty Images

Key takeaways:

Prostate cancer — and prostate cancer treatment — can affect your sex life in many ways.
Erectile dysfunction is the most common sexual side effect of prostate cancer treatment.
Many people with prostate cancer continue to have satisfying sexual experiences, both during and after treatment.

Prostate cancer is a type of cancer that affects your prostate. It’s one of the most common cancers in the world, which means that it’s likely either you — or someone close to you — will be affected.

But did you know that prostate cancer can have a big impact on your sex life? In fact, erectile dysfunction is the most common side effect of prostate cancer treatment — affecting up to 87% of men. Treatment can also cause other challenges, like changes in ejaculation, sex drive, and even sexual pleasure.

Read on for more information about how prostate cancer can affect your sex life as well as strategies for continuing to have satisfying sexual experiences during and after treatment.

How does having prostate cancer affect my sex life?

Having prostate cancer can affect your sex life, even before you begin treatment. But the way it affects you may not be immediately apparent.

Prostate cancer usually doesn’t interfere directly with your sexual function (unless your prostate gets very large). But being diagnosed with cancer — any cancer — can have a psychological or emotional impact. And if your diagnosis has you feeling worried, anxious, or depressed, then you’re less likely to be interested in having sex. This is sometimes called having a “low libido.”

If you have a regular sexual partner, they might also feel stressed or sad about your diagnosis — which means their libido might be low as well.

And as you can imagine, if both you and your partner aren’t feeling very interested in sex, it’s less likely to happen very often. This means that people who are diagnosed with prostate cancer may be less likely to have sex.

And in many cases, starting prostate cancer treatment can introduce new sexual challenges.

How do prostate cancer treatments affect your sex life?

First-choice treatments for prostate cancer include hormone therapy, surgery, and radiation therapy.

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All of these treatments can affect your sex life. That’s why it’s important to understand the risk of sexual side effects in prostate cancer treatment — so that you and your healthcare team can make choices that are right for you.

Prostate cancer treatment can affect your:

Libido (sex drive)
Erections
Ejaculation
Sexual pleasure
Penis and testicle size

Next, we’ll talk about different types of treatments and how they affect your sexual health.

Sexual side effects of hormone therapy

Hormone therapy is a treatment that lowers your testosterone levels.

Lowering your testosterone levels can help in the fight against prostate cancer. But it can also have many sexual side effects — especially if you take it for a long period of time.

Side effects of hormone therapy include:

Feeling less interested in sex
Having trouble getting an erection
Having orgasms that feel different or that are less intense
Having difficulty reaching orgasm
Having smaller than normal amount of ejaculate (cum)
Feeling depressed, moody, or tired
Having a smaller penis and testicles

Keep in mind: Sexual side effects from hormone therapy often go away once you stop treatment (as your testosterone levels come back to normal).

Sexual side effects of surgery or radiation therapy

Surgery and radiation therapy are different treatments, but they have the same goal — to get rid of prostate cancer cells in your body. Surgery removes cancer cells by cutting them out. Radiation therapy targets cancer cells and kills them.

Surgery and radiation therapy can both cause:

Erection problems: You need good blood flow and healthy nerves to have an erection. Surgery and radiation therapy can damage your nerves and blood vessels — making it physically harder (and sometimes impossible) to have an erection.
Orgasm changes: Your orgasms may feel different or painful after surgery or radiation therapy.
Ejaculation changes: Surgery and radiation therapy can both decrease the amount of semen you produce. Surgery can also cause “dry orgasms,” which means you don’t have any semen come out of your penis during an orgasm.
Challenges with anal sex: Both surgery and radiation therapy can make your erections less firm. This can make it challenging for you to have penetrative anal sex. Surgery can also make receptive anal sex less pleasurable.
Infertility: Surgery or radiation therapy may make it impossible for you to father children by having sex.

Can surgery change my penis size?

Yes. Prostate cancer surgery can cause a temporary decrease in penis length, though there’s evidence that your penis will recover to its pre-surgery length.

Penis size does not seem to change with radiation therapy alone.

Can I have sex during or after prostate cancer treatment?

Yes. It’s okay to have sex, unless you’re recovering from a medical procedure (like surgery). Having sex will not make your cancer come back, or make your treatment less effective.

You also can’t spread prostate cancer to your partner(s) by having sex.

Can sex expose my partner to radiation?

Yes. If you’re being treated with implanted radiation therapy seed (brachytherapy), your partner can be exposed to small amounts of radiation during sex — especially if they penetrate your anus with their penis.

If you’ve had brachytherapy, talk to your healthcare provider to understand the risks. They may recommend you wear a condom, and/or hold off on having sex for a period of time.

Does prostate cancer treatment affect your long-term sexual health?

Yes and no. Some people will have long-term sexual health problems. Other people will not.

Many side effects of hormone therapy usually go away once you stop treatment. But there can be long-lasting sexual side effects from surgery and radiation.

Your likelihood of having long-term effects depends on:

Your age
Your overall health
What type of treatment(s) you had
What type of prostate cancer you had
How much your nerves and vessels were affected by the treatment
What your baseline sexual health was like before treatment

Can I still have a satisfying sex life after prostate cancer?

Absolutely! Even if your erections, orgasms, or ejaculation are different after treatment, sexual activities can still be very pleasurable. You don’t need a firm erection to experience physical pleasure, or even to have an orgasm.

Talking openly with your partner(s) can help you find activities you still enjoy — even if your abilities have changed.

Your healthcare providers are also a great resource. They can help you understand your body and suggest options that can help you meet your sexual goals.

How do you treat erection problems caused by prostate cancer treatment?

If you have erection problems after prostate cancer treatment, there are many different treatment options. These include:

Oral medications: Medications like Viagra and Cialis can increase blood flow to your penis, making it physically easier to have an erection.
Medicated pellets: MUSE (alprostadil) is a medicated pellet that is inserted into the opening at the tip of your penis to stimulate blood flow.
Injections: Caverject has the same medication that’s in the MUSE pellet. The medication is injected directly into your penis.
Mechanical devices: Vacuum pumps can pull blood into the penis, and keep it there to maintain your erection.
Surgically implanted penile implant: This is a narrow, flexible plastic tube that’s surgically inserted into your penis. It has a balloon that inflates to make your penis hard and erect.

These options can all help you have erections. Your provider may also suggest using them as part of a “penis rehabilitation” program, to help you get back to your pre-treatment baseline.

The bottom line

Sexual challenges are common in people who have prostate cancer. Many people with prostate cancer will recover some of their previous sexual function. But other people will have long-lasting changes — especially with their erections and orgasms.

If you’re dealing with prostate cancer, don’t be shy about talking to your sexual partner(s) and healthcare providers. They can support you during and after prostate cancer treatment and help you continue to have satisfying sexual experiences for many years to come.

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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References

American Cancer Society. (2019). Surgery for prostate cancer.

Begley, S. (2017). Penis shrinkage, a side effect of prostate cancer surgery, is temporary, study finds. STAT.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.