What can happen?

About 1 out of every 7 men will be diagnosed with prostate cancer in his lifetime, making it the most common cancer in men. Prostate cancer affects the walnut-shaped gland that wraps around a man’s urethra.

Treatments like surgery, radiation, and hormone therapy remove or destroy the cancer. However, all of these treatments can have sexual side effects. This can include trouble getting an erection, having an orgasm, and fathering children.

Here’s a look at some of the potential sexual side effects of prostate cancer treatment and how to deal with them.

Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.

Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive. Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge. If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal. This depends on your overall cancer treatment plan.

Some men notice that their penis is slightly smaller after prostate cancer treatment. In a 2013 study, about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy. The men said their smaller penis affected their relationships and their satisfaction with life.

For men who do experience this, the change in size is generally half an inch or less. This decrease in size may be due to tissues shrinking in the penis. These tissues may shrink because of nerve and blood vessel damage.

If you’re concerned about this side effect, ask your doctor about taking a drug for an erectile dysfunction (ED), such as Cialis or Viagra. The increased blood flow from these drugs may help prevent your penis from getting smaller. They’ll also help with acquiring and maintaining an erection.

When you’re sexually excited, nerves cause tissues in your penis to relax, allowing blood to flow into the organ. The nerves that control erection are very delicate. Surgery or radiation for prostate cancer may damage them enough to cause ED. When you have ED, you can’t get or keep an erection.

Radical prostatectomy is a surgery to remove the prostate gland. When your surgeon removes the gland, they may damage the nerves and blood vessels that run along it. If they’re damaged enough, you won’t be able to get an erection following the procedure.

Today, doctors can do nerve-sparing surgery, which helps prevent permanent ED. Your surgeon can still touch those nerves and blood vessels, causing ED as a temporary side effect. Many men have trouble getting an erection for a few weeks, months, or even years after their procedure.

Radiation therapy also damages blood vessels and the nerves that control erection. Up to half of men who have radiation for prostate cancer experience ED afterward. In some men, this symptom will improve with time. Sometimes radiation side effects don’t appear until a few months after the treatment. If ED starts late, it may not be as likely to go away.

A few treatments can help with ED until you’re able to have erections on your own again.

Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are drugs that relax the muscles in your penis so you can have an erection. About 75 percent of men who’ve undergone nerve-sparing prostatectomy or radiation can achieve an erection with these drugs. Talk to your doctor before taking them if you have heart problems or you take alpha-blockers for benign prostatic hyperplasia because these drugs may be risky for you.

Additional treatments include the following:

  • MUSE is a suppository medication that you insert into your urethra with an applicator. It allows more blood to flow into your penis.
  • A vacuum pump is a device that forces blood into the penis to create an erection. Once your penis is hard, you place a rubber ring around the base to maintain the erection.
  • Penile injections are shots that you give yourself into the base of your penis. The medicine lets blood into your penis so you can get an erection.

If these ED treatments don’t work, you can have surgery to place an implant inside your penis. Then, when you press a button, fluid will flow into the penis from a pump placed inside your scrotum, creating an erection.

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Surgery for prostate cancer can affect both your orgasms and your ability to have children. The prostate gland normally adds a fluid called semen to sperm to nourish and protect it. You’ll no longer make semen after surgery, which means your orgasms will be dry. Radiation therapy can also reduce the amount of fluid you ejaculate. Without semen, you won’t be able to father children. If you’re concerned about fertility, you can bank your sperm before your surgery.

After surgery, orgasms will also feel different. You won’t have that normal buildup of sensation before you have an orgasm. You’ll still be able to feel pleasure, though.

Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:

  • Bring your partner with you to doctor’s visits. Being part of the conversation may help them understand what you’re experiencing.
  • Listen to your partner’s concerns, too. Remember that this issue affects both of you.
  • See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
  • If sex is a problem right now, it’s possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.

Sexual side effects from prostate cancer treatment are often temporary, especially if your doctor used nerve-sparing surgery. While your body recovers, you can try a few things to maintain your sex life:

  • Let your doctor know about any sexual problems you’re having right away. Although it can be hard to talk about sex, being open and honest will help you get the treatment you need.
  • See a therapist. Couples therapy can help you and your partner understand and deal with sexual issues.
  • Take care of yourself by exercising, eating a well-balanced diet, reducing stress, and getting enough sleep. Looking and feeling your best will give your self-esteem and mood a boost.

Keep reading: Impotence and recovery from prostate surgery: What to expect »