A radical prostatectomy is an operation to treat prostate cancer, in which the prostate gland and the tissues surrounding it are removed, along with the seminal vesicles and the section of the urethra (the tube that carries urine) that sits within the prostate gland.
Diagnosing and treating prostate cancer can affect various aspects of your sex life, which many men find distressing1. However, some of these issues are temporary and there are ways to effectively manage them.
If your prostate cancer will be treated with radical prostatectomy, here’s how it can affect your sexual health and what you can do to manage the side effects.
Erectile dysfunction after prostate surgery
At least one in five men over the age of 40 experience some degree of erectile dysfunction, which is the difficulty getting or maintaining an erection. Erectile dysfunction is more common if you have a chronic disease such as diabetes, are overweight, smoke cigarettes or don’t exercise.
Prostate cancer treatment increases your likelihood of erectile dysfunction considerably, with up to 85% of men having problems with getting and keeping an erection after surgery2. This is because your prostate is located next to the nerves, blood vessels and muscles that help you have an erection, and surgery to treat prostate cancer can damage these areas. However, surgical techniques and technologies can help prevent damage to the nerves that allow erections and lower the chance of permanent erectile dysfunction. Factors such as your age, erectile function before surgery, other health conditions you may have, how well the nerves are preserved during surgery and the recovery process can influence your outcomes. It can take between 18 and 24 months after prostate surgery for your erections to improve.
Diagnosing and treating prostate cancer can have a significant effect on how you feel mentally. Stress, anxiety and depression are common in men dealing with prostate cancer and these psychological factors can also contribute to erectile dysfunction. Psychosexual therapist Christopher Brett-Renes says plenty of patients struggle with the changes they experience after surgery for prostate cancer, especially their sense of masculinity, self-identity and sexuality.
“The main concern is around erectile function, with clients making statements like ‘how can I have sex if I can’t get it up?’,” he says. “What I also see is cis-men who feel they have lost a part of their identity. They think that they are ‘not a real man’ or that they are ‘damaged’. I see cis-men who are grieving for the life they have lost, I see cis-men who are angry, I see cis-men who are experiencing depression as well as anxiety and fear around engaging in any form of physical intimacy with their partner.”
The process can be particularly distressing for transwomen. “The diagnoses of prostate cancer and the interaction with the health system can be a rather traumatic period for these individuals,” Brett-Renes says.
The impact of erectile function can also depend on sexual practices. For example, an erection that is firm enough for vaginal sex may not be firm enough for anal sex.
There is a range of treatments available for erectile dysfunction including medication, injections, vacuum devices, pelvic floor exercises, penile rehabilitation and surgery. Working with your medical team can help you find the best option for you. Peer support forums, psychosexual education and counselling can also improve sexual confidence, intimacy, self-esteem and satisfaction.
Other ways sex may change after prostate surgery
1. Dry orgasm
Removal of the prostate gland and seminal vesicles means you’ll no longer ejaculate, this is called anejaculation. This might change how your orgasm feels after surgery and you’ll no longer be fertile.
2. Reduced penis length
A possible side effect of surgery is reduced length of your penis, while erect and/or flaccid, which may be due to scar tissue or poor functioning of the nerves and blood supply.
3. Loss of libido
If you’re having androgen deprivation therapy as part of your treatment, it might reduce your sex drive due to the decrease in testosterone. This can also affect your ability to get and maintain an erection. A prostate cancer diagnosis can cause stress, poor sleep, anxiety and depression, and these factors can also impact your sex drive.
4. Leaking urine at orgasm
Some men can also experience climacturia, which is when you leak urine at orgasm.
5. Changes to anal sex
If you’re experiencing any of these issues and they bother you, it’s important to talk to your doctors and other specialists for help.
You don’t need an erection to enjoy sex
It might come as a surprise to many, but erections aren’t essential for a satisfying sex life. In fact, you can orgasm without an erection. Brett-Renes encourages men with erectile dysfunction to think outside the box when it comes to intimacy.
“When you ask people what they think sex is, most people will say vaginal penetration,” he says. “So, it’s about re-educating the client that sex is a wide and amazing spectrum of possibilities.” Possibilities that don’t require penetration but involve other ways to give and receive pleasure.
If you have a partner, get them involved from the start
If you’re in a relationship, you should discuss sexual issues with your partner before and after surgery. Aside from the potential changes to your sex life together, your psychological distress and frustrations with sexual function can significantly impact your partner’s mental health as well3.
“It’s important to get your partner involved as soon as possible and take them on this journey with you, because the cancer doesn’t just impact you, but it impacts your partner as well, be it the worry and stress of you going through the surgery and treatment or the long-term impact post-surgery and treatment,” Brett-Renes says. “From my experience, most partners want to be involved, and are very glad that they get to be heard and validated in this experience.”
It might not be an easy topic to discuss but it’s incredibly important that you do, for both you and your partner’s sexual health and overall wellbeing.
“With the couple working as a team they are going to achieve better outcomes as they are firstly, both on the same page, and secondly, they’re aware of what’s is happening with each other,” Brett-Renes says.
Don’t hesitate to seek support together with the help of your GP, counsellor or psychosexual therapist, who can offer strategies for better communication, emotional regulation and sexual satisfaction.
You can find more resources about sex and prostate cancer from the Prostate Cancer Foundation of Australia.
- Understanding sexual issues following prostate cancer treatment
- Understanding prostate cancer for LGBTIQA+ people
You can also read more about the real experiences of men with prostate cancer and how it affected their sexual health.
- Alan on making treatment decisions for prostate cancer
- Ben on life and love after surgery for prostate cancer
- Ian on erectile dysfunction and masculinity after prostate cancer