Sex After Prostate Cancer: How to Maintain Your Sex Life

You just got a cancer diagnosis — you’re probably dealing with a lot of emotions. 

Sex might not be at the top of your mind right now. Still, it’s fair to worry about how prostate cancer and treatment could impact your quality of life, including your sex life.

Cancer sucks, and so can the effects of treatments like chemotherapy and surgery. Not to mention the psychological impact of coping with the C word.  

But you’re not alone. Prostate cancer is one of the most common cancers among men — and the most common form of cancer in men over 50. Estimates suggest nearly 300,000 men in the U.S. will get a prostate cancer diagnosis in 2023 alone.

Though it has a high survival rate when caught early, many prostate cancer treatments can impact erectile function, potentially causing erectile dysfunction (ED) symptoms.

Below, we’ll cover how prostate cancer can cause sexual problems, including the specific effects of different treatments. 

We’ll also answer your burning questions about prostate cancer removal — like can you ejaculate without a prostate, and how soon after treatment or surgery can you have sex? Plus, we’ll provide recommendations to help you make the most of your post-cancer diagnosis sex life.

First off, simply getting a cancer diagnosis can cause lots of emotional stress, which itself can negatively impact your sex life. In other words, it might be difficult to get excited if you’re worrying about your health.

Before we dive into the effects of prostate treatment, let’s briefly cover what your prostate gland actually does.

The prostate is a small, walnut-shaped organ that plays a key role in:

• Producing fluid that is a component of semen and “ejecting” semen

• Hormone function, essentially balancing your male hormones (aka androgens)

• Regulating urinary function

Additionally, many nerves around your prostate help promote blood flow to the blood vessels in your penis during arousal. 

You might be starting to see why treatments for prostate cancer could impact your sexual health. Let’s cover them now.

Prostatectomy

Prostatectomy (prostate removal surgery) involves — you guessed it — surgically removing the prostate gland. The goal is to get all the cancer out before it can spread to other parts of the body.

A simple prostatectomy involves removing part of the gland. A radical prostatectomy, on the other hand, means removing the whole shebang, including the entire prostate and seminal vesicles, which produce fluid that is a component of semen.

Erectile dysfunction is a potential side effect of this type of surgery.

Here’s the thing: Science is magical, and newly developed surgical techniques have helped reduce the risk of nerve damage that can lead to problems with erectile function.

Following a nerve-sparing prostatectomy, some report that 40 to 50 percent of men who develop ED will return to their pre-treatment sexual function within a year. Two years after surgery, some report about 30 to 60 percent of prostate cancer patients should experience a return to pre-treatment sexual function.

But ED is still a common issue post-surgery because removing the prostate gland can impact hormone health. How so? The prostate is responsible for transforming testosterone into its biologically active form, DHT (short for dihydrotestosterone), essentially regulating your male sex hormone levels.

No prostate = hormone imbalances that can affect your libido and ability to get and keep an erection.

Radiation Therapy

Radiation therapy (or radiotherapy) is an effective cancer treatment, but it comes with some unfortunate side effects. Up to 60 percent of people who receive radiation therapy for prostate cancer develop ED.

In many cases, though, the resulting erectile dysfunction isn’t permanent. 

Hormone Therapy

Receiving hormone therapy for prostate cancer can impact the levels of male hormones, like testosterone, in your blood. For some, low T (low testosterone) likely causes a dip in libido, leads to erection issues or even impacts your ability to orgasm. 

Chemotherapy

Chemotherapy can cause a host of side effects, including some you’re probably already familiar with, like hair loss and nausea. 

Anti-cancer chemo drugs can make you feel tired and unwell, impacting your sexual desire. Some chemotherapy drugs may even cause nerve damage.

Let’s be clear: Prostate removal involves getting your prostate removed — not your penis. 

While ED is a common side effect of prostate surgery, it’s not necessarily permanent. 

Plus, treatments are available.

You can absolutely have a healthy sex life after prostate surgery. You might just need a helping hand in the erection department — and that’s okay. It’s pretty common.

Remember how we outlined the function of the prostate? Since one of its main roles is to produce and excrete semen, you won’t be able to ejaculate or impregnate someone after a radical prostatectomy.

But can a man function sexually without a prostate? Don’t panic. You can still achieve orgasm without a prostate, and sex can still be pleasurable.

You might need medication to help you reach the big O, but — bonus! — a dry orgasm means less mess. So, there’s that, possibly. Additionally, often orgasm is prolonged, less muted, and can be recurrent.

Can you have sex after prostate cancer surgery? Yes.

But how soon varies from person to person. The effects of this kind of surgery are highly variable, so your experience might not mirror someone else’s.

As with many surgeries, it can take a while to recover from a prostatectomy — meaning it can take time before you’re cleared to get frisky again. And even with a healthcare provider’s go-ahead, you might need additional time to emotionally prepare.

Depending on your recovery time, it could be months before you find out how much impact prostate removal surgery has had on your erectile function.

Prostate cancer doesn’t have to put the brakes on your sex life.

The stress of a diagnosis and the treatments themselves can impact your erectile function, but treatment for ED symptoms is available.

Whether you need a bit of help or not, a healthy sex life might even help you cope with your condition and the stress that comes with it. 

If you’re struggling with getting or maintaining an erection, medication, devices, and lifestyle changes can help. We outline your options below.

ED Medications

ED symptoms affect about 85 percent of men after a radical prostatectomy.

Medications for ED can help. Evidence suggests that about 75 percent of men who undergo nerve-sparing prostate removal surgery are able to restore erectile function with erectile dysfunction medications.

Let your cancer care team or urologist know if you’re experiencing ED symptoms. Your healthcare provider may recommend the following prescription treatment options to help improve erectile function:

• Sildenafil (generic for Viagra®) 

• Tadalafil (generic for Cialis®) 

• Stendra (brand-name avanafil)

• Vardenafil (generic for Levitra®)

• Hard mints chewable ED meds

These medications, known as PDE5 inhibitors, help improve blood flow to the penis, making it easier to get and keep an erection.

Other Medications and Devices

Although ED medications like sildenafil and tadalafil are safe and effective for most guys, conventional erectile dysfunction treatments aren’t right for everyone. 

If ED meds don’t work for you or if you take meds for health conditions like hypertension (high blood pressure) or angina (chest pain), ask your healthcare provider about the following penile rehabilitation options:

• Penile injections. Injectables, such as Trimix or Caverject, containing medications like alprostadil (the generic version of Muse®) are thought to help promote blood flow and healthy erections. The downside? You need to inject the medication into your penis, and the effects don’t last long. Plus, injections aren’t FDA-approved, so there’s little data to support their safety and effectiveness.

• Vacuum constriction devices (VCDs). Vacuum erection devices (also known as vacuum pumps or penis pumps) work by creating a vacuum around your penis. The vacuum seal helps improve blood flow, making it possible to achieve an erection.

• Penis rings. Devices like the Eddie by Giddy go around the base of your penis. The rings apply pressure to help maintain blood flow and an erection. 

• Penile implants. Your healthcare provider may suggest a penile implant, a surgical implant that allows for on-demand erections during sexual activity.

Daily Habits and Lifestyle Changes

Health is relative. If you have a cancer diagnosis, you probably already know this.

While healthy habits and lifestyle changes can’t cure cancer or completely reverse prostate cancer-related ED, they can help manage symptoms and make it easier to get hard.

Here’s a rundown of some lifestyle changes you might consider if you’re dealing with prostate cancer-related ED:

• Eat a healthy diet. A nutrient-dense diet filled with whole grains, fruit and veggies will support your overall health. Eating well can also help prevent diseases that can worsen ED symptoms.

• Get physical. Incorporating regular physical activity into your routine can help improve your heart health, which is essential for healthy sexual and penile function. 

• Quit smoking. Smoking cigarettes can increase your risk of various diseases and conditions, including heart disease and ED. 

• Cut down on the booze. Sure, alcohol can loosen you up socially, but it can do the same to your penis, making it harder to, well…get hard.

You can read more about habits to promote erectile health in our guide on how to maintain an erection.

If you’re doing everything right and still experiencing sexual dysfunction, it may help to speak to a mental health professional like a counselor or sex therapist to get to the root of your erectile issues.

Sexual side effects are common with a prostate cancer diagnosis and subsequent treatment. Here’s what you might expect:

• Loss of sex drive. A cancer diagnosis can make it harder to feel excited about sex — so, too, can certain prostate cancer treatments. 

• ED symptoms. Cancer treatments like radical prostatectomy, chemotherapy, radiation therapy and hormone therapy can make it harder to get and maintain an erection.

• Emotional stress. The emotional impact of a prostate cancer diagnosis can also, understandably, impact your sex life.

Life after prostate removal has its challenges, but it’s possible to regain sexual function with the help of medication and other treatments. 

Your prostate cancer diagnosis and treatment don’t have to mean the end of a satisfying sex life. There are ways to increase blood flow to your penis and achieve and maintain an erection, such as taking PDE5 inhibitors like sildenafil and tadalafil. 

If you’re struggling with ED symptoms after prostate cancer surgery, consider speaking with a healthcare provider. They can recommend the best erectile dysfunction medications to help you feel like yourself again.