Regaining a healthy sex life after prostate cancer

By Dr. Elmari Mulder Craig, Specialist Sexologist

Prostate cancer is one of the most common male cancers in the Western world and can have many sexual implications on patients and their partners. Physical changes include impotence and a loss of libido, while urinary incontinence can disrupt intimacy and sexuality.

However, prostate cancer as a disease does far less damage to sexual function than the treatments that aim to cure it. Patients typically go through a long period of fear, from the initial fear of death to the fear of recurrence often rising before follow-up examinations. As a result, many patients suffer from depression, anxiety, adjustment disorder or dysthymia.

Depression and anti-depressants can have a negative influence on sexuality. So can fatigue, another common side effect found in up to 80% of all patients. The sexual relationship can be changed by fatigue and impaired assertiveness – turning daily life into a rollercoaster of emotions for patients and their partners.

When deciding on a treatment, there are two main aspects to consider. The first pertains to life expectancy. Adopting a “watchful waiting” approach can preserve your quality of life, including sexual function. The second aspect is the stage and spread of the disease. Localised prostate cancer can be treated with several surgical and radiotherapy methods but both can harm erectile potency. While cure rates are the same, side effects differ and should be evaluated in the decision-making process.

In later stages of treatments, physical effects of the disease can have a negative influence on sexual function itself. Cachexia, dizziness, nausea and pain can become too disturbing to allow sexual feelings to develop. Men experience these implications as far more disturbing than the side effects of surgery or radiotherapy. In treating this, extra attention should be devoted to renegotiating sexual roles and scenarios.

The erectile system in the penis needs the regular circulatory effects of an erection. For this reason, penile rehabilitation is becoming the standard after radical prostatectomy. This refers to the regular evoking of an erection by method of vacuum, injection, intra-urethral or daily oral method. In some cases, maximum stimulation with erotica, a vibrator and partner are recommended as a relevant addition.

How to regain a healthy sex life

In spite of being together for years, many couples don’t understand how a sexual disturbance affects one another. Over the years, most couples develop rather fixed sexual patterns that can be brought to a standstill with the interference of cancer.

  • Dealing with fatigue: There are many solutions available such as timing of the lovemaking; adapting activities to each other’s capacities; the use of a strong vibrator when muscular movement is desired; medication; etc.
  • Dealing with pain: Some partners avoid sex out of fear of causing their male counterparts pain or harm. Couples can manage pain by fine-tuning and timing pain medication; restructuring sexual scripts; using comfortable positions; and using sexual arousal to increase the pain threshold.
  • Renegotiating sexual intimacy: When sex is no longer possible, some patients and their partners are so strongly influenced that no alternative for penetration is possible. It is important to discover new forms of intimacy through touch, tools and toys. These can be useful in regaining sexual arousal.
    • Take time to relax, spend time on foreplay and focus on non-sexual physical touch
    • Try sexual positions that you both find comfortable and pleasurable
    • For men with erectile dysfunction, try sex with your partner on top as hardness is less important
    • Sexual aids such as a vibrator or penis ring can help men last longer and women to reach orgasm quicker
    • The more sex you have, the quicker your sex drive will return and increase naturally

Couples therapy and medication can help you navigate this changing landscape. Sex might be different but can be just as enjoyable. Focus on intimacy, sensuality and physical touch as sexual alternatives. Let go of expectations. Adopt a positive attitude and an open mind about sex. It is the best time to rediscover both the emotional and sensual aspects of your sexuality.

Here4You is a portal of information and real-life experiences around prostate cancer. Visit Here4You for hope and support at every stage of prostate cancer.


Here4You is a portal of information and real-life experiences around prostate cancer. Here4You, providing hope at every stage of the cancer.