Sex and relationships after bladder cancer treatment

Bladder cancer treatments can affect your sex life in different ways.

For women, there might be changes to your vagina or clitoris which alter the sensation of sex.

For men, some treatments can damage the nerves that you need to get an erection. Or make you unable to ejaculate.

Treatment can also affect the way you feel about yourself and how you feel about having sex. There might be things you can try to help you adapt or cope with these changes.

Bladder cancer surgery and your sex life

Your sex life might change after having surgery for bladder cancer. This depends on the type of surgery you have.

Having a stoma can also affect the way you feel about yourself and how you feel about having sex. 

Women

After surgery to remove your bladder, sex may feel different. This is because surgery can damage nerves in the area, and your vagina might be shorter. This can change the sensation and might affect how much you enjoy having sex. 

Surgery for bladder cancer can narrow or shorten your vagina. Talk to your surgeon about this before the operation. They can try to change your vagina as little as possible.

You might also be able to use dilators afterwards. Dilators are plastic, cone shaped objects. They stretch your vagina and can reduce the effects of scar tissue. They come in various sizes and you use them every day, for a few minutes.

You start by using the one that goes in most easily first. Over a few weeks, you gradually use larger sizes to stretch your vagina. Sex will do this too, but you might not feel like having sex soon after your operation.

If you have problems because of vaginal dryness, your health care team or GP can help. They can tell you about vaginal gels and creams you can use.

Surgery can also cause early menopause because the surgeon might remove your ovaries. This means you can't become pregnant. You might get hormone replacement therapy (HRT) and vaginal creams with hormones in to help with this. Some women may just have the cream, or just the HRT. Your doctor can talk through what might be best for you.

Men

During surgery to remove your bladder (cystectomy), the surgeon might also remove your prostate gland. This is because bladder cancer can often come back in the prostate.

Having surgery to remove your prostate means you will not be able to ejaculate. So your orgasms will be dry.

This operation can also affect the nerves that control your erections. So you may not be able to get an erection anymore.

There are some options to help you get an erection. You might:

• use drugs such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Stendra)
• have cream
• use a vacuum pump that draws blood into the penis to stiffen it - this is like physiotherapy for your penis and is unlikely to be enough for penetrative sex
• have injections or pellets that go into the penis 
• penile implants

Your doctor can tell you more about these options and if they are suitable for you.

During surgery your surgeon might be able to avoid damaging the nerves that control your erections. This is called nerve sparing surgery. You still may need medicines to help you get an erection.

Your body image after bladder cancer surgery

Changes to your body can affect how you feel about yourself. This might affect your relationships. You might feel more self conscious and lack confidence about what your body looks like after surgery. You may worry about being intimate with your partner or a future partner. It may be that you’re also worried about how you would tell a new partner.

There are many things to think about, here are a few tips that may help:

• If you’re in a relationship your partner might need a bit of time to adjust to changes to your body
• Be open with your partner or future partner about what’s worrying you.
• Join a support group to help meet other people with similar experiences - they’ll have experience that may help you overcome some of your worries.
• Tell your healthcare team, they may be able to help.
• It might help to find new underwear or clothes that help you feel more attractive – there are some websites that sell underwear and clothing for people who have had bladder surgery.

Bladder cancer radiotherapy and your sex life

Radiotherapy for bladder cancer can cause problems with sex.

Women

Some women have vaginal dryness after having radiotherapy. There are gels and creams that can help with this. Your specialist nurse can tell you about this.

You might also notice your vagina is tighter. Using vaginal dilators or having regular sex can help with this.

Radiotherapy can damage the ovaries, so they stop working. You might take HRT or use vaginal creams to help with this. Your doctor will talk through what is best for you. 

Men

Some men can't get an erection after having radiotherapy to the bladder. Or they might have erections that aren't as strong as they used to be.

There are some options to help you get an erection. Ask your doctor or specialist nurse if you would like to try any of them. You can also read about these in our surgery section above. 

Bladder cancer chemotherapy and your sex life

Chemotherapy into the bladder doesn't usually cause any long term problems with sex. But chemotherapy into your bloodstream, can make you feel tired and less interested in sex for a while.

Some chemotherapies may stop your ovaries working properly, so you may get early menopause. This can lower your sex drive and lead to vaginal dryness. Women might take HRT or use a vaginal cream to help with this. Your doctor will talk through what is best for you. The chemotherapy might also affect whether or not you can become pregnant. 

Whilst your receiving your course of chemotherapy you’re advised to wear condoms during sex.

BCG treatment and your sex life

Treatment with BCG into the bladder does not usually cause any long term effects on your sex life. But the treatment might affect how you feel about having sex.

You should not have sex for 24 hours after each treatment. During your course of treatment and for a week afterwards, you should wear a condom during sex.

Women might have problems with vaginal dryness. If this happens, speak to your specialist nurse who may recommend creams.

Get help

You'll probably find that talking things over with your partner, or close family or friends, can help. It will take time for you and your partner to adjust to all that has happened to you. But sharing how you feel can help you to understand each other better.

You might find it easier to talk to someone outside your own friends and family. Your doctor or specialist nurse can put you in touch with a councillor or a psychosexual therapist if you feel you would like this type of help. Or you can talk to a Cancer Research UK nurse.