Surgery to the pelvis or genitals for men
Surgery for a number of different cancers can affect your sex life and sexuality. These include:
- prostate surgery
- bowel or rectal surgery
- surgery to remove your bladder
- having all or part of your penis removed
- surgery to remove both testicles
- surgery to remove lymph nodes from the back of the abdomen
Having prostate surgery
surgery can cause several changes that affect your sex life. These include ejaculation and fertility problems, and problems with erections.
Ejaculation and fertility problems
If you have your prostate removed (radical prostatectomy) you will no longer produce semen at all. This is because the prostate gland and seminal vesicles are removed. Your testicles will still make sperm cells but they will be reabsorbed back into your body. So you are still able to have an orgasm, but it is called a dry orgasm.
Some men say that a dry orgasm without semen feels normal, or even better than before prostatectomy. But other men say that it is less intense and pleasurable.
Sometimes men leak urine when they have an orgasm. This is called climacturia. This does not cause harm. It might help to pass urine before you have sex, or to use a condom. If you are leaking a large amount of urine, you could have sex in the bath or shower.
If you have dry orgasms, you will not be able to have children by sexual intercourse because your sperm cannot pass into your partner's vagina. If you want to have children, sperm can be saved before surgery, or it might be possible to take sperm directly from your testicles following surgery. The sperm can be used to fertilise your partners egg directly, or with in vitro fertilization (IVF).
Problems with erections
Depending on the surgery you have, there is also a risk it might become difficult to get or keep an erection. This is called erectile dysfunction (ED). It used to be called impotence.
After any surgery to the prostate, you may have temporary problems with getting or keeping an erection. These problems are more likely to be permanent if you had a radical prostatectomy. There are treatments available that might help.
If you have a radical prostatectomy, you might want to ask your surgeon about nerve sparing surgery. This means your surgeon will be very careful not to disturb the nerves that control getting an erection. These nerve bundles go around the prostate gland. Nerve sparing surgery is only suitable for men with very early prostate cancers that have not grown into the nerve bundles. You are much less likely to have erection problems after nerve sparing surgery.
If the nerve bundles have to be removed during the operation, you won't be able to have spontaneous erections afterwards. But there are treatments that can help.
Erection problems can be very difficult to come to terms with. It might be helpful to talk to your doctor or specialist nurse about this before you have your operation.
Penile rehabilitation
Penile rehabilitation is a programme to help encourage erections, prevent the muscle in the penis shrinking, and help you adapt to changes with your sexual function and relationship.
Whether you are in a relationship or single, it is important you have the chance to discuss these changes. Self pleasuring (masturbation) can be helpful during penile rehabilitation.
A penile rehabilitation programme may include:
- taking tablets
- trying a cream
- pellet injections into the shaft of the penis
- using a vacuum pump (vacuum constriction device)
It may take about 3 to 4 years to get your erections back after a radical prostatectomy.
Hormone therapy might be used for a time after surgery. This can affect your ability to have an erection and can reduce sexual desire. When you stop having the injections or tablets, your erections might improve. So it is really important to keep penile tissue healthy during hormone treatment.
Ask your specialist doctor or nurse about penile rehabilitation if this hasn't been mentioned. If they are not able to help, they can refer you to a different doctor for information.
Having bowel or rectal surgery
Sometimes, surgery to the bowel or back passage (rectum) can cause nerve damage that makes it more difficult to get an erection after surgery. This is more likely if your surgeon has to operate near the nerves that control erection.
You might want to ask your surgeon about this before your surgery. Radiotherapy and chemotherapy (or a combination called chemoradiotherapy) might be used before surgery. These treatments increase the risk of sexual changes or problems.
There are treatments that might help. For example, you can try creams, injections or vacuum pumps to help you achieve an erection.
Having your bladder removed
If you have bladder cancer you may have your bladder removed, as well as your prostate gland and part of your . This is called a radical cystectomy. This operation means you won't be able to get or keep an erection. Your surgeon might be able to avoid damaging the nerves that control your erections, but this is not always possible.
Talk to your specialist doctor or nurse if you find you have erection problems. There are treatments you can use (such as creams and injections) to help you achieve an erection.
Having all or part of your penis removed
Removing all or part of the penis is called a penectomy. It is an uncommon treatment for penile cancer. Most treatment for penile cancer will not affect your physical sex life in the long run.
Some men who have part of their penis removed (partial penectomy) can still enjoy sex. The remaining part of your penis can still become erect and is usually large enough for penetrative sex. The most sensitive part of the penis (the head) is removed. But you will still be able to have an orgasm and ejaculate.
But if you have the whole of your penis removed (total penectomy) your sex life will obviously be seriously affected. This can be devastating for a man’s self image and intimate relationships. Some men decide to give up all sexual activity after having a total penectomy. But with some effort a man can still have sexual pleasure.
Your surgeon may make a new penis (reconstruction) after a penectomy, using tissue from elsewhere in the body. This operation is not common. It can only be done when doctors are happy that there is no more evidence of penile cancer.
Stroking and touching sensitive areas such as the scrotum and the skin behind the scrotum can lead to an orgasm. Sexual fantasies can help to make this easier.
Talking about this surgery
It can be awkward to talk about this type of surgery. Many people feel uncomfortable about discussing things that are so personal or private. But professionals who work in this area are very sensitive to this and are used to talking about these issues. If you can talk to your partner about how you feel, it usually helps both of you come to terms with the change in your relationship.
Specialist nurses and counsellors have skills and experience in helping men to adjust after a partial or total penectomy. Some men might find it helpful to talk to a nurse or counsellor. Your GP should be able to arrange this for you. Or you could contact some of the organisations that deal with relationships and sexual issues.
Having both testicles removed
Your testicles produce your sex hormones. Sex hormones give you the urge to have sex and get an erection. Having both testicles removed is sometimes used as a treatment for prostate cancer. If you have both testicles removed, you will not be able to have an erection and will have a low sex drive. Some people have no interest in sex at all after this.
If you have testicular cancer you will most likely only have one of your testicles removed. It's very rare to have both testicles removed to treat testicular cancer. Having one testicle removed should not stop you getting an erection. Your remaining testicle will produce extra hormones to make up for the one you have lost.
Surgery to remove lymph nodes from the back of the abdomen
Surgery to remove the lymph nodes from the back of your tummy (abdomen) is called a retroperitoneal lymph node dissection. You might have it to treat testicular cancer, or another type of cancer that has spread to these lymph nodes.
This operation usually causes retrograde ejaculation. This means that when you ejaculate your semen and sperm go back into your bladder instead of coming out of your penis.
Retrograde ejaculation is not dangerous or harmful. And it will not stop you having an orgasm. But your orgasm will feel different because it will be dry. Some men say that an orgasm without semen feels normal, or even better than before surgery. But others say that it is less intense and pleasurable.
Dry orgasms
If you have dry orgasms, you will not be able to have children by natural sexual intercourse. This is because your sperm can not pass into your partner's vagina. If you want to have children, it might be possible to take sperm directly from your testicles or from your urine after you have had sex. The sperm can be used to fertilise your partners egg directly, or with in vitro fertilization (IVF).
Sometimes a retroperitoneal lymph node dissection can also make you lose erections due to nerve damage. It is worth talking to your surgeon about this possible side effect before your surgery.
Help and support
These changes and the emotions it can bring can be difficult to cope with. It might help to talk to a partner, relative or friend. Let your nurse, specialist or GP know how you are feeling. They can let you know what help and support is available in your treatment centre or in your area.
Some people choose to talk things through with a counsellor or therapist. Or you could contact some of the organisations that offer support and information about relationships and sexuality.
