Sexual problems

Low levels of sex hormones can cause a loss of interest in sex and make it difficult to have an erection.

Prostate cancer needs testosterone to grow. Hormonal treatments aim to:

  • stop the testicles from making testosterone
  • stop testosterone reaching cancer cells

Low hormone levels can lead to changes in how you feel about yourself and your relationships.

Loss of interest in sex (libido)

Testosterone plays a role in your sex drive. So if you're having treatment for cancer that lowers the amount of your testosterone, your sex drive may be lower. Not everyone who has low hormone levels has a loss of interest in sex. For most people, the cause is a combination of factors, rather than just the level of hormones in the body.

These include:

  • tiredness (fatigue)
  • stress or anxiety
  • loss of confidence or self esteem
  • changes to how your body looks or how you feel about your body
  • other medications that you are taking, particularly blood pressure & antidepressant tablets

It can be difficult to think about sex if you are experiencing side effects such as hot flushes or feeling generally unwell. Managing these side effects may help you to have an interest in sex.

Talking to your partner if you have one about how you feel might also help. You may not feel like having sex for a while but hugging, cuddling and kissing can be comforting and help you relax.

You may want to put intercourse on hold for a while. Some people find that feeling relaxed and having other physical contact can gradually lead to them becoming aroused and wanting to have sex.

Some antidepressants can cause a low sex drive. Speak to your doctor before you stop taking any anti depressants as you may have side effects if you stop suddenly and your depression may come back.

Erection problems (erectile dysfunction)

Lower amounts of testosterone can lead to problems getting and maintaining an erection. This is a common side effect of hormone therapy.

Other treatments for prostate cancer such as surgery and radiotherapy can also cause erection problems for many men. This can be a very difficult side effect to cope with. It can often have a big effect on confidence, self esteem and quality of life.

Talk to your partner about any problems you have and let your doctor know. There are a number of treatments that can help.

Different treatments work for different people and they can have side effects.  

Vacuum pumps

Vacuum pumps can help if you can’t get an erection or if the erection isn’t firm enough for penetration. You use the pump before sex. It works by drawing blood up into the penis. You then put a soft plastic ring around the base of your penis. This helps keep the erection firm.

Injections or pellets

You use these each time you want to have sex. You give yourself the injection of alprostadil into your penis. It will have an erection in 5 to 15 minutes after the injection.

Alprostadil also comes as a pellet inserted into the tube that carries urine from the bladder to the tip of your penis (urethra).  It is also available as a cream that is rubbed into the tip of the penis, but this takes a little longer to work.


Implants are semi rigid rods that a doctor puts into your penis during an operation. It means your penis is partly erect all the time. This method doesn’t suit everyone and is usually used when other methods haven’t worked. Penile implants can be inflatable or semi rigid.

You need to have an operation for the doctor to put the semi rigid implants inside your penis. The penis is always semi erect. There are joints so you can position your penis.

Inflatable implants have a pump and a bag of fluid. The pump is put into your scrotum. The bag of fluid is put behind your tummy (abdominal) muscles. When you want an erection you pump the fluid into your penis.

Hormone treatment and sperm banking

Difficulty having and maintaining an erection can affect whether you can ejaculate. You can collect and freeze some semen before you start hormone treatment if you think you may want to have children. Talk to your doctor about it, as there are special arrangements that have to be made beforehand.

Help and support for erection problems (erectile dysfunction)

There are doctors and nurses who specialise in erection problems. They can help you decide which is the best treatment for you. There are also counsellors who can help.

Talk to your doctor about getting a referral.

Last reviewed: 
17 Jul 2019
  • NHS choices
    Erectile Dysfunction treatment, Last accessed July 2019

  • Erectile dysfunction frequently asked questions
    British Association of Urological Surgeons (BAUS). 2016

  • Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer Systematic review
    I White and others.
    International Journal of Clinical Practice, 2015. Vol 69, Pages 106-123

  • British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men—2017

    Geoff Hackett and others 

    The Journal of Sexual Medicine, 2018

  • Prostate cancer: diagnosis and management
    National Institute for Clinical and Care Excellence (NICE), 2019

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