Sex After Prostate Cancer

Good news! There is life and sex after prostate cancer. But it may be different than before. In some ways, it may even be more intimate. 

Prostate cancer and its treatments can significantly impact a man's sex life, affecting him both mentally and physically, as well as his relationships. It's completely normal to have concerns about this, and it's important to remember that you're not alone in these feelings.

Understanding the Impact

• No Link to Sexual Orientation or Practices: First, let's clear up some common misconceptions. Being gay or bisexual doesn't increase your risk of prostate cancer. Similarly, oral or anal sex doesn't cause prostate cancer.
• Emotional and Mental Effects: A cancer diagnosis can be incredibly tough, leading to feelings of sadness or anxiety that might change how you feel about sex. Your thoughts and feelings about yourself and others play a big role in your sexual response.
• Physical Changes: Prostate cancer treatments can affect your body in various ways:
  • Erectile Dysfunction (ED): This is a very common side effect after treatment because nerves and blood supply vital for erections can be damaged.
  • Hormonal Changes: Hormone therapy, a treatment that blocks hormones that encourage cancer growth, can reduce your desire for sex.
  • Loss of Ejaculatory Function: You might experience changes in your ability to ejaculate.
  • Changes in Sensitivity: Rectal and prostate sensitivity can change.
  • Impact on Anal Intercourse: If your prostate gland is removed, it can affect anal intercourse.
• Relationship Dynamics: Dealing with cancer can shift your close relationships or make you think differently about starting new ones. It's worth noting that gay and bisexual men may be more negatively affected by these side effects, especially regarding intimacy. Much of the current focus on managing side effects often overlooks the specific needs of gay and bisexual men.

 FAQs: Ejaculation After Prostate Cancer Treatment

Q1: Can men regain the ability to ejaculate semen after prostate cancer treatment?

A: It depends on the treatment.

• Radical Prostatectomy (Surgery): No. The prostate gland and seminal vesicles, which produce the fluid for ejaculation, are permanently removed. This results in anejaculation (the inability to ejaculate semen) or a dry orgasm.
• Radiation  Therapy (External Beam or Brachytherapy): In most cases, the ability  to ejaculate semen is significantly reduced or lost over time due to scarring of the tissues. While some men may see a partial return of semen volume, a complete return to pre-treatment ejaculation is uncommon, and there are currently no standard treatments to restore it.

Q2: If I can't ejaculate semen after surgery, does that mean I can't have an orgasm?

A: No, you can still have an orgasm. The sensation of orgasm (climax) is a distinct event from the physical release of semen (ejaculation). After a radical prostatectomy, you will experience a dry orgasm, meaning you will still feel the pleasure of climax, but little to no fluid will be expelled. For some men, the sensation may feel different or less intense.

Q3: What is the difference between anejaculation and erectile dysfunction (ED)?

A: They are two different things:

• Anejaculation: The inability to ejaculate semen. This is typically a permanent outcome      after a radical prostatectomy.
• Erectile  Dysfunction (ED): Difficulty achieving or maintaining an erection. ED is a common side effect of both surgery and radiation, but it is often treatable with medications (like Cialis or Viagra), injections, or other devices.

Q4: Can treatment for erectile dysfunction (ED) restore my ability to ejaculate semen?

A: No. Treatments for ED, such as oral medications and injections, work by increasing blood flow to the penis to facilitate an erection. They do not restore the prostate or seminal vesicles and therefore do not restore the ability to produce and release semen.

Q5: Is it possible to have children naturally after a radical prostatectomy?

A: No. Since the prostate and seminal vesicles are removed and the pathway is interrupted, sperm cannot be ejaculated. This causes sterility. Men who wish to have biological children post-treatment should discuss sperm banking or other fertility preservation options with their doctor before starting any treatment.