Sexual side-effects for men and people assigned male at birth

You may find it difficult to get or keep an erection that is strong enough for sex. This can be caused by damage to nerves or blood vessels after some types of surgery. Other treatments that can affect erections include radiotherapy, hormone therapy, chemotherapy, immunotherapy and targeted therapy.

What can help? 

There are treatments that can help with ED, so let your doctor know if this is a problem for you. You might need to try a few different things or use 2 treatments together to find what works for you. Treatments for ED include:

• Tablets that help you to get an erection.
• A vacuum pump, which is placed over your penis. The pump creates a vacuum that causes blood to flow into your penis, creating an erection.
• Urethral pellets contain drugs to help you get an erection. They are put into the opening or 'eye' of your penis.
• Penile injections that are injected into the base of your penis
• Penile implants involve an operation during which tubes, a reservoir (container) and a pump are put inside your body. The implant means you can press on the pump to make your penis fill with fluid and get hard.

'Dry' orgasm

Some people find that after certain treatments, such as pelvic radiotherapy or prostate surgery, their orgasms have less semen than usual or they have a 'dry' orgasm, where no semen is ejaculated. This is not a health issue unless you are hoping to have children. If this is the case, you should speak to your medical team about it.

Changes to how orgasms feel

Many people say that the sensation of orgasms is different for them after surgery. A few describe it as lasting longer. Others say they have some pain after orgasm in the early days. Some simply describe it as different.

You may notice that your penis shortens after prostate surgery. This can be temporary or permanent. Hormone therapy may also make your testicles smaller.

Losing interest in sex can be caused by physical or emotional changes. For example, if your hormone levels are affected by treatment or you are very fatigued, you may find you have less sex drive.

Emotions like anxiety, depression or sadness can make you less interested in sex too. You may also feel less confident about your physical appearance, if it has changed after treatment. 

What can help?

If low libido is caused by low testosterone, your doctor may prescribe testosterone for you. Or you may be too sore to have sex after surgery. 

Trying to find out the cause of fatigue and treating it can help. For example, you may need a blood transfusion if your fatigue is due to a low red blood cell count or dietary advice can help if you’re not eating well. Read more about fatigue and tips to help.

It may be difficult to hold or hug your partner, especially if your wounds are still healing or if you have scarring after surgery. And areas treated with radiotherapy may be tender and painful to touch if it has been treated with radiotherapy. 

What can help?

• Taking painkillers before sex
• Changing position during sex so there is less direct pressure on the affected area.

• Give yourself time to recover, and don’t rush into sex if you don’t feel ready. 
• It may help to talk openly to your partner or a counsellor about how you’re feeling. 
• Talk to your specialist nurse if you’re worried about your sex life or sexual side-effects. You don’t need to feel embarrassed. They will be happy to talk to you and give you advice.
• If having sex is uncomfortable try different positions, such as lying on your side. 
• Pregnancy should be avoided during cancer treatment as some treatments can harm a developing baby. If you are having sex with someone who may become pregnant, you should use contraception.