Sex and Men With Cancer -- Overview

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Surgery and sex

Some operations cause more sex problems than others. For instance, a man does not regain full erections after having all the organs in his pelvis removed (bladder, prostate, rectum, and more). We also know that men who had good erections before cancer surgery are far more likely to have them again than men who had problems with erections before surgery.

How surgery can affect erections

It can cut down blood flow to the penis

Some of the problems with erections after surgery are caused by loss of blood flow. The surgeon may need to seal off some of the blood vessels that help fill the penis. After surgery, the penis still swells when the man is aroused, but may not be firm enough to enter his partner. He should still be able to feel pleasure from touch and have an orgasm.

It can damage nerve bundles that control blood flow to the penis

This is like fraying a phone wire. The signal to start an erection is either weak or lost. Some doctors try to take out the prostate without hurting the nerves around it. This can’t be done in every case, because sometimes the cancer is right around or on the nerves. But when surgeons can use “nerve-sparing” surgery, more men are able to have erections after. Nerve-sparing methods are sometimes also used when the prostate, bladder, and the colon or rectum are taken out.

Some men can still get full erections after surgery, but it may take up to 2 years. It’s unclear why some men do and others do not. Even if the nerves are spared, they’re still injured during the operation and need time to heal. And the healing and growth of new blood vessels may help more blood get to the penis. All of this takes time, which could explain part of the delay in the return of full erections.

Studies have been done in which doctors looked at ways to help men get erections starting just weeks after surgery. The results of these studies suggest that no matter what method is used, getting erections, called penile rehabilitation or erectile rehabilitation, should be started shortly after surgery.

How surgery can affect ejaculation

Damage to the nerves that control the prostate and other parts needed for normal ejaculation

This can block or change the way ejaculation happens. But a man can still have the feeling of pleasure that makes an orgasm. The difference is that little or no semen comes out.

Some men say an orgasm without semen feels normal. Many others say the orgasm does not feel as strong or last as long. Others are upset because they wish to father a child. (See the section called “Fertility and cancer treatment” for more on this.)

Removal of the prostate and seminal vesicles or the bladder

The sperm cells made in the testicles ripen, but then the body simply absorbs them. This does not cause problems with orgasm, but the man will not make semen.

Damage to the nerves that come from the spine

When this happens, the semen is there but can’t come out. At the moment of orgasm, it shoots backward into the bladder. This happens because the valve leading back to the bladder stays open after some surgeries. This backward ejaculation does not cause pain or harm to the man. When a man passes urine after this type of dry orgasm, it looks cloudy because semen gets into it during the orgasm.

Surgery for cancer of the penis

When a man has cancer in his penis, the best treatment may be removing part or all of the penis. This surgery is rare, but it can be painful for a man’s self-image and his sex life.

If only the end of the penis is removed it’s called partial penectomy. The surgeon leaves enough of the shaft for the man to direct his stream of urine away from his body. A satisfying sex life is possible after partial penectomy. The remaining shaft of the penis still becomes erect when the man is aroused. It usually gets long enough to allow him to enter his partner. Even with the most sensitive area of the penis (the head) gone, a man can still reach orgasm and ejaculate. His partner also can still enjoy sex and may reach orgasm in the same way as before the surgery.

The surgeons try to save as much of the penis as they can, but all of the cancer must be taken. If the shaft and head of the penis cannot be saved, the man must have the whole penis removed, even the base that extends into the body. The surgeon makes a new opening for urine to come out behind the man’s scrotum.

If a man is willing to put some effort into his sex life, pleasure is possible even after a total removal. He can learn to reach orgasm when sensitive areas, such as the scrotum, the skin behind the scrotum, the area around the surgical scars, or even areas inside the anus are stroked. He can help his partner reach orgasm by stroking with the fingers, oral sex, or using a vibrator.

Last Medical Review: 05/16/2013
Last Revised: 06/12/2013