Sexuality for the Man With Cancer

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How pelvic radiation therapy can affect erections

Prostate, bladder, and colon cancer are often treated with radiation to the pelvis. This can cause problems with erections. The higher the total dose of radiation and the wider the section of the pelvis treated, the greater the chance of an erection problem later.

One way that radiation affects erection is by damaging the arteries that carry blood to the penis. As the treated area heals, the blood vessels lose their ability to stretch due to scar tissue in and around the vessels. They can no longer expand enough to let blood speed in and create a firm erection. Radiation can also speed up hardening (arteriosclerosis), narrowing, or even blockage of the pelvic arteries. Radiation may affect the nerves that control a man’s ability to have an erection, too.

A reasonable estimate is that 1 out of every 3 to 4 men who get radiation will notice that their erections change for the worse over the first year or so after treatment. This change most often develops slowly. Some men will still have full erections but lose them before reaching climax. Others no longer get firm erections at all.

As with surgery, the older you are, the more likely it is you will have problems with erections. And men with heart or blood vessel disease, diabetes, or who have been heavy smokers seem to be at greater risk for erection problems. This is because their arteries may already be damaged before radiation treatment. Doctors are looking at whether early penile rehabilitation could help after radiation therapy, too. (Penile rehabilitation is discussed under “Early sexual rehabilitation after surgery” in the “How pelvic surgery to treat cancer can affect erections” section.)

In a few men, testosterone production will slow after pelvic radiation. The testicles may be affected either by a mild dose of scattered radiation or by the general stress of cancer treatment. If a man notices erection problems or a loss of desire after cancer treatment, his first thought may be that he needs to have a blood test for testosterone. But testosterone levels usually get back to normal within 6 months after radiation therapy, so extra hormones may not be needed. And men with prostate cancer should not take testosterone, since it can speed up the growth of prostate cancer cells.

For men with prostate cancer treated with radiation

Most men will report difficulty with erections (erectile dysfunction or ED) within 4 years of getting external beam radiation for prostate cancer. Some of these men may have erections that allow penetration, but only about 15% will report their erections are as good as they were before treatment. Many men with early stage prostate cancer have a choice between radiation and surgery to treat their cancer. When looking at how men’s erections are affected by these treatments, ultimately there really is not much difference between the two. Men who have had radiation may see a general decrease in the firmness of their erections over time (up to 5 years after radiation). In contrast, after surgery most men have poor erections right away and then have a chance to recover erections in the first 2 years following the surgery. About 4 years after either treatment, the percentage of men reporting ED is about the same. Treatments can help these men get their erections back, and these treatments usually work for men who have had either surgery or radiation.

Last Medical Review: 08/19/2013
Last Revised: 08/19/2013