Sex Following Prostate Cancer – The Real Truth from a Prostate Cancer Survivor!

October 4, 2008

Before reading this post…if you have been diagnosed with Prostate Cancer or are a Prostate Cancer survivor, I would appreciate your help.  I am writing a book, from a layman’s perspective, about Prostate Cancer and how to find solutions to improve our lives.  I am conducting interviews during the months of October 2008 through November 2008.  The interviews are confidential and your name will not be revealed.  If you are willing to discuss your experience…please contact me at  From there we can set up a time for a phone interview.  Likewise, this disease no only affects the man diagnosed but also his family, so I am interviewing spouses and/or significant others.  Thank you in advance for your help.  Now I hope this article is of some benefit to you.

First, if you are reading this you, like I, have had the unpleasant experience of being diagnosed with Prostate Cancer.  Just like a diagnosis of breast cancer to a woman, prostate cancer to a man is devastating to hear and begins a long physical and emotional road to a life changing phase of life.

Allow me to make certain assumptions:

(1) You are alive and have survived.  If you have just been diagnosed then this article, while informative, will be a bit premature.  Yes, I know the issue of sex following successful treatment for prostate cancer is on your mind, but your priorities must first be – what is the best treatment that will cure this cancer and eliminate the issue of mortality from my mind.

(2) The therapy you chose allowed for the physical nerves to be spared and hence allow for the potential resumption of sexual function.  All the research for years has shown that removing or substantially damaging the nerves eliminates the ability to achieve an erection and hence resume a “normal” sex life.

(3) Lastly, you recognize that you have undergone a substantial change in your body and accept that sexual function may never be quite the same.  That does not mean that sexual function can’t be quite good, approaching normal, but more than likely by the time you’re diagnosed and have gone through treatment, you are middle aged.  Face it, middle aged men aren’t quite as viral as they were when, say they were seventeen.

In an earlier blog entry I wrote about my experience with sexual function following a highly successful prostate cancer surgery.  The article is referenced here.  For clarity and convenience, allow me to restate a portion of that article here:

Sexual Function: Candidly, that returned much slower than I expected.

  • Within three weeks of the catheter being removed I wanted to test sexual function. To my pleasant surprise with physical and visual stimulation I was able to achieve a marginal erection and orgasm. I was elated. However, I soon found out that my first experience was not sustainable on a regular basis.
  • Like most men, I was given prescriptions for Viagra and informed about other alternatives.
  • Within three to six months, I found that achieving an erection was difficult and that any mental distraction would prove to be an impairment.
  • Viagra would provide some help, but the side effects were bothersome – especially the flushed feeling I felt in my chest and nasal cavity. Even with Viagra or the other alternatives, I did not feel that the result was successful.
  • By the seventh month I was concerned about the lack of consistence in sexual function. That took it’s toll emotionally. While women may not completely understand, men will get it. We are sexual beings and, while we don’t define ourselves by sex, we certainly understand the important role sexual function has in our lives. Inability to perform can have direct effects in other areas of ones life.
  • I was told there would be no ejaculate. That was true and false. There was no ejaculate as men generally know it. However, I did leak a fair amount of urine. I think the urine leakage surprises and disturbed me more than it did my partner She understood that urine is harmless. I soon learned that I should empty my bladder before sex otherwise, there would generally be urine leak when orgasm was reached.
  • By the ninth month I woke to a nocturnal erection. I must admit I was surprised and elated. However, the natural erection was still missing.
  • There had been no significant change from the sixth month through the tenth month, so I was becoming a bit concerned. I sought help in an unusual way, I sought Hypnotherapy as a possible solution. Wow…now that was worth it.

Hypnotherapy: Perhaps for the skeptics I had just healed enough to experience a change, but when I sought help I had the same results. Not knowing what to expect, I was open to anything that would provide some normalcy. I had come to know that things would never be the same. For one thing, I wasn’t 17 years old any more. I had to know that with age sexual performance will change. Likewise, I knew that without a prostate (the old plumbing if you will) I would never have an ejaculation – although an orgasm is quite normal without ejaculation. In any event, I elected this alternative form of therapy. What did I have to lose?

I went through the process feeling quite relaxed. The female hypnotherapist wasn’t sure that it would be comfortable for a man. Frankly, in my mind, if I got the result I didn’t care who provided the service. The process lasted and hour to and hour and one-half.

Within three days it was time to test the program. To my great surprise, I had an erection with less effort than it took over the prior 10 months and the orgasm was powerful. Since that point, there has been a marked difference in sexual function. Why? I’m not sure I know. I feel that two things converged at the same point. One – I had taken time to heal physically and with practice one can achieve a return to normalcy. Two, I feel the hypnotherapy allowed me to by pass my conscious emotional fears and empower my subconscious to know that I was fine and fully functional (within the physical confines of surgery). Either way…the process worked.

Three Years Later

There is a reality for us all.  For now all I can speak for is myself. (I am conducting research into this area – see the tab “Prostate Cancer” if you are willing to help). There are three areas that I feel need to be exposed as men and those who love them deal with the very real and significant issue of sexual function after prostate cancer.  There is no order to the issues listed below – each are important in their own way.

Issue One:  Psychological ramifications of sexual function after prostate cancer surgery. Following my earlier articles and blogs I received a number of e-mails and calls from men and women who appreciated the candid discussion and insight.  As time has moved on I have come to understand that sexual function, especially following prostate cancer, is as much (if not more) about the mind than it is about the body.

Women/Partners – I am not yet sure that you know just how much a man’s identity is tied up in his sexual function.  Now, I can hear two responses as this is being read: (1) you think I didn’t know that? and (2) it can’t be that important.  At the risk of sounding preachy – ladies – No you don’t really know that and, yes it is more important you’ll ever conceive.

While a man is far more than his sexual ability, the lizard brain in us all sends messages that we cannot control – to a man it is to procreate.  So to eliminate that possibility means that the subconscious mind diminishes the worth and value of the being.  On the outside he may seem invincible, but on the inside he is crumbling, but rarely will he be emotionally connected enough to show it or willing to show it.  Showing that pain (emotional pain) is a form of weakness to most men and revealing that would only slide him further into a downward spiral.

What to do? The less pressure there is to sexually perform the easier it is to perform.  Now, by that statement, I do not mean reduce the frequency of sexual attempts.  First, create an environment that will allow for play, fun and all the joy that comes from being sexually with your partner.

Secondly, be willing to become more active in order to help the recovery process.  I have been told by several physicians that muscles grow if they are used.  Basically they were telling me to use my penis (sexually of course) and do so whether through masterbation or with a partner.  I will be blunt here.  I have found that masterbation produces a more consistent result.  For a while I wondered why, then it hit me – I can take all the time I want to with myself.  There is no pressure and I can image that where ever my thoughts may take me, the person I imagine myself with is patient, willing and engaged.

Let me be clear, I am married and my wife has encouraged me to continue this writing knowing that others may, very well, be feeling the same thing or experiencing the same issues.  That said, while sex with my wife is very pleasing, I find that while I can gain an erection, often the sexual experience does not result in an orgasm.  As we have spent time discussing this, it has become clear that my inability to achieve a satisfactory sexual result was psychologically connected to my wife’s attitude and engagement in the process.  It takes more effort to achieve what used to be easy.  Hence, in order for the experience to be satisfying to me – my wife has to, bluntly put, work harder.  Not only is that a substantial change for her, but it puts pressure on me and the more pressure the less performance.

Issue Two:  Bodily Function. As I mentioned in the first article, it took me time to recognize that my body was different.  While sex was more difficult following surgery, it became clear that there was a greater than likely chance that urine would be released sometime during the act of sex.  Hence, I have discovered three things: (1) the less you drink before attempting sex the less chance of leakage; (2) urination immediately before sexual intercourse (or whatever method of sex is selected) reduces the chance for any substantial leakage; and (3) since urine is sterile and effectively harmless, allow it to be used as a form of lubricant or play.  I can hear many scoffing at the third suggestion, but going back to Issue One – if a man is concerned about what might happen (urine leak) during sex, he will be constrained physically (because of that mental state) and hence have a much more significant problem with achieving an erection or achieving a sexually satisfying experience.

Issue Three:  Practice…Practice…Practice. Now, as I write those words, it occurs to me that some may interpret this as applying pressure and increasing the sexual anxiety associated with prostate cancer.  I don’t mean “practice” in that sense.  Rather, it means either love yourself or love your partner (that will depend on who is reading this – you or your partner) enough to provide any and all outlets necessary to heal.  I would suggest that you consider spicing up your sex life so that the stimulation (whether visual, auditory or by feeling) is enhanced.  Having talked with others I know that sexual healing can take place, but it does come with a cost – and in most cases that cost is increased effort.

Question: If your dog broke his or her leg in an accident and the vet told you that he had to walk at least two mile each day and do other physical activities in order to heal – would you do what was necessary to help your dog heal?  If you answer no – “I’d put him to sleep,” please quit reading this article – it’s hopeless.  But, I think most would agree that we’d all say, “I love my pet and would do what ever.”  Strange example, but we need to do whatever is necessary to heal, both physically and emotionally.  No one said it would be easy – physical therapy is hard.

Simply put, sexual healing from prostate cancer is physical therapy that heals on both a physical and emotional plain.  If sex is still a struggle…hang on and keep trying.  It may never be what it was, but in most cases you can sexually recover from prostate cancer.  I did and so have countless others.