Apart from the psychological adjustments, the operation may have made physical changes which can cause problems with sex.

Although your doctors will do all they can to prevent nerve damage during the operation it may not be possible to avoid it. If nerve damage occurs it can be difficult for a man to get an erection.

Women may find that the sensations they have during sex are different, as the vagina is usually smaller.

If you have problems getting or maintaining an erection there are several options to help you. They can usually be prescribed by your GP or cancer specialist.

Medicines

Tablets of sildenafil (Viagra®) help to produce an erection by increasing and restricting the blood supply in the penis. They are usually taken an hour before lovemaking. They can’t be taken by men who take nitrate-based medicines for heart problems.

Vardenafil (Levitra®) is a similar tablet that can be taken 25–60 minutes before sex. Tadalafil (Cialis®) is another tablet that can be prescribed and may be taken up to 24 hours before lovemaking. It should not be taken by people who are taking certain heart medicines.

Pellets and injections

Pellets of alprostadil (MUSE®) can be inserted into the tip of the urethra. The pellet melts into the surrounding area and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is uncomfortable to begin with.

Alprostadil (Caverject®) or Viridial® can be injected directly into the penis (using a small needle) to cause an erection. At first you may need to experiment to get the dose right.

Pumps and other devices

Vacuum pumps can also be used to produce an erection. The pump is a simple device with a hollow tube that you put your penis into. The pump has a handle which draws blood into the penis by creating a vacuum. The blood then gets caught in the penis by a rubber ring placed around the base. The ring allows you to make love without losing the erection. Once you have finished making love, the ring is taken off and the blood flows normally again.

The advantage of a vacuum pump is that it doesn’t involve inserting anything into the penis, but it does need a bit of practice. It’s particularly helpful for people who are not able to take other medicines.

Penile implants are sometimes used after other methods have been tried. It means having a flexible rod or a thin inflatable cylinder inserted into your penis during an operation. Your doctor can discuss penile implants with you.

In some women, the vagina may have been shortened or narrowed during the operation. This can make sex difficult or uncomfortable at first. One of the best ways of overcoming this problem is to start having sex regularly and gently, as soon as you feel ready. This will gradually stretch the vagina, making it more supple, and will make sex easier and more enjoyable. If you don’t have a regular sexual partner, you can use a vaginal dilator. Your nurse or doctor can show you these, and explain how to use them.

Some women find that they have different sensations during sex. It may be more difficult to have an orgasm. The womb is usually removed during a cystectomy and this may make a woman feel that she has lost a part of her female identity.

You may find it difficult or embarrassing to talk about sexual problems. Most doctors are very understanding and can refer you to a specialist in sexual problems, or a trained counsellor for advice and support. These specialists can give emotional support and advice on how to cope with sexual difficulties. If you have a partner, it may be helpful for them to see the specialist with you.

One common fear is that cancer can be passed on to your partner during sex. You can’t catch cancer by having sex. It is perfectly safe for you and your partner to have sex as soon as you feel ready.

Our section on sexuality and cancer may be useful.