Pelvic radiotherapy can affect your sexuality and sex life. This section discusses the possible changes that may happen. You may also have effects from other treatments, such as surgery, chemotherapy or hormonal therapy. It may be helpful to read information about how these other treatments can affect your sex life. If you have had a combination of treatments, you may be more likely to have effects on your sex life than if you only had pelvic radiotherapy.

Our separate section on sexuality discusses ways of dealing with the physical and emotional changes that cancer treatments can cause.

You may find it helpful to talk to your partner about the changes you have noticed in how your body responds sexually. You can talk to sexual therapists or counsellors in detail about the effects these changes or difficulties are having on you and your partner. They can be contacted through:

• your treatment team (doctor or specialist nurse)
• your GP
• your hospital erectile dysfunction (ED) service
• directly through the websites and sources of help listed: for example, the British Association of Sexual and Relationship Therapists (BASRT).

During and after cancer treatment, many men find that their interest in sex reduces, or may disappear completely. There are many reasons for this, including:

• the emotional impact of adapting to the changes that a cancer diagnosis brings
• the treatments they have had
• any side effects, such as nausea, diarrhoea or tiredness.

Interest in sex may also be reduced by treatments which lower the levels of the male hormone, testosterone, in the body. An example of this is if you are taking drugs such as hormonal therapies for prostate cancer.

Testosterone replacement therapy can increase sex drive, particularly if blood tests show that you have low testosterone levels. Your doctor can tell you whether testosterone replacement therapy may be helpful for you. However, testosterone cannot be used in men who are having hormonal therapy to block their normal testosterone production as part of their cancer treatment.

You and your partner may find it helpful to talk with each other about the changes you have noticed. It is good to look at ways of overcoming them as a couple. You may want to have general, relationship or sexual counselling. Counselling can help increase interest in sex and help you to come to terms with changes.

Some men have problems getting or maintaining an erection. This is due to the effects of radiotherapy on the blood vessels and nerves in the pelvic area. The risk of erection problems depends on the dose of the radiotherapy and the exact area being treated. It is common after radiotherapy for prostate cancer.

Between a third and a half of men (30–50%) will have long-term problems with erections after pelvic radiotherapy. It is more likely if you are also taking hormonal treatments for cancer or have had other cancer treatments (such as surgery to the pelvic area or chemotherapy).

Dealing with erection difficulties

Some treatments can help you to get and maintain an erection. These include:

• tablets that increase the blood supply to the penis, such as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®)
• pellets that are placed into the tip of the penis (alprostadil, MUSE)
• injections into the base of the penis (alprostadil, caverject)
• vacuum pumps which are placed over the penis.

Your doctor or nurse should be able to advise you on the different methods and can refer you to a specialist if necessary. You can get leaflets about all the medicines and pumps from the Sexual Dysfunction Association.

After pelvic radiotherapy the amount of semen your body produces is reduced. When you ejaculate you may notice that only a small amount of fluid is produced from the end of your penis. For some men, no semen is produced at all. This is known as a dry ejaculation.

Although you will still be able to have an orgasm (climax), some men find that the sensation feels different from before. The sensation may feel less intense and for some men it may take longer to reach orgasm. This is thought to be due to changes in the blood flow and nerves in the pelvic and genital area, especially after pelvic surgery or radiotherapy. It may also be due to changes in how you feel your body works and feels sexually. If you have any changes that make you feel worried or upset it can help to speak to someone such as a sexual counsellor. You can explore whether there are things that can improve the situation.