Most prostate cancer treatments affect erections and sometimes bladder control, but how much and when depends on the treatment: surgery has the biggest effect on erections and urine leakage, radiotherapy has little effect on bladder control, and hormone therapy lowers sex drive and makes erections harder [1, 5]. Most of these problems can be treated: pelvic floor muscle exercises for bladder control, and tablets, injections, a vacuum device or an implant for erections [7, 9]. Cancer is not contagious and is not passed to a partner through sex; most men can also have sex during treatment, but check with your doctor first [4, 10].
Key points
- Cancer is not contagious and is not passed to a partner through sex [10]. Talk to your doctor about when you can have sex again and any precautions you need [4].
- Surgery has the biggest effect on erections and bladder control. Urine leakage is common in the first months and gradually improves in most men [1, 9].
- Radiotherapy also weakens erections but has little effect on bladder control; it sometimes makes the bowel sensitive [1, 2].
- Hormone therapy lowers sex drive and makes erections harder, and the longer it is given, the more side effects it causes [5].
- Erection tablets are the first treatment; injections into the penis, vacuum devices and penile implants are also available [7]. If you take a nitrate heart medicine (such as nitroglycerin), do not take erection tablets [11].
- Do not be embarrassed to raise the subject with your doctor; guidelines ask the care team to start this conversation themselves, and counselling, together with your partner, helps [6].
Erectile dysfunction after prostate cancer treatment: how does each treatment affect your sex life?
The prostate lies next to the nerves and blood vessels that make erections possible, and it surrounds the urine tube (urethra). This is why prostate cancer treatment can affect erections, ejaculation and bladder control [3, 4]. The type and severity of these effects depend on the treatment, your age, and how good your erections and bladder control were before treatment [4, 7].
| Treatment | Erections and sex | Bladder control, bowel and other effects |
|---|---|---|
| Surgery (removal of the whole prostate) | The biggest effect; erections improve a little over the following years but usually do not return to how they were [1, 2]. After surgery no semen comes out [7], and the penis may become 1 to 2 centimetres shorter [3] | Urine leakage is common in the first months and gradually improves; in some men some leakage remains for years [1, 2, 9] |
| Radiotherapy (sometimes with a few months of hormone therapy) | The biggest drop is in the first 6 months, then erections improve a little and stay stable [1]; orgasm may happen without semen coming out [4] | Little effect on bladder control; in the first months you may pass urine more often and the bowel becomes more sensitive. Sometimes, years later, there is blood in the stools or leakage from the bowel [1, 2] |
| Hormone therapy | Sex drive and erections are reduced; the longer the treatment, the more side effects [5] | Hot flushes, tiredness, weight gain, loss of muscle, mood swings and weaker bones [5] |
| Regular monitoring (no immediate treatment) | Erections gradually weaken with age [1, 2] | Bladder control also gradually weakens with age [1, 2] |
These are the experiences of most men; each person's situation may be different.
In a large study in the United Kingdom, men with prostate cancer confined to the prostate were randomly assigned to surgery, radiotherapy or regular monitoring, and filled in questionnaires themselves for many years [1]. Before treatment, about 2 in 3 men had erections firm enough for sex. Six months later, the biggest drop was in the surgery group: only about 1 in 10 men had erections firm enough. The drop was slightly smaller in the radiotherapy group and smallest in the monitoring group [1]. By 12 years, erections had weakened in all three groups and the groups had become similar [2].
Anxiety, depression and overall quality of life did not differ between the three groups [1]. So the choice of treatment depends mostly on the type and severity of the cancer and on your own priorities. Read about choosing treatment: Prostate cancer and What does my Gleason score mean?
Erectile problems after prostate surgery: when do erections come back?
In some patients, the surgeon can preserve the nerves that control erections (nerve-sparing surgery); but if the tumour is large or very close to the nerves, this is not possible [3]. Age, the quality of erections before surgery and how well the nerves are preserved are the most important factors for the return of erections [7].
Erections come back slowly. In the UK study, erections improved a little in the first years after surgery, but in most men they did not return to how they were before [1]. The European guideline recommends starting treatment for erections as soon as possible after surgery [7]. But it is still not clear which plan works best: in studies, taking tablets regularly every day from the start was no better than taking them when needed [7, 8].
Treatment for erectile dysfunction after prostate cancer treatment
- 1
Talk to your doctor
Erection problems and lower sex drive are common after cancer treatment, and they can be treated. The American Society of Clinical Oncology guideline asks the care team to ask about sexual health themselves and to offer counselling to all patients [6]. Conditions such as diabetes, high blood pressure and smoking also make erections worse and should be managed [4, 7].
- 2
Erection tablets
Tablets such as sildenafil (Viagra) and tadalafil (Cialis) increase blood flow to the penis and are the first treatment [6, 7]. Sildenafil is usually taken about 1 hour before sex and not more than once a day [11]. If the tablets do not work, ask your doctor how to take them correctly before giving up; taking them the wrong way is the most common reason they do not work [7]. If you take a nitrate heart medicine, these tablets must not be used, because together they can lower blood pressure dangerously [11].
- 3
Injections into the penis, or medicine placed in the urethra
A medicine injected into the side of the penis with a thin needle produces an erection. It is the next treatment for men whom tablets have not helped or who cannot take tablets. One of these medicines (alprostadil) also comes as a cream or a small pellet that is put on the penis or into the urine tube [7]. Your doctor will teach you how to inject.
- 4
Vacuum device (vacuum pump)
A cylinder is placed over the penis, and suction draws blood into it; no medicine is needed [7].
- 5
- 6
Sexual counselling, together with your partner
Counselling and talking therapy, especially together with your partner, help with closeness, body image and satisfaction with your sex life, and work best alongside medical treatment [6, 7]. Even if your desire or ability to have sex is not what it was, closeness and intimacy with your partner still matter [4].
Incontinence after prostatectomy: how long does it last?
Most men who have their prostate removed by surgery have urine leakage for at least a while [9]. In the UK study, almost nobody used pads (absorbent pads for urine) before treatment; 6 months after surgery almost half of the men were using pads, and after 6 years fewer than 2 in 10 [1]. From 7 to 12 years, about 2 in 10 men in the surgery group still needed pads [2].
What helps?
- Pelvic floor muscle exercises: the American Urological Association guideline recommends these exercises, because they can help bladder control come back sooner [9]. These are the muscles you use to hold in urine or wind. Learn the correct way from your doctor or a physiotherapist.
- Drinking enough water and cutting down on things that irritate the bladder, such as caffeine, alcohol and tobacco [12].
- Surgery for incontinence: if urine leakage is still present a year after surgery, or is still severe after 6 months, operations such as an artificial urinary sphincter (a valve that closes the urine tube) or a sling that supports the urine tube can help [9].
After radiotherapy, urine leakage is less common; but in the first weeks you may have burning when passing urine and need to go often, which usually improves a few weeks after treatment ends [1, 12]. Read more: What is radiotherapy, and what are its side effects?
Hormone therapy for prostate cancer: side effects on your sex life
Hormone therapy (such as leuprolide and goserelin injections) lowers the male hormone, because prostate cancer needs it to grow [5]. This usually lowers sex drive and makes erections harder [4, 5]. Its other side effects include hot flushes, tiredness, weight gain, loss of muscle and strength, mood swings, breast growth and weaker bones [5]. The longer hormone therapy is given, the more likely side effects are [5]. In some patients hormone therapy is given with breaks; one possible benefit is fewer side effects during the breaks [5].
For hot flushes, behavioural methods such as slow, calm breathing, and some medicines can help; talk to your doctor [6]. Read about exercise during treatment: Can I exercise during cancer treatment?
Is sex risky for my partner?
No; cancer is not contagious and does not pass from one person to another, including through sex [10]. Most men can also have sex during treatment, but confirm this with your doctor [4]:
- If you are having chemotherapy, small amounts of the drug may be in your semen for a while; your doctor may advise using a condom [4].
- If radioactive seeds have been placed in your prostate (brachytherapy), ask your doctor what precautions you need in the first weeks.
- After surgery no semen comes out, so fathering a child naturally is not possible [7]. If you want to have children in the future, ask about sperm freezing before treatment. Read: Fertility and sex during cancer treatment.
Read more: Is cancer contagious?
When should I call my doctor?
Go to an emergency department straight away or call your local emergency number if:
- you have an erection that has lasted more than 4 hours; if it is not treated quickly, it damages the tissue of the penis [11].
- after taking an erection tablet, your sight suddenly gets worse in one or both eyes; stop the tablets [11].
- you get chest pain during sex; stop, and if you have taken an erection tablet, be sure to tell the medical staff, because nitrate medicines must not be given with it [11].
- you cannot pass urine at all, or you have burning when passing urine together with a temperature of 38 °C or higher, chills or back pain [12].
Talk to your doctor within the next few days if:
Frequently asked questions
When can I have sex after prostate surgery?
Does the penis get smaller after prostate surgery?
Does incontinence get better after prostate surgery?
In most men, yes; urine leakage is worse in the first months and gradually improves during the first year [1, 9]. Pelvic floor muscle exercises can make this improvement faster [9]. If you still have leakage after a year, operations such as an artificial sphincter can help [9]. See the section “Incontinence after prostatectomy: how long does it last?”.
Are erection tablets risky for someone who has had prostate cancer?
These tablets are the first treatment that guidelines recommend for erection problems after cancer treatment [6, 7]. The most important reason not to take them is nitrate heart medicine. If you take an alpha-blocker (for blood pressure or an enlarged prostate, such as doxazosin or tamsulosin), your doctor should start you on a lower dose [11]. Take the tablets only on a doctor's prescription.
Does hormone therapy take away sex drive?
Hormone therapy lowers the male hormone and can reduce sex drive and erections [4, 5]. Talk this through with your doctor and your partner before treatment starts; counselling and treating the side effects help [6]. Read about hormone therapy when the cancer has spread: Treatment of prostate cancer that has spread.
My partner is worried and afraid of having sex; what can we do?
Cancer is not passed on through sex [10]. Talking openly with each other and with your doctor, and couples counselling, help many couples [6]. Read: Anxiety, depression and fear of cancer coming back and A guide for family and carers.
Related pages
ProtecT data and guideline recommendations (for doctors)
For physicians
ProtecT (1643 men; active monitoring, radical prostatectomy, radical radiotherapy with neoadjuvant ADT). Erections firm enough for intercourse were reported by 67% at baseline and fell at 6 months to 52% (monitoring), 22% (radiotherapy) and 12% (prostatectomy); at year 6: 30%, 27% and 17%. Pad use after prostatectomy rose from 1% at baseline to 46% at 6 months (monitoring 4%, radiotherapy 5%), and at year 6 was 17% versus 8% (monitoring) and 4% (radiotherapy). Bloody stools from year 2 onwards were more frequent with radiotherapy (P<0.001). Anxiety, depression and overall quality of life did not differ significantly [1]. From years 7 to 12: pads in 18–24% (prostatectomy), 9–11% (monitoring) and 3–8% (radiotherapy); erections sufficient for intercourse at year 7 in 18%, 30% and 27%, with all three groups converging to low levels by year 12; faecal leakage at year 12 in 12% with radiotherapy versus 6% in the other two groups; nocturia (voiding at least twice per night) in 34% after prostatectomy versus 48% (radiotherapy) and 47% (monitoring) [2].
EAU Sexual and Reproductive Health 2025. PDE5I first line (strong); intracavernous injections as an alternative first line in well-informed patients or as second line (strong); topical/intraurethral alprostadil (weak); vacuum erection device for drug-free management (weak); penile prosthesis if other treatments fail or by patient preference (strong); CBT including the partner (strong). Before active treatment, discuss reduced desire, changes in orgasm, anejaculation, Peyronie's-like disease and penile size changes (strong). Data are inadequate to support any specific penile rehabilitation regimen (weak); start pro-erectile treatment at the earliest opportunity after prostatectomy (weak) [7]. In the Cochrane review (8 trials, 1699 participants), scheduled PDE5I versus placebo gave short-term self-reported potency RR 1.13 (95% CI 0.91–1.41), and daily versus on-demand RR 0.97 (0.62–1.53) in the short term and RR 1.00 (0.60–1.67) in the long term; all very low-quality evidence [8].
AUA/SUFU 2019. PFME can hasten continence recovery; for incontinence persisting one year after surgery, or severe at 6 months, surgical treatment (such as an artificial urinary sphincter) may be chosen [9].
Sildenafil (FDA label). 50 mg as needed about 1 hour before sexual activity (30 minutes to 4 hours), may be increased to 100 mg or decreased to 25 mg, at most once a day. Contraindicated with nitrates and guanylate cyclase stimulators such as riociguat; with an alpha-blocker, start at 25 mg once the patient is stable. Erection lasting more than 4 hours: seek immediate care; sudden loss of vision: stop the drug (NAION) [11].
Related cancer types
Related questions
References
12 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/questions/prostate-cancer-sex-life/