All treatments have side effects, and some of these may be particularly relevant to you as a gay or bisexual man. Depending on the treatment you have, side effects can include:
We have some specific information on these side effects below, as well as more general information about ways to manage them on our living with prostate cancer pages.
You’ll have your own reasons for choosing one treatment over another, including how the possible side effects could affect your lifestyle. For example, if you’re usually the receptive partner in anal sex (bottom) and you’re thinking about having radiotherapy, you might want to find out about how radiotherapy can affect the bowel and the back passage.
Speak to your doctor or nurse about your treatment options and the possible side effects. Consider telling them about your sexuality and lifestyle so they know how treatment and side effects could affect you. This might also help them to support you better. Read more about talking to health professionals about your sexuality.
Sexual side effects
Treatments for prostate cancer can cause sexual side effects. These include:
- how you feel about yourself sexually
- your desire to have sex (libido)
- your ability to get an erection (erectile function)
- not being able to ejaculate and having a dry orgasm
- not being able to orgasm
- urinating or leaking urine when you orgasm (climacturia)
- reduction in penis size
- your sexual satisfaction
- your ability to have children (fertility).
We talk about some of these side effects below, as well as in our information on sex and relationships. You can also check out our online guide on how to manage sexual side effects.
How sexual side effects affect you could depend on your approach to sex, sensuality and intimacy. Not all gay and bisexual men have anal sex – but if you do, then the impact of side effects will depend on whether you’re being the ‘top’ or ‘bottom’ partner.
I now think about sex in a completely different way – I try to approach relationships from a friendship point of view first. I’m more sensual and in many ways I find it more relaxing.
Your experience of sex
Dealing with cancer and side effects of treatment may change the way you have or think about sex. It may also affect how you feel about yourself. Many men find changes to their sex life difficult to deal with. We know from research that gay and bisexual men can find these changes particularly difficult to come to terms with.
When you're being the receptive partner in anal sex (bottom), a lot of the pleasure comes from the penis rubbing against the prostate. This is why the prostate is often referred to as the male g-spot. If you prefer to be the receptive partner during anal sex (bottom), your experience of sex will probably change after you’ve had treatment.
If you have radiotherapy, your prostate may feel less sensitive afterwards. Or if you have surgery to remove your prostate (radical prostatectomy), the prostate will no longer be there to stimulate. You should think about these possible changes when deciding which treatment is best for you.
If you're the receptive partner in anal sex (bottom) and you’ve had permanent seed brachytherapy to treat your prostate cancer, there is a risk that your partner might be exposed to some radiation during sex. Your doctor may suggest you avoid having anal sex in the first six months after having permanent seed brachytherapy. Ask your doctor or radiographer for more information about having anal sex after permanent seed brachytherapy. They might be able to give you specific advice about how long to wait before having sex, which is tailored to you and your treatment.
Even though your sex life may not be the same as it was before cancer, you don't have to give up on having pleasure, closeness or fun. It can help to be realistic but flexible in your approach to sex. It may not be possible to find a quick fix, but you may be able to explore new ways of giving and receiving pleasure.
It’s also important to look after yourself and your body. Try to focus on the things you like about yourself. Do activities or hobbies you are good at or try something new. Being physically active can lift your mood, keep your body in shape and may help your sex life.
If you have a new sexual partner or you’re starting to think about dating, you may worry about explaining sexual problems, such as difficulty getting erections, not being able to ejaculate semen or less desire for sex. Fear of rejection or being worried about what other people think about you is normal and everyone has their own worries, whether or not they’ve had cancer.
Talk about your worries with someone you feel comfortable with and ask for support if you need it. Some men find it helpful to attend a support group, where you can share your experiences and get support from others.
If you’d prefer to talk to someone you don’t know, you could get information and support at a sexual health clinic. They know a lot about sexual issues, and may have ideas that can help. You can also talk to a sex therapist or registered counsellor about sexual problems.
Find out more about prostate cancer, sex and relationships.
Watch Martin’s story, for one gay man’s experience of dealing with the impact of prostate cancer on sex and relationships.
My husband and I ended up enjoying all sorts of things we never did before my prostate surgery. I used to almost always be the active partner during sex, but now he’s more dominant and it’s been lovely.
If you prefer being the penetrative partner during anal sex (top) you normally need a strong erection. You could try using a constriction ring around the base of your penis. Or some men use a vacuum pump to help with their erection problems. If you decide to try a vacuum pump, a health professional will usually show you how to use it properly. They will fit a constriction ring at the same time, to make sure the ring is the right size for you. Our interactive online guide has a video showing you how to use a pump.
A vacuum pump and constriction ring can be used together with another treatment like tablets, to help keep your erection hard enough for anal sex. There are also other treatments for erection problems, such as injections, pellets and cream. There’s not always a quick fix. You often have to stick with them for a while or try different treatments to see what works best for you.
You could also think about other ways to pleasure yourself and your partner, such as oral sex and masturbation by using your mouth and hands. You don’t always need a strong erection for oral sex. Some men may also decide to change their roles during sex if they have erection problems. Talking to a sex therapist or registered counsellor may help you come to terms with these changes and think of ways you can have a fulfilling sex life.
Changes to ejaculation and orgasm
If you have surgery for prostate cancer (radical prostatectomy), you won’t be able to ejaculate semen, but you may still be able to have a dry orgasm. Some men also ejaculate less semen or stop ejaculating completely after radiotherapy. This can be difficult to come to terms with if you feel you need to ejaculate to enjoy sex, or for your partner to think that you’re enjoying sex. It can take some time to adjust to these changes.
Treatments for prostate cancer can cause urinary problems such as leaking urine. For many men this improves over time, but it can be a long-term problem. Urinary problems may affect how you feel about your body and about sex, and can make you worry about having oral sex and masturbating.
If you get any urinary problems, tell your doctor, nurse or radiographer. There are treatments to manage them, as well as things you can do to help yourself. Read more about urinary side effects after prostate cancer treatment, or find tips to help manage urinary problems in our interactive online guide.
Bowel problems and anal sensitivity
If you prefer to be the receptive partner during anal sex (bottom), then bowel problems or sensitivity in the anus after radiotherapy may be an issue.
Your doctor, nurse or radiographer may suggest you avoid having anal sex while you are having radiotherapy. If you have bowel problems or a sensitive anus after radiotherapy, you may want to wait until these have settled before trying anal sex again. Although problems in the back passage may settle down after a few months, there can be some permanent changes.
Here are a few ideas for when you feel ready to try anal sex again. You could try sitting on your partner and moving up and down on his penis so that you have more control of the penetration, and then moving positions if you want to. Try using a condom and extra lubrication. Or ask your partner to gently insert a small, well-lubricated dildo until anal sex becomes more comfortable.
Cleaning yourself before sex can also make you feel more comfortable. Some men prefer to just clean the outside area, rather than cleaning inside. Remember that douching before or after sex doesn’t protect you from infections.
Read more about possible bowel problems after prostate cancer treatment.