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Cancer and its treatment
Surgery affects the nerves that produce erections and removes ejaculation entirely; radiotherapy affects erections gradually over months to years; and hormone therapy removes testosterone, which takes desire with it. Which treatment someone had largely determines which effect they get, and the difference is rarely explained clearly enough beforehand.
See someone about this if
Editorial categories, not percentages, and never a prediction about you. Each links to the fuller picture of that change.
Erections that are slower, softer, or do not hold. Because this depends on blood vessels and nerves, it can also be an early signal of something cardiovascular — which is why it is worth a clinical conversation rather than only a product.
Much less fluid, no fluid at all, or ejaculation that goes backwards into the bladder. Alarming the first time it happens and, with some classes, an expected and harmless mechanical effect.
Wanting sex less often, or losing the spontaneous interest that used to arrive on its own. This is the effect people most often assume is psychological and most often is not only psychological.
The body responds less, or much more slowly, even when the interest is there. Blood flow, nerve signalling, and hormone levels all feed this, and medicines can act on any of the three.
Sex stops happening because there is nothing left in the tank by the time there is an opportunity. A real medicine effect, not a motivation problem.
Touch registers less, or feels muted and far away. Reported with several medicine classes and easy to mistake for loss of attraction.
Condition or treatment?
Hormone therapy is the part that removes desire rather than just erection, and it is also the part people are least prepared for — the difference between 'I cannot' and 'I do not want to' is enormous and is worth naming with a partner.
For almost every condition on this site, the condition and the medicines that treat it both affect sex — by different mechanisms, on different timescales, and with different answers. Being able to say which half you are asking about is the single most useful thing you can bring to an appointment, and it is the thing patients are least often given.
Never stop, pause, reduce, or change a prescribed medicine because of anything on this page. Some of the medicines listed here are dangerous to stop suddenly, and the condition being treated does not pause while you experiment. Everything here exists to make your next conversation with a prescriber more specific — not to replace it.
Surgery affects the nerves that produce erections and removes ejaculation entirely; radiotherapy affects erections gradually over months to years; and hormone therapy removes testosterone, which takes desire with it. Which treatment someone had largely determines which effect they get, and the difference is rarely explained clearly enough beforehand.
The effects reported most often are difficulty getting or keeping an erection, a change in ejaculation, lower sexual desire, arousal is slower or harder to reach, and fatigue or sedation getting in the way. Reported does not mean inevitable — the picture varies a great deal between people, and most people have more than one thing contributing at once.
Hormone therapy is the part that removes desire rather than just erection, and it is also the part people are least prepared for — the difference between 'I cannot' and 'I do not want to' is enormous and is worth naming with a partner. Timing is the most useful clue you have: an effect that appeared within weeks of starting or changing a treatment points at the treatment, while one that predates it points at the condition. Never stop, pause, or change a prescribed treatment to find out — take the timeline to the person who prescribed it.
The classes commonly used here that carry documented sexual effects are gnrh analogues, anti-androgen medicines, and cytotoxic chemotherapy. Each has its own profile, so which one you are on matters — and that is a prescribing conversation, never a reason to stop anything.
Penile rehabilitation after surgery is an established programme and is time-sensitive — ask about it early rather than after a year. Approaches that do not depend on erection are the mainstay during hormone therapy and are well described in survivorship care. Bringing a partner to a review appointment changes the conversation more than most people expect.
Sooner than most people do, and specifically without waiting: Sexual rehabilitation is a recognised part of prostate cancer care and is routinely under-offered — asking for it by name is often what unlocks it.
Educational information about what a diagnosed condition tends to do — not a diagnosis, not a way to work out whether you have something, and not advice about your treatment. Conditions on this page overlap, and most people with a long-term condition have more than one thing affecting them at once. Nothing here can examine you or run a test. Pain, bleeding, or a new and unexplained symptom always deserves assessment.