Prostate cancer and your sex life

Transcription

1 Prostate cancer and your sex life

2 2 Prostate cancer and your sex life About this booklet This booklet is for men who want to know how prostate cancer and its treatment can affect your sex life, how you feel about yourself and any relationships you have. It takes you through the sexual side effects you may experience and the treatment and support that is available. This booklet is for all men with prostate cancer, whether you are single or in a relationship. We hope it will be useful for you whether you are heterosexual, gay, bisexual or transgender. If you are a partner of a man with prostate cancer you may also find this booklet useful. We have listed sources of information and support at the end of this booklet. Each hospital will do things slightly differently so use this booklet as a general guide and ask your doctor or nurse for more details about the care you will receive. You can also speak to our Specialist Nurses by calling our confidential helpline. The following symbols appear throughout the booklet to guide you to sources of further information: Prostate Cancer UK Specialist Nurse helpline Prostate Cancer UK publications If you would like to know more about anything you read in this booklet, you can call our Specialist Nurses on our confidential helpline. The quotes with the photos are not the words of the people who appear.

3 Specialist Nurses prostatecanceruk.org 3 Personal stories At the back of this booklet is a DVD featuring six personal stories of men dealing with changes to their sex life during and after treatment for prostate cancer. The stories include men talking about their experiences of sexual problems after surgery, radiotherapy and during hormone therapy. The men have tried a variety of treatments for erection problems like injections, vacuum pumps and pellets. They all have different ways of dealing with the impact of these changes on their lives and relationships. This symbol appears throughout the booklet to guide you to different men s stories on the DVD. The photos in this booklet are of people personally affected by prostate cancer. The quotes with the photos are not the words of the people who appear.

4 4 Prostate cancer and your sex life

5 Specialist Nurses prostatecanceruk.org 5 Contents About this booklet How will prostate cancer affect my sex life? Focus on what to expect at an ED clinic Problems getting an erection Focus on keeping your penis active after surgery Treatments for erection problems Your desire for sex (libido) Changes in penis size Changes to ejaculation and orgasm Fertility Your thoughts and feelings Sex and your relationships Focus on sex therapy Gay and bisexual men Sex when you re single Support for partners More information from us Other useful organisations About Prostate Cancer UK Prostate cancer and my sex life: Personal stories DVD

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7 Specialist Nurses prostatecanceruk.org 7 How will prostate cancer affect my sex life? Sex is an important part of life for most of us. Dealing with a diagnosis of prostate cancer and living with the side effects of treatment can have an impact on your sex life. Many men with prostate cancer say that changes to their sex lives and relationships are some of the biggest issues they have to deal with. Feeling sexual depends on how well your sexual organs, like your penis, are working. And whether other parts of the body are helping them work this includes your blood supply, nerves, brain and hormones. The way your body responds sexually also depends on your thoughts and feelings about yourself and others. You don t think you re ever going to have an erection again, you don t think you re going to be a man again really. That s the thing that worries you about the erectile side of it. However, when you get these injections and you stand there and you think it works without being crude, it s a fantastic feeling. A personal experience

8 8 Prostate cancer and your sex life Prostate cancer can affect your sex life in three overlapping ways your mind, body and relationships. Body Treatment can damage the nerves and blood vessels needed for erections. Hormone therapy reduces testosterone levels, which can affect your desire for sex. Relationships Coping with cancer can change the dynamics of your close relationships, or your thoughts about starting one. Mind The diagnosis of cancer can make you feel down or anxious, changing your feelings about sex.

9 Specialist Nurses prostatecanceruk.org 9 Having treatment for prostate cancer can affect: how you feel about yourself sexually your desire to have sex (libido) your ability to get an erection (erectile function) your ability to ejaculate and have an orgasm your sexual satisfaction your fertility the appearance of your body your relationships. But there are treatments and support that can provide some answers and ways for you to work through any problems. Penetrative sex and masturbation Many men want to know is there sex after prostate cancer treatment? Whether you can have sex or masturbate after treatment will depend on a number of things, including what type of treatment you have had, how you are feeling, and whether you already have sexual problems. This varies from man to man some men will have temporary problems with their erections, while others may never totally get back their erections without the help of treatment. Many men with prostate cancer will have sexual problems before treatment. It is normal for our sex lives to slow down as we get older and problems with erections are more common in older men. But that doesn t mean you have to put up with them. The following table is a basic guide to the type of problems you may have. For more detailed information about these treatments and their effect on sex and masturbation read our Tool Kit fact sheets.

10 Your treatment When can I have sex or masturbate? Surgery (radical prostatectomy) Surgery to remove the whole prostate gland and seminal vesicles Avoid having sex for the first six to eight weeks after open surgery Masturbation and night time erections are safe during this time With keyhole surgery you can have sex if you feel like it once your catheter is removed Radiotherapy (external beam radiotherapy) Radiotherapy using high energy X-ray beams directed at the prostate gland from outside the body As soon as you feel like it, some doctors recommend using contraception for a while after treatment find out more on page 45 If you receive anal sex wait until any bowel problems or sensitivity in this area has gone What problems might I experience? Erection problems this varies depending on whether the surgeon can spare the nerves that control erections Erections can gradually improve but not all men regain erections Your penis may become shorter No ejaculation, but you can still orgasm (dry orgasm) Infertility Erection problems can gradually develop after treatment Produce less or no semen Painful ejaculation Fertility problems

11 Your treatment When can I have sex or masturbate? Brachytherapy A type of internal radiotherapy for treating localised prostate cancer using radioactive seeds As soon as you feel like it It is rare for men to pass any implanted seeds when they ejaculate but, as a precaution, you should use a condom during sex for the first two months after treatment See page 45 for information about changes to sperm and fertility Temporary brachytherapy (also know as high dose rate brachytherapy) Internal radiotherapy is inserted into the prostate gland for a few minutes at a time No radioactive material is left in the prostate so it is safe to have sex when you feel like it See page 45 for information about changes to sperm and fertility What problems might I experience? Erection problems Ejaculating less semen Fertility problems Erection problems may gradually get worse over several years Less fluid in ejaculation or no ejaculation (can still orgasm) Fertility problems

12 Your treatment When can I have sex or masturbate? High intensity focused ultrasound (HIFU) A treatment that uses high frequency ultrasound waves to heat and destroy cancer cells You can have sex or masturbate if you feel like it once the catheter is removed Cryotherapy A treatment that uses freezing and thawing to kill the cancer cells in the prostate gland You can have sex or masturbate if you feel like it once the catheter is removed What problems might I experience? Erection problems Ejaculate less semen (can still orgasm) Fertility problems Erection problems

13 Your treatment When can I have sex or masturbate? Hormone therapy Hormone therapy controls prostate cancer by stopping testosterone reaching the prostate cancer cells. It can be given by injection, implants or tablets. Some men have surgery to remove part or all of the testicles (orchidectomy) You can have sex or masturbate whilst on hormone therapy injections or tablets After orchidectomy avoid strenuous sex for two weeks See page 39 for more information about hormone therapy and sexual function What problems might I experience? Erection problems Reduced desire for sex Changes to penis shape and size Changes to orgasm Other changes to your body weight gain, breast swelling and tenderness, hot flushes

14 14 Prostate cancer and your sex life Some common worries It is not possible to pass on cancer through sex. Having sex will not affect your prostate cancer or the success of your treatment. Erections are still safe if you have a catheter in. Getting treatment and support There are treatments and support available for sexual problems. Speak to your GP or doctor or nurse at the hospital to find out more. They can refer you to a specialist service such as an erectile dysfunction (ED) clinic. Men with prostate cancer can get free medical treatment for problems with erections or other sexual problems on the NHS. Your GP or doctor or nurse at the hospital can prescribe treatment if you want help getting erections for masturbation or sex. There is no age limit for receiving treatment but there may be a limit on how much your GP can prescribe. If you are receiving treatment from your GP and you would like treatment more regularly or treatment has not worked, go back and let your GP know. They may review your treatment or refer you to a specialist.

15 Specialist Nurses prostatecanceruk.org 15 Talking about sex It can be tricky talking about sex, but talking to your doctor or nurse will mean you can get treatment and support, and can make you feel better and more in control. The doctor or nurse treating you for prostate cancer should let you know about the side effects of treatment, including the impact on your sex life. They should ask you about your erections and sex life before, during and after treatment for prostate cancer. But, if they do not raise the subject of sex you can do this yourself, especially if you are having any sexual problems, worries or questions.

16 16 Prostate cancer and your sex life Questions to ask your doctor or nurse: How could my treatment for prostate cancer affect my sex life? How soon after prostate cancer treatment can I masturbate or have sex again? What are the treatments for erection problems and which will be best for me? What happens if the treatment does not work? Are there other treatments I can have? What treatments can I get from my local NHS?

17 Specialist Nurses prostatecanceruk.org 17 What other support is available to me? Can my partner also get support? Add your own questions here:

18 18 Prostate cancer and your sex life Focus on what to expect at an ED clinic If you have been referred to see an ED (erectile dysfunction) clinic or specialist you might see one or all of the health professionals listed on the next page. The health professionals you see will be familiar with talking about sexual problems and should put you at ease. What happens at the appointment will vary, but you will normally have a chat about your sexual function, your concerns and any other issues such as how you are feeling generally. If you have a partner, you can ask them to go with you to the appointment. The doctor or nurse may check your penis and testicles. This will be done in a private room or curtained area. You may have your blood pressure and heart rate checked, if you haven t had them measured in the past three to six months. If you have problems getting an erection, you will be able to find out more about the available treatments. The doctor or nurse may also give you a test dose of one of the treatments (see page 27 for more information) to see whether it works. Again, this will be done in a private room or curtained area.

19 Specialist Nurses prostatecanceruk.org 19 What health professionals might I see? Urologist A doctor who specialises in the urinary and reproductive systems. Urologists are also surgeons. Clinical nurse specialist (urology) A nurse who has specialist knowledge of diagnosing and treating people with prostate or bladder problems. They may also have specialist knowledge of diagnosing and treating people with erection or sexual difficulties. As well as medical treatment they can also often offer information, advice and support. Andrologist Andrologists are doctors who deal with the male reproductive system, including fertility and problems with the penis, testicles or hormones. Sex therapist Sex (or psychosexual) therapists or counsellors usually have a background in medicine, nursing or psychological therapy. They will also have had special training in the causes and treatment of sexual problems. They offer counselling and advice about sexual issues. See page 57 for more information.

20 Dealing with erection problems calls for a willingness to keep an open mind, patience and some resourcefulness. But the positive results make that so very worthwhile. A personal experience

21 Specialist Nurses prostatecanceruk.org 21 Problems getting an erection You may hear this called erectile dysfunction (ED) or impotence. This means having difficulty getting or keeping an erection, and is more likely to happen as men get older. It can have many possible causes, including treatment for prostate cancer. For detailed information on the risks of erection problems after each type of prostate cancer treatment, read our Tool Kit fact sheets. Causes of erection problems When you are sexually aroused your brain sends signals to the nerves in your penis. The nerves increase the blood flow to your penis, and fill the spongy tissues, making it stiff and giving you an erection. Anything that interferes with your nerves, blood supply, or your sexual desire (libido) can make it difficult to get or keep an erection. Treatment for prostate cancer Some treatments for prostate cancer can damage the nerves and blood vessels that are needed for an erection. Treatments that can have this effect include surgery, external beam radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) and cryotherapy. All types of hormone therapy can cause erection problems because hormone therapy can reduce your desire for sex. Other health problems Other health problems can affect your erections, including high blood pressure, diabetes, heart disease, high cholesterol, neurological conditions, other prostate problems and penis problems.

22 22 Prostate cancer and your sex life Hormone problems like low testosterone can also cause problems with erections and desire. Older men may have problems with erections or reduced desire for sex because of low testosterone levels in their body. See page 37. Other medicines A number of medicines are linked to erection problems. These include medicines for high blood pressure, high cholesterol levels, depression and anxiety, ulcers, irregular heart beat and epilepsy. If you are taking any of these drugs, do not stop taking them, but talk to your doctor or nurse about whether they may be contributing to your difficulties. Depression and anxiety Feeling low or anxious can affect your erections, because many of the physical parts of how we react sexually are influenced by how we think and feel. Getting treatment for erection problems Speak to your doctor or a nurse. They will be able to discuss possible treatments with you or make an appointment for you to see a specialist. Treatments Many of the treatments for erection problems work by improving the flow of blood to the penis. The treatments are: tablets injections pellets vacuum pump surgical implant sex therapy (see page 57).

23 Specialist Nurses prostatecanceruk.org 23 Because getting an erection also relies on your thoughts and feelings, a combined approach to erection problems often works well. Try getting some medical treatment as well as tackling any worries or relationship issues you may have. There are lots of ways to do this, so pick what works best for you. It may be talking to someone close to you, seeing your nurse or getting some counselling or sex therapy. See page 47 for more information. What is the best treatment? There is not enough evidence to say whether one treatment for erection problems is better than another in men who have had treatment for prostate cancer. The effectiveness of each treatment varies. Younger men, men who are in good overall health and men who had good erections before they had treatment for prostate cancer may be more likely to find treatment successful. But even if you don t fit into these categories, treatment may work for you. Will the treatments work if I am on hormone therapy? All types of hormone therapy may reduce your desire for sex, so treatments that only work when you have desire, such as PDE5 inhibitor tablets (see page 27) are unlikely to work. But injections, pellets, vacuum pumps and surgical implants will be able to give you an erection as they do not need you to have sexual desire to work. The treatment for erection problems you choose will depend on your own preferences. You can try one treatment but, if you find this doesn t work for you, remember that there are other options.

24 24 Prostate cancer and your sex life Stick with it Treatments for erection problems are not always a quick fix, and you often have to stick with them for a while or try different treatments to see what works best for you. Research shows that men who tried more treatments for erection problems were more likely to find one that worked. If you have had surgery then your erections may improve over time as your nerves heal. So if treatments do not work at first, it is worth giving them a try again in a few months. I tried different tablets, with no effect other than giving me headaches and a red face. I then tried the injection, which worked intermittently at first but after persevering, it now works very well every time. A personal experience. Fitting treatments into your sex life Some of the treatments for erection problems can seem artificial and you may feel like you lose the moment. With a little understanding and patience, you can overcome some of the embarrassments and difficulties. Some couples even find that they use the preparation for treatment, such as the vacuum pumps or pellets, as part of their foreplay.

25 Specialist Nurses prostatecanceruk.org 25 Your partner could come with you to any appointments and, if possible, try to use treatments with your partner in the room. It may be helpful if they know how they work. See page 52 for more information about sex and relationships. Sex therapy may help you work through changes to your sex life. Some treatments are not suitable for men with a condition called Peyronie s disease or with sickle cell trait, because they can cause a persistent and painful erection, known as a priapism. Ask your specialist team for advice if you have these conditions. Watch Paul s story Find out about trying different treatments for erection problems.

26 26 Prostate cancer and your sex life Focus on keeping your penis active after surgery Although you may not be ready or recovered enough for sex, you can still start treatment for erection problems during the weeks and months immediately after surgery. It could be a low daily dose of medication or using a vacuum pump, or sometimes both together. The idea behind this is that medication or treatment alongside masturbation encourages blood flow to the penis and makes sure that the tissue you need for erections is kept healthy. You may hear this called penile rehabilitation. You could think of it in the same way as having physiotherapy if you had injured your arm or leg. Although some research shows that starting treatment early may be beneficial for erections, we need more research to say how effective early treatment is and it may not work for every man. My nurse encouraged me to take the tablets and to masturbate even if my penis was soft, he said I shouldn t give up as it was keeping my penis active. I found that masturbating in the shower was best as I was more relaxed. A personal experience.

27 Specialist Nurses prostatecanceruk.org 27 Treatments for erection problems Tablets (PDE5 inhibitors) A group of medicines called phosphodiesterase type 5 (PDE5) inhibitors can help men get erections. These drugs are called: sildenafil (Viagra ) tadalafil (Cialis ) vardenafil (Levitra ). How well do they work? The success rate of these drugs varies. There has not been any research comparing the effectiveness of the different types of PDE5 tablets in men who have had treatment for prostate cancer, so we cannot say if one drug is better than another. How do they work? These tablets don t cause spontaneous erections, they only work if you are sexually stimulated. This means when something turns you on or arouses you, such as when you have sexual contact with your partner or sexual thoughts. They normally take 30 minutes to an hour before they start to work. If you take Viagra and Levitra it will be active in the body for around four hours and you will be able to get an erection with sexual stimulation within that time. Cialis will be active for about 36 hours, so you will have a longer window of time to have sex. The dose of drugs you have will vary. Some men start with a low dose of the drugs, but you can go up to a higher dose, depending on whether the drug works. If the maximum dose of one drug does not work, one of the other drugs may work better for you. Other men, particularly those who have had surgery (radical prostatectomy) will start on the highest dose and may gradually reduce it.

28 28 Prostate cancer and your sex life Don t give up Try each tablet at least eight times before deciding how effective it is or changing to a different one. If you have a partner, it may also take a while to get the timing right. Some of these tablets may not work as well after a big meal, particularly one that contains a lot of fatty foods. Read the patient information leaflet that comes with your tablets for more information. Cialis (tadalafil) also comes in a one-a-day version. You might prefer to take a tablet once a day if you want to have sex often or if you and your partner prefer spontaneous rather than pre-planned sex. Side effects All PDE5 inhibitors can cause some side effects including: headaches indigestion a flushed face itchiness or swelling in your nose (rhinitis) back pain. These side effects are usually mild and do not last long.

29 Specialist Nurses prostatecanceruk.org 29 You should not take PDE5 tablets if you are taking a group of heart drugs called nitrates. Nitrates are usually used to treat heart problems. If you have a heart problem or are using nitrates, discuss ways to treat your erection problems with your GP or specialist. There are other drugs that you should not take PDE5 tablets with, such as alpha blockers. Check the patient information leaflet that you get with the drugs or ask your doctor or nurse. Buying medicine on the internet Only use medicines for erection problems that have been prescribed to you by a health professional, such as your GP or doctor. Buying medicine on the internet is dangerous as the medicines can be fake and could contain ingredients that may be harmful or react with other medications you are taking. Herbal medicine Herbal medicines for erection problems, like herbal Viagra that you can buy in Chinese herbal medicines stores, can also be unsafe. Speak to your GP or a health professional before taking any herbal medication for erections.

30 30 Prostate cancer and your sex life Injections Erection problems can also be treated with a drug called alprostadil (Caverject, Caverject Dual Chamber or Viridal Duo ) injected into your penis. Spongy tissue of penis Very fine needle Injection Plunger The idea of an injection may sound alarming but many men find it is not that bad and doesn t hurt. The first time you use the drug a nurse or doctor in clinic will show you how to inject it into your your penis with a very fine needle. They will make sure you are happy giving the injection yourself before you go home. How well does it work? If you are shown how to use them properly then injections can be a successful way of treating erection problems.

31 Specialist Nurses prostatecanceruk.org 31 How does it work? The injection causes the penis to fill with blood, and you will get an erection within around 15 minutes. The erection will normally last for 30 to 40 minutes. You need to be able to see you penis to use the injection so if you have sight problems, have a big belly or have a retracted penis it may not be suitable for you. Also if you have difficulties with your hands it may be harder to use the injection. Your doctor or nurse will discuss other options with you. Side effects Some men find their penis aches for a few hours afterwards. If you have any other problems, tell your doctor or nurse. Occasionally your erection may stay beyond a comfortable length of time. This is called a priapism which is rare and affects less than one in 100 men (one per cent). If your erection does not go away, try having sex, masturbating or having a cold shower. Some doctors advise squatting or walking up and down the stairs. If the erection hasn t gone away after four hours you should go to your local hospital accident and emergency (A&E) department straight away for treatment. Getting the injection technique right is important and may need some experimentation. A personal experience

32 32 Prostate cancer and your sex life Pellets The drug, alprostadil, is also available as a small pellet, called MUSE. Applicator stem Applicator Opening or eye of penis Applicator stem Applicator Pellet Urethra How well does it work? It is not as effective as using the injections, but may be a good alternative if you do not like the idea of an injection.

33 Specialist Nurses prostatecanceruk.org 33 How does it work? You use a disposable applicator to insert the pellet into the opening or eye of the penis. It helps if your urethra (the tube you pass urine through) is already moist. So before you use MUSE, urinate and gently shake your penis several times to remove excess urine. You or your partner can then massage or stimulate your penis and help melt the pellet. If the pellet works, you should get an erection within 15 minutes, which will last between 30 and 60 minutes. Injections or pellets can be used by men who have little or no sexual desire (libido), but they work better when you have some sexual interest and stimulation. Side effects MUSE can cause some pain in the penis or testicles and dizziness in some men.

34 34 Prostate cancer and your sex life Vacuum pump This treatment for erection problems involves a pump and tube that creates a vacuum in order to make blood flow into your penis. Pump Penis Rubber ring stays on the penis Plastic cylinder How well does it work? The vacuum pump can be an effective way to get an erection. Satisfaction with the pump varies from man to man, but men who get on well with it often use it long-term. How does it work? The pump is made up of a plastic cylinder that you put your penis into and a pump that you operate by hand or battery. The pump creates a vacuum inside the tube and this makes blood flow into your penis to make it erect. You then slip a rubber ring onto the base of your penis. This stops most of the blood escaping once you remove the vacuum pump. You should only wear the ring for a maximum of 30 minutes at a time. It can take a bit of practice to get used to but some men prefer this option because it avoids using drugs and there s no limit to how often you can use it.

35 Specialist Nurses prostatecanceruk.org 35 Your nurse or doctor will show you how it works. You may also be given an instruction DVD to take home. Some men find that because the base of their penis is still soft, it moves around and can be difficult to have sex at first. You or your partner may need to guide the penis in. This can take some practice. Side effects Your penis may feel slightly cooler than usual when using a vacuum pump and the skin may look darker. I find it helps to shave the hairs around my penis before I use my vacuum pump. This makes it easier to use the ring at the base of my penis. A personal experience

36 36 Prostate cancer and your sex life Implants This involves having an operation to insert an implant into your penis. An inflatable implant Fluid Implant Pump in scrotum Implant when inflated How well do they work? Most men who have an implant tend to be satisfied with it. How do they work? You will need to have surgery to insert the implant. There are two main types of implants. The first type uses semi-rigid rods that keep the penis fairly firm all the time but allow it to be bent down when you don t want an erection. The second type is an inflatable implant in the penis, and a pump placed in your scrotum. When you squeeze the pump the implant fills with fluid (saline) which makes penis hard. Your erection will last for as long as the implant is inflated.

37 Specialist Nurses prostatecanceruk.org 37 Side effects The two main things that can go wrong are an infection or if the implant stops working. Around two out of 100 men (two per cent) who have this surgery get an infection which means the implant has to be taken out. With the inflatable implant, five out of 100 men (five per cent) may need further surgery after five years because the implant has stopped working. The semi-rigid implant is less likely to need replacing. Testosterone replacement therapy If you have had treatment for prostate cancer that was contained within the prostate (localised), and you have erection problems caused by low testosterone levels, then you may be able to have testosterone replacement therapy. It works by increasing the lower level of testosterone in your body to a normal level. It may improve your orgasms, ejaculation and erections and it may make some drugs for erection problems (PDE5 inhibitors) work more effectively. Some research has shown that it is safe for men who have had successful treatment for localised prostate cancer to have testosterone therapy. If your doctor or nurse advises you to have testosterone replacement therapy ask them about the risks and benefits. If you do decide to have testosterone replacement therapy you will have regular prostate specific antigen (PSA) blood tests and digital rectal examinations to check for any signs of your cancer returning.

38 38 Prostate cancer and your sex life Self-management Lifestyle choices Being a healthy weight and being physically active may be beneficial if you have erection problems. Follow a low fat diet and do regular physical activity to lose weight gradually and healthily. You can read more about eating a healthy diet in our fact sheet, Diet, physical activity and prostate cancer. Smoking may increase the risk of erection problems, and treatments may not work as well if you are a smoker. The charity QUIT and NHS Choices have information and advice about giving up smoking. Some research shows that pelvic floor muscle exercises may improve the quality of a man s erection. For more information about how to do these, read our fact sheet, Pelvic floor muscle exercises.

39 Specialist Nurses prostatecanceruk.org 39 Your desire for sex (libido) Prostate cancer and its treatment can affect your desire for sex. If you do not feel interested in sex then let your partner know and, if possible, explain why and how you feel as they may feel rejected. Try and talk about other ways you can be intimate together, whether sexually or not. There is more information about this on page 52. Hormone therapy Hormone therapy for prostate cancer will change your sex drive and may mean you have much less interest in sex. This is because of the decrease in testosterone, which is the hormone responsible for giving you your sex drive. You could ask your doctor or nurse about the option of intermittent hormone therapy. Desire for sex should return to normal after hormone treatment is stopped, but it can take up to a year. Read our booklet, Living with hormone therapy: A guide for men with prostate cancer for more information about the side effects of hormone therapy. If having sex is an important part of who you are, important in your relationship, or important to your partner, then you can still try treatment even if your sex drive is reduced. Some of the treatments for erection problems may still work for you. See page 23. Watch Bruce s story Find out how he dealt with changes to his sex drive.

40 40 Prostate cancer and your sex life What else can affect your sex drive? Testosterone is not the only factor that can affect your sex drive. Your thoughts and feelings Some men with prostate cancer describe feeling that they have lost their self-esteem and confidence, particularly about their masculinity. If you are feeling depressed or anxious then you may be less interested in sex. If you are feeling like this then get some support, it may help improve your sex life. Read more about dealing with the changes to how you feel on page 47. Tiredness All treatments for prostate cancer can cause tiredness (fatigue). This can be during and after treatment. If you are feeling very tired this can affect your sex life, you may lose interest in sex, or not have enough energy for it. Try sex in a different position, where you do not have to move around much. You may also prefer to have sexual contact for just a few minutes at a time and take breaks. Just holding hands or hugging are some ways to stay close, when you don t feel like full sex. See page 52 for more details about sex and relationships. Other side effects Other physical side effects such as urinary, bowel problems and physical changes after hormone therapy, such as putting on weight, or breast swelling may make you feel embarrassed and less interested in sex. Let your partner know about any side effects you are having, and speak to your doctor or nurse if you need help managing side effects.

41 Specialist Nurses prostatecanceruk.org 41 Changes in penis size Some men find that their penis gets shorter after surgery (radical prostatectomy). This happens because of changes to the tissue inside the penis. Men may be less likely to experience these changes if the surgeon has been able to save the nerves that control erections during surgery (nerve sparing surgery). Other types of prostate cancer treatment such as radiotherapy and hormone therapy may also cause changes to the size of your penis. Some studies have shown that encouraging blood flow to the penis after surgery may improve erections and prevent your penis becoming smaller. In particular using a vacuum pump after surgery may stretch the tissue and help maintain your penis size. Changes to your body and your penis can feel difficult to deal with. Read about what support is available to you on page 48. My penis has shrunk and my orgasms are much less intense. I have a loving and understanding partner, so it hasn t been a problem. A personal experience

42 42 Prostate cancer and your sex life Changes to ejaculation and orgasm If you have had surgery you will not be able to ejaculate afterwards. This is because the prostate gland and seminal vesicles, which store and transport semen, are removed during the operation. Instead, you may have what is called a dry orgasm where you feel the sensation of orgasm but do not release any semen from your penis. This may feel different to the orgasms you were used to. Occasionally, some men will find that a small amount of liquid comes out from the tip of the penis during orgasm, which may be fluid from glands lining the urethra. If you have had radiotherapy, brachytherapy, high intensity focused ultrasound (HIFU) or hormone therapy, you may notice that you produce less semen during and after treatment and it may have a bit of blood in it (haematospermia). You will still have feeling in your penis and you should still be able to have an orgasm, but you may find that it feels different to before treatment. Some men have also found that they have less intense orgasms while they are having hormone therapy. Retrograde ejaculation You may experience retrograde ejaculation if you have had surgery called TURP (transurethral resection of the prostate) to remove prostate tissue that is pressing on the tube which you pass urine through (urethra). Retrograde ejaculation is when you orgasm and the semen does not come out straight away, but is passed out of the body the next time you pass urine. It is not harmful and should not affect your enjoyment of sex but it may feel quite different to the orgasms you are used to.

43 Specialist Nurses prostatecanceruk.org 43 Ejaculating quickly Some men find that they do not last as long during sex and reach orgasm more quickly. If you are experiencing this you could try to reduce your sensitivity by wearing a condom, or varying positions. Leaking urine If you have had a radical prostatectomy you may leak a small amount of urine when you orgasm. This is called climacturia. Although it could be a shock at first, urine is germ-free and safe. If it does bother you, you could try: going for a pee before you have sex wearing a condom having sex in the shower having sex on a towel, or keeping towels or tissues nearby. Tip After going for pee before sex, wait a few seconds and then use your fingertips to press gently behind the scrotum. Move your fingers forward towards the base of the penis under the scrotum and keep pressing gently. This should push the urine further along the urethra. You can then shake the last few drops out in the normal way. If leaking urine is still bothering you, your doctor or nurse can give you further advice. Some men also find that pelvic floor muscle exercises help. Read more about this and about managing urinary problems in our fact sheets Urinary problems after prostate cancer treatment and Pelvic floor muscle exercises. Watch Colin s story Find out about how he dealt with this side effect.

44 44 Prostate cancer and your sex life Short term pain A small number of men who have had radical prostatectomy or brachytherapy experience pain in their penis and the surrounding areas when they orgasm. For some men this lasts less than a minute, for others it can last longer. Some men who have had radiotherapy find that the tube they pass urine and semen through (urethra) is inflamed and ejaculation is uncomfortable. The pain usually improves over time. Let your doctor or nurse know about the pain, especially if the pain does not get better. You may have some scarring or a blockage in your urethra that needs treatment.

45 Specialist Nurses prostatecanceruk.org 45 Fertility Prostate cancer treatment can affect your ability to produce sperm or ejaculate and can lead to infertility. This is because the prostate gland and seminal vesicles, which produce some of the fluid in semen, are removed during surgery. The cells that make semen can also be damaged during other treatments such as radiotherapy. Brachytherapy may have less of an effect on fertility than other treatments for prostate cancer but we still need more research into this. You may notice that you produce less fluid when you ejaculate, but it is possible that you are still fertile. You might be able to store some sperm before treatment so that they can be used later to fertilise an egg. This is called IVF (in vitro fertilisation). There is no age limit to storing your sperm for your own use. Sperm banking is usually available on the NHS. But this is not always the case, so you may need to pay for sperm storage and possibly for infertility treatment. Ask your specialist team about what fertility treatment is available locally. Changes to your sperm during radiotherapy, brachytherapy and chemotherapy could affect any children you may conceive during this time, but the risk of this happening is very low. You may wish to avoid fathering a child before treatment and for a while after having treatment, by using a condom or other form of contraception. If you are planning to have children, you should seek further information from your GP or specialist team. If you have a partner, talk to them about your plans for having children and what this would involve. Macmillan Cancer Support and The Infertility Network UK produce more detailed information on fertility.

46 My side effects lasted for a while, and I found that I went through good and not so good emotions. A personal experience

47 Specialist Nurses prostatecanceruk.org 47 Your thoughts and feelings If your ability to get erections and your experience of sex has changed then this can have a big impact on you. Sex and masturbation may be an extremely important part of your life and a way to be close to your partner, if you have one. Masturbation and sex may be a way of having fun, relaxing, coping with difficult times, or boosting self esteem and happiness. Changes to, or loss of, your erections or sex life can make you feel unsatisfied, angry and as if you have lost a part of yourself. But there are ways to tackle these issues and find solutions that work for you. Feeling down or worried Changes to your sexual function such as problems with erections and sex drive, do not just affect your sex life, they can affect how you feel. Everyone is different, but sexual side effects after prostate cancer treatment may make you feel less satisfied with life. Some men get anxiety and depression. If you have prostate cancer it is not unusual to feel worried or down and you may need to deal with these feelings before you can address any sexual issues. If you are finding it difficult to cope, speak to your GP or specialist team. If you need to speak to someone immediately, you could ring the Samaritans on Your identity Treatment for prostate cancer and side effects, like problems with erections may change how you feel about yourself. If getting erections, masturbating and having sex was a big part of who you were before you had prostate cancer then these changes might be harder to cope with.

48 48 Prostate cancer and your sex life Your body Changes to your body after operations or treatments like hormone therapy or radiotherapy can make you feel different about yourself. Some men say these changes to their body make them feel old and unmanly or that they have lost a part of their identity. Self-management Try and go easy on yourself Are you putting too much pressure on yourself? It can take time to come to terms with being diagnosed with prostate cancer, having treatment and dealing with the side effects particular sexual ones. If you are having problems with sex then getting some advice or support as soon as possible may stop any difficult feelings becoming overwhelming. Look after yourself and your body Focus on the things you like about yourself, do some 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 with erection problems. Making changes to your diet can help with losing weight and keeping healthy. Read our Tool Kit fact sheet, Diet, physical activity and prostate cancer for more information. Getting support If you are stressed or down about changes to your sexual function, getting some support may improve how you feel. Some men prefer to cope on their own. This works for certain people, but getting things off your chest can also help. There are lots of different ways to get support.

49 Specialist Nurses prostatecanceruk.org 49 Remember that other men with and without prostate cancer also experience sexual difficulties, you are not alone. Talking to other men who have had the same experiences can be useful. Peer support service Our peer support service offers individuals confronted with prostate cancer the opportunity to talk with a trained support volunteer. Many people find talking with someone who has been in a similar situation helpful. Our volunteers listen to concerns and share their own personal experience to support others in a similar situation. They can talk about erection problems, the impact of prostate cancer on relationships and sex life, and loss of desire. Peer support can be offered to men diagnosed with prostate cancer and their partners, friends and family. To access the peer support service call our Specialist Nurses on our confidential Helpline. Find a support group Get in touch with your local prostate cancer support group. Support groups can be a good way for you to meet people with similar experiences. These groups are often set up by local health professionals, or by people who have experience of prostate cancer. Meetings are usually informal and offer an opportunity to find out about other people s experiences as well as discussing your own thoughts and concerns. Many support groups also welcome partners, friends and relatives.

50 50 Prostate cancer and your sex life Join the Prostate Cancer UK online community If you have access to the internet, sign up to our online community, where members share their experiences of prostate cancer. It is a place where men and those close to them can openly: seek and offer support ask questions share information share personal stories and experiences of prostate cancer. It is very simple to join. Registration is free and only takes a few minutes. Visit our website at prostatecanceruk.org to sign up to the online community and to find a list of support groups in the UK. Or call our confidential helpline to speak to our Specialist Nurses about support groups and the online community. Counselling Counsellors are trained to listen and work with you to understand your feelings and find your own answers. Your GP can refer you to a counsellor or you can see a private counsellor. To find out more, contact the British Association for Counselling and Psychotherapy. Specialist nurses If you have questions about any of the issues described in this booklet you can speak to our Specialist Nurses on our confidential helpline. Some people feel embarrassed about discussing personal issues over the phone, and you can also send a query to the Specialist Nurses by using our contact form at prostatecanceruk.org Other organisations such as the Sexual Advice Association and the College of Sexual and Relationship Therapists can also help.

51 You might well have some jolly good sex afterwards, I would never have believed them. And yet it happens. Now that is something that I wish someone had told me way back. A personal experience

52 52 Prostate cancer and your sex life Sex and your relationships If you have a partner, then coping with cancer and side effects may have changed your relationship and the way you have sex. You may experience some or all of the following: Your normal pattern of having sex can change. Some couples will stop having sex completely or avoid any kind of closeness because they are worried that it will lead to expectations of penetrative sex. Dealing with the practicalities of cancer sometimes means relationships can change from romantic or sexual, to more like a close friendship, or patient and carer. You ll probably be facing other changes in your relationship such as changing priorities and plans for your life together. On the other hand, some couples find that dealing with cancer is a journey of discovery and may re-ignite their relationship and bring them closer together. Even though your sex life is unlikely to be the same as it was before cancer, you don t have to give up on having pleasure, closeness or fun together. It can help to try being realistic but flexible in your approach to sex. You may not find a quick fix, but keeping some kind of physical closeness alive, in whatever ways possible, can protect or even improve your relationship. Watch Ally s story To find out about communicating as a couple.

53 Specialist Nurses prostatecanceruk.org 53 Practical tips Try the medical treatments If you are having problems with erections then try the different medical treatments for erection problems, or other sexual difficulties. See page 27. These treatments will work for some men but not for everyone. You may need to stick with a treatment for a while before you see results. But if one treatment does not work for you, then speak to your doctor or nurse about trying another type or treatments in combination. Also, if you have had surgery, then your erections may get better over time, so if treatment doesn t work straight away, you could try it again at a later date. Don t be put off by other people s negative experiences everyone is different. Yes we still have sex, but in different ways and with a little bit of medical intervention. A personal experience Communicate If you have a partner, talking about sex, your thoughts and feelings will help you both deal with any changes. Try not to guess how your partner feels about things guesses can often be wrong. It is not always easy to talk about sex and relationships, even if you have been together for a long time. But communication can bring you even closer together and make you feel more confident about facing changes and challenges. If you are finding talking

54 54 Prostate cancer and your sex life difficult you could see a relationship counsellor. The charity Relate provides relationship counselling and a range of other relationship support services. A sex therapist can also help you communicate about sex (see page 57). It is life-changing. You are going to have to make changes and your partner is going to have to make changes. A personal experience Stay close Try different (non-sexual) ways of being close. This could be as simple as holding hands or going out and trying new activities. Some couples try and have a date night every few weeks. Some men say that they just miss having a hug with their partner keeping this going can keep you close. You need to have time alone together whatever your situation. If you are in a hospital, hospice or have carers coming to your house, make sure they know when you need private time. Watch Kevin s story Find out how he accepted changes to his sex life.

55 Specialist Nurses prostatecanceruk.org 55 Maybe we don t want to have sex, maybe we want to go and have a curry. Maybe we want to go to the pictures. Maybe we just want to lie on the bed and cuddle. A personal experience Focus on pleasure not erections Take the spotlight off performance. Remember having sex is not just about having erections or penetrative sex. Men can have orgasms without having an erection or ejaculating and some men get pleasure from pleasuring their partner. Find a space to be together that is warm and comfortable, and take some time to be physically close. Try some mutual massage sessions. You could start with massage that avoids the sexual parts of the body and then add some genital touching later or at another time. Take things slowly and later add in a session when you spend more time touching each others genitals which may lead to orgasm. If men relax and use all the senses, they can have an orgasm with a soft (flaccid) penis. Have fun and experiment There s no one way to have sex or experience sexual pleasure but people can get stuck in sexual habits. Think of this as an opportunity to revitalise your sex life.

56 56 Prostate cancer and your sex life Sex is more than just penetration. You could try alternatives such as massage, mutual masturbation, oral sex, vibrators and dildos, watching erotic films or reading erotic books. You can buy lubricants and vibrators in pharmacies and chemists. You can also buy them online and from high street lingerie and sex shops. But try making changes gradually. Start off with holding hands or kissing, if you don t normally do this and move on to new sexual activities when you feel comfortable. Our love-making has improved in ways that are very fulfilling, despite lack of penetration. A personal experience Get some advice If you have questions or concerns about sex speak to your doctor, nurse or other health professional as soon as possible. Some couples need more than just medical treatment for erection problems and you can get specialist advice and counselling. Sex therapy Sex therapy (also sometimes called psychosexual therapy or sexual counselling) is available on the NHS or privately. You can often refer yourself to a private counsellor, but for NHS services you will usually need a referral from your GP or other health professional. Check that any sex therapist you see is registered with the College of Sexual and Relationship Therapists or a general counselling accreditation organisation like British Association of Counselling and Psychotherapy.

57 Specialist Nurses prostatecanceruk.org 57 Focus on sex therapy Sex (or psychosexual) therapists or counsellors, usually have a background in medicine, nursing or psychological therapy. As well as this they will also have had special training in the causes and treatment of sexual problems. Sex therapy normally involves a series of counselling sessions and if you have a partner it is best for them to be involved as well. The first appointments will focus on the therapist getting to know you and finding out about what is going on in your sex life. If you are in a couple you may also have separate appointments as well. At the end of the these first sessions, the therapist will give you some brief information and advice and talk to you about whether further therapy might be useful. They may refer you for couples counselling, or other psychological services or treatment. If you have further sex therapy it will often involve more discussion of sexual problems and specific activities and ways to work through them. You might have homework, such as a series of exercises for you and your partner to get more in tune with your senses (often called sensate focus exercises), ways to communicate more effectively, or experimenting with different ways of being intimate. Sometimes just having someone listen to how you are feeling helps you find your own answers. There are some myths about sex therapy you will never be asked to undress or do anything sexual in the therapy room.

58 I really started to push myself to explore other possibilities. And what I found was actually there are other people out there, other gay men, who actually want sensuality and not just sex. A personal experience

59 Specialist Nurses prostatecanceruk.org 59 Gay and bisexual men Prostate cancer affects gay and bisexual men in many of the same ways as heterosexual men, but there can be some other separate issues too. Not all gay or bisexual men have anal sex, but if you do give anal sex you may need a harder penis than for vaginal sex. You could try using a constriction ring around your penis, together with another treatment like PDE5 tablets, to help keep your erection hard enough for anal sex. You can buy constriction rings online or from most sex shops. If you receive anal sex, then bowel problems after radiotherapy may be a particular issue. Some men also find that the skin inside their anus is more sensitive. If you are experiencing bowel problems or sensitivity in this area then wait until these side effects have subsided before trying vigorous anal play or sex. Talk to your doctor or nurse for further advice. Try using a condom and extra lubrication once the sensitivity settles down. Cleaning yourself before sex can make you feel more comfortable. There is more information about managing bowel problems in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues. Some men who receive anal sex find that if they have had surgery to remove their prostate then their experience of sex changes. As with all sexual changes, you may be able to find ways to work through this and find new ways of giving and receiving pleasure.

60 60 Prostate cancer and your sex life Talking to health professionals Some men may not want to tell their doctor or nurse about their sexuality. Or find that their doctor or nurse assumes that they are heterosexual. Letting your doctor or nurse know about your sexuality can be useful, particularly if you have specific issues you want to talk about. Seeing a counsellor or a sex therapist may help if you find it difficult to talk to the nurse or doctor at the hospital about specific sexual issues. See page 56 for more information. Watch Martin s story For one gay man s experience. All of Prostate Cancer UK s services are open to everyone, whether you are gay, bisexual, transgender, heterosexual, single or in a relationship. You may also want to talk to gay and bisexual organisations such as Health with Pride, LLGS switchboard or Stonewall. Sex when you re single Being sexually active and feeling attractive can be just as important if you are a single man. Remember all of the treatments and tips that have been described here are available to you if you are single whether you want to be able to masturbate, because you are single but sexually active, or want to start a new relationship. If you are starting a new relationship, sexual problems and other side effects like urinary or bowel problems could be a worry. Some men worry that having problems with erections will affect their chances of having a new relationship in the first place. Fear of rejection is natural, and everyone has their own hang-ups whether they have had cancer or not. If you are single, you may want time

61 Specialist Nurses prostatecanceruk.org 61 to come to terms with any changes prostate cancer has caused for you, before you start having sex or dating. Try talking over your worries with someone you feel comfortable with, such as a friend. Counselling or sex therapy may also help if you would prefer to talk to someone you don t know. If you re not in a relationship but are sexually active, want to start dating or start a new relationship then these tips may help. Be upfront Pick the right moment to talk about sexual problems wait until you feel comfortable with the person and trust them. Pick a situation where you are both relaxed and have privacy, Take your time You may not want to try full sex with a new partner straight away, especially if you have problems with erections. You could hold off for a while and concentrate on getting to know each other. Rejection can happen, but many people will accept sexual differences and some will not think penetrative sex is the be-all and end-all of a relationship.

62 62 Prostate cancer and your sex life Support for partners If you are a partner of a man with prostate cancer then it is likely that you will also be affected by changes to your relationship and sex life. Some partners feel very distressed and may go on to develop anxiety and depression. You may go through: worries about the future, about what will happen if your relationship breaks down or your partner passes away changes to how you feel about yourself if your partner has a low sex drive this might make you feel less desirable or attractive feeling frustrated or unsatisfied if your sex drive is higher than your partner or you are having less sexual contact anger or sadness at the loss of the old ways of being together guilt for still having sexual feelings. Your own desire for sex may change after your partner s diagnosis and during treatment. For example, if you are feeling anxious, you may have less interest in sex. If your roles have changed in the relationship, this might also affect how you feel about sex. You may be dealing with your own health problems or sexual problems. Some men may distance themselves from close relationships because they feel uncomfortable with changes to their bodies and erections, because they have reduced sex drive or because they feel under pressure to perform sexually. But this does not mean that they no longer care for you. If your partner is using any treatment for problems with erections such as tablets, injections or pumps then finding out more about them and how to use them can make it easier to incorporate them into your sex life. Read more on page 24.

63 Specialist Nurses prostatecanceruk.org 63 You can explore the suggestions about sex and relationships in this booklet and get some information and advice together if you need it for example sex therapy or relationship counselling. See page 57. Many partners don t talk about their own feelings because they want to protect their loved one. But it is also important to get some support for yourself, perhaps without your partner. Talking to other partners who are experiencing the same thing or getting some counselling may improve things. The Sexual Advice Association has further information written for partners. Talking about sex can be difficult, even for a couple who have known each other for a long time. If you or your partner are finding it difficult to approach the issue of sex, you may find it helps to see a sex therapist. We ve just developed a really honest, open relationship where we can talk to each other about absolutely anything; it s made us appreciate each other a little bit more as well. Because at the end of the day we re not all going to be around forever so it just makes you really appreciate that what we ve got is good. A personal experience

64 64 Prostate cancer and your sex life More information from us The Tool Kit The Tool Kit information pack contains fact sheets that explain how prostate cancer is diagnosed, how it is treated and how it may affect your lifestyle. Each treatment fact sheet also includes a list of suggested questions to ask your doctor. Leaflets and booklets Other leaflets and booklets about prostate cancer can be ordered free of charge from Prostate Cancer UK. To order publications: Call us on Visit our website prostatecanceruk.org Call our Specialist Nurses If you want to talk about prostate cancer or other prostate problems, call our Specialist Nurses in confidence. You can also the nurses using the contact form on our website. Visit prostatecanceruk.org and click on We can help. Speak to our Specialist Nurses * prostatecanceruk.org * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK.

65 Specialist Nurses prostatecanceruk.org 65 Other useful organisations British Association of Counselling & Psychotherapy (BACP) BACP will help you find qualified counsellors. They are happy to discuss any queries or concerns you have about choosing a counsellor or the counselling process. College of Sex and Relationship Therapists Information on sexual and relationship therapy, including a list of therapists. Health with Pride An online resource for lesbian, gay and bisexual patients. This website has information on cancer issues and erection problems for gay men. Infertility Network UK Advice line: Support, information or advice on fertility or infertility. LLGS Helpline: (10am - 11pm daily) Free and confidential support and information for lesbian, gay, bisexual and transgendered communities throughout the UK.

66 66 Prostate cancer and your sex life Macmillan Cancer Support Freephone: (9am - 8pm, Mon - Fri) Practical, financial and emotional support for people with cancer, their family and friends. Macmillan also has further information on sex, relationships and cancer. NHS Choices Provides information to support you in making decisions about your own health, including an A-Z of treatments and conditions, and information on NHS health services in your local area. QUIT QUITLINE: UK charity that helps smokers to stop, they have a helpline and community programmes. Relate Telephone: Relate provide relationship counselling and sex therapy and a range of other relationship support services. Samaritans Helpline Provides confidential non-judgemental emotional support, 24 hours a day, by telephone, , letter, or face to face.

67 Specialist Nurses prostatecanceruk.org 67 Sexual Advice Association Helpline: Detailed information on treatments for erection problems. Stonewall Info Line: (Mon - Fri, pm) Stonewall runs a free info service for anyone looking for details about gay rights.

68 68 Prostate cancer and your sex life About Prostate Cancer UK Prostate Cancer UK fights to help more men survive prostate cancer and enjoy a better life. We support men by providing vital information and services. We find answers by funding research into causes and treatments and we lead change, raising the profile of the disease and improving care. We believe that men deserve better. At Prostate Cancer UK, we take great care to provide up-to-date, unbiased and accurate facts about prostate cancer. We hope these will add to the medical advice you have had and help you to make decisions. Our services are not intended to replace advice from your doctor. References to sources of information used in the production of this booklet are available at prostatecanceruk.org This publication was written and edited by: Prostate Cancer UK s Information Team. It was reviewed by: Jane Booker, Macmillan Urology Clinical Nurse Specialist, The Christie NHS Foundation Trust, Manchester Lorraine Grover, Nurse Psychosexual Therapist, The London Clinic, London Paul Hegarty, Consultant Urologic Surgeon, Guy s & St Thomas NHS Foundation Trust, London Sarah Hughes, Urology Nurse Specialist, Port Talbot Hospital, Wales Sue Lennon, Macmillan Urology Nurse Specialist and Psychosexual Therapist, Harrogate and District NHS Trust Dr David Ralph, Consultant Uroandrologist, The Institute of Urology, London

69 Specialist Nurses prostatecanceruk.org 69 Dr Isabel White, Psychosexual Therapist, The Royal Marsden NHS Foundation Trust, London Prostate Cancer UK Specialist Nurses Prostate Cancer UK Volunteers Donate today help others like you Did you find this information useful? Would you like to help others in your situation access the facts they need? Every year, 40,000 men face a prostate cancer diagnosis. Thanks to our generous supporters, we offer information free to all who need it. If you would like to help us continue this service, please consider making a donation. Your gift could fund the following services: 10 could buy a Tool Kit a set of fact sheets, tailored to the needs of each man with vital information on diagnosis, treatment and lifestyle. 25 could give a man diagnosed with prostate cancer unlimited time to talk over treatment options with one of our specialist nurses. To make a donation of any amount, please call us on , visit prostatecanceruk.org/donations or text PROSTATE to 70004*. There are many other ways to support us. For more details please visit prostatecanceruk.org/get-involved *You can donate up to 10 via SMS and we will receive 100% of your donation. Texts are charged at your standard rate. For full terms and conditions and more information, please visit prostatecanceruk.org/terms

70 70 Prostate cancer and your sex life Prostate cancer and my sex life Personal stories This DVD features six personal stories of men dealing with changes to their sex life during and after treatment for prostate cancer. Colin, 52 Colin talks about how he and his wife have dealt with changes to their sex life after surgery (radical prostatectomy) and his experience of using a vacuum pump and injections to help get erections. Bruce, 51 Bruce explains how radiotherapy and hormone therapy has affected his sex life, what he has done to deal with this and how he has overcome these challenges and started a new relationship. Ally, 62 Ally stayed close to his wife, even though their sex life has changed whilst having radiotherapy and hormone therapy. Paul, 64 Paul had surgery and tried different treatments for erection problems, including a vacuum pump. Kevin, 56 Kevin had surgery, radiotherapy and is on hormone therapy. He talks about the challenge of accepting the changes in his sex life.

71 Specialist Nurses prostatecanceruk.org 71 Martin, 58 Martin had surgery, radiotherapy and hormone therapy which meant he couldn t get an erection and lost his desire for sex. He tried different treatments for erections and changed his approach to sex discovering his more sensuous side. DISCLAIMER: These films feature men s personal prostate cancer stories. Everyone s experiences will be different. The films are not intended to provide medical information.

72 Speak to our Specialist Nurses * prostatecanceruk.org Prostate Cancer UK December 2012 To be reviewed December 2014 Call our Specialist Nurses from Mon to Fri 9am - 6pm, Wed 10am - 8pm * Calls are recorded for training purposes only. Confidentiality is maintained between callers and Prostate Cancer UK. Prostate Cancer UK is a registered charity in England and Wales ( ) and in Scotland (SC039332). Registered company number SEX/OCT13