https://carlaperna.co.uk/wp-content/uploads/2026/03/Prostate-Cancer-and-Your-Sex-Life-Questions-Every-Man-Should-Feel-Able-to-Ask-Client-Version.mp4When men are first diagnosed with prostate cancer, most of the conversation quite understandably focuses on curing the cancer, how the treatment works, how long it will take, and what the main side effects might be. These discussions often cover urinary symptoms and bowel function, because these are common areas affected by treatment. What is talked about less often – but is just as important for many men – is sexual function and intimacy. Many patients feel too embarrassed to bring this up or worry that it is not a priority when they are facing cancer. In reality, sexual health is a key part of quality of life, and it deserves attention from the very start. At major urological cancer meetings such as ASCO GU, there is now a strong focus on quality of life after treatment, not just on survival rates and scan results. One message that keeps coming through is how little time is often spent talking about sexual function with men treated for prostate cancer. For many patients, sex and intimacy remain a quiet worry in the background, even while they are making big decisions about treatment. Why Sexual Health Should Not Be a Taboo Sexual dysfunction after prostate cancer treatment can include changes in erection quality, loss of libido and difficulties with intimacy. These changes can affect self-esteem, relationships and emotional well-being, even when the cancer itself has been successfully treated. Many men feel too embarrassed to ask about sex, or they assume it is not appropriate …
When men are first diagnosed with prostate cancer, most of the conversation quite understandably focuses on curing the cancer, how the treatment works, how long it will take, and what the main side effects might be. These discussions often cover urinary symptoms and bowel function, because these are common areas affected by treatment. What is talked about less often – but is just as important for many men – is sexual function and intimacy. Many patients feel too embarrassed to bring this up or worry that it is not a priority when they are facing cancer. In reality, sexual health is a key part of quality of life, and it deserves attention from the very start.
At major urological cancer meetings such as ASCO GU, there is now a strong focus on quality of life after treatment, not just on survival rates and scan results. One message that keeps coming through is how little time is often spent talking about sexual function with men treated for prostate cancer. For many patients, sex and intimacy remain a quiet worry in the background, even while they are making big decisions about treatment.
Why Sexual Health Should Not Be a Taboo
Sexual dysfunction after prostate cancer treatment can include changes in erection quality, loss of libido and difficulties with intimacy. These changes can affect self-esteem, relationships and emotional well-being, even when the cancer itself has been successfully treated. Many men feel too embarrassed to ask about sex, or they assume it is not appropriate to talk about when they are facing cancer. Some worry that they are being “selfish” or “vain” for caring about their sex life when their health is at stake. In reality, sexual health is an entirely valid concern and a key part of personalised prostate cancer care.
Every man’s priorities are different. Some will place a very high value on maintaining sexual function, while others may be less concerned. The important thing is that you feel able to say what matters to you, and that your clinical team takes this seriously and builds it into your treatment discussions.
Starting the Conversation About Sex
In the clinic, most men do not raise sexual concerns unless they are invited to do so. They may feel shy, unsure if it is appropriate, or worried about taking up the doctor’s time with something so personal. Experience shows that if the doctor does not ask about sex, most patients will not raise it themselves. This means important fears and expectations remain hidden, and opportunities to protect sexual function can be missed.
Dr Carla Perna makes a point of asking her patients directly whether their sex life is important to them and whether they would like to talk about it. Her approach is to use open questions such as:
- “What about your sexual life?”
- “How important is your sexual life to you?”
- “Is this something you would like to talk about?”
- “Are there worries about sex or intimacy that you would like to discuss?”
Once the topic is opened in a calm, non‑judgemental way, most men feel more relaxed and relieved. It becomes much easier to discuss their worries and expectations, which is essential for building a trusting relationship and planning treatment in a way that also supports long‑term sexual well‑being.
Common Questions Men Want to Ask
Patients often have very direct but unspoken questions, for example:
- “Can I have sex after this treatment?”
- “Will it feel the same as before?”
- “Will I need to take tablets or use a device?”
These are normal, understandable concerns. Addressing them early allows your team to explain likely changes, discuss realistic expectations, and introduce strategies to maintain function wherever possible. Knowing what to ask can also help you feel more in control of your care and more prepared for life after treatment.
Protecting Sexual Function During and After Treatment
Modern prostate cancer treatments can affect erections, libido (desire for sex) and how a man experiences intimacy. However, in many cases, there are practical strategies available to help preserve or restore sexual function.
For many men, a combination of:
- Tablets (such as medications to support erections, when medically suitable)
- A vacuum pump device (also known as a vacuum erection device or penis pump)
can be used as part of a “penile rehabilitation” programme. This is sometimes described as a “penile gym”: gentle, regular exercises for the penis to keep the blood flow and tissues healthy while the body is recovering from treatment. Even if libido is reduced because of treatment, these measures can help maintain function so that, when you feel ready to resume sexual activity, your body is better prepared.
What Is Penile Rehabilitation?
Penile rehabilitation is a proactive approach designed to:
- Maintain blood flow to the penis
- Protect the muscle and tissue structure
- Reduce the risk of long‑term erectile problems and penile shortening
This may involve regular use of tablets, a vacuum pump, or other treatments recommended by your specialist team. The aim is not just to treat erectile dysfunction once it happens, but to protect sexual function from as early as possible. For men receiving radiotherapy – often combined with hormone therapy – this is particularly important. Hormone therapy can reduce libido, so you may feel you do not “need” erections during treatment. However, if erections are lost for a long period, it can become harder to regain function later.
To prevent this, Dr Perna often recommends what she calls a “penis gym” for patients undergoing radiotherapy. Regular use of a vacuum pump to increase blood flow and keep tissues healthy, combined with erection medication when appropriate, aims to maintain what you currently have so that function is still there waiting when treatment is over and libido returns. It is about prevention and preservation, not just treating problems after they appear.
Personalising Treatment Around What Matters to You
Ultimately, personalised prostate cancer care is about more than choosing the right scan or the right treatment schedule. It is about understanding who you are, what matters most in your daily life, and how treatment will affect that – including your sex life. By encouraging open conversations about sex in the clinic, doctors can:
- Understand each patient’s expectations and concerns
- Offer realistic information about side effects
- Suggest practical steps to protect sexual function where possible
If you are living with prostate cancer, it is completely appropriate to talk about your sex life with your oncology team, even if you feel embarrassed or unsure where to start. Your sexual well‑being is an important part of who you are, and there are often ways to help protect or improve it during and after treatment. Dr Carla Perna encourages her patients to raise any questions they may have about intimacy, erections or libido, either alone or together with their partner. With the right guidance and early support, many men are able to complete their treatment and still enjoy a satisfying sex life in the future.
