— Poor sexual function is the most common consequence of prostate cancer treatment, but support through the NHS is patchy and many men suffer in silence.
By Laura Milne
When BBC presenter Gabby Logan and her husband Kenny, the former Scotland rugby union winger, experienced difficulties with their sex life after he had his prostate removed last year, rather than keep it under wraps, they decided to make a podcast about it.
The couple, who have been married for 22 years, discussed their issues in an interview about Kenny’s prostate cancer diagnosis and subsequent erectile dysfunction on Gabby’s podcast The Mid Point.
Kenny, 51, who won 70 international caps representing Scotland, said his wife, 50, had expected the passion in their relationship to be reignited “immediately” after his operation and when he was unable to perform, it knocked his confidence badly.
He said: “When we first tried to have sex after the operation, Gabby said, ‘Oh, it’s not working, that’s it, it’s not working’. You didn’t even give me a chance. What actually happened from that was my confidence went rock bottom.
Gabby and Kenny’s experience is far from unusual. In the UK, prostate cancer is the most commonly diagnosed cancer in men and more than 395,000 were living with it, or had been successfully treated for it, in 2018.
According to the Life After Prostate Cancer Diagnosis (LAPCD) study of 35,000 men in the UK, funded by men’s health charity Movember, poor sexual function is the most common consequence of prostate cancer treatment (79 percent with prostate cancer compared with 48per cent of men in the general population).
Unfortunately, the problem remains one that is either not addressed routinely or at all in prostate cancer care.
The LAPCD study found that 56 per cent of men were not offered any help with sexual dysfunction following their treatment.
Problems with sex can lead to stress, anxiety, anger and even shame.
Some men don’t like to talk about vulnerable feelings because they think they should be “strong and silent”. Others avoid talking because they’re overwhelmed or trying not to burden their partner.
But learning how to face these challenges and work through them can strengthen your sexual wellbeing, explains Dr Karen Robb, Implementation Director for Cancer at Movember. “Sexual wellbeing – the balance between the physical, social and emotional aspects of sex – has not always been a common topic of conversation, but fortunately that is changing,” she says.
“Talking about sex after prostate cancer can be uncomfortable but open communication between you and your partner, if you have one, is a key part of sexual recovery following treatment. Acknowledge what has changed for you so that you can do something about it, with the right support.”
Almost every kind of prostate cancer treatment, including surgery, can cause sexual dysfunction, the most common of which is erectile dysfunction or ED, following a prostatectomy (surgical removal of the prostate).
This means that although you may feel aroused or in the mood for sex, chances are you’ll have difficulty getting an erection.
Why does ED happen after prostate cancer surgery?
“Surgery to remove the prostate affects the nerves and blood supply around the penis,” explains Karen. “The penis needs a healthy blood flow to get an erection. Without this, it won’t become as hard as it did before surgery.”
During surgery, the entire prostate is removed. The nerves that help create erections run down the left and right sides of the prostate gland. The surgeon can usually take out the prostate without causing permanent harm to the nerves on either side.
But if your cancer is too close to the nerves, they may need to be cut out.
How long does ED last after surgery?
It might take some time to improve, and the level of function you get back depends on a number of things including your age, lifestyle, any medications you take and whether you had nerve-sparing surgery.
As Karen explains: “Some things you can work on, such as exercise and keeping a healthy weight.
“Some are a bit more out of your control. However, all are things you can talk about with your doctor and see what recommendations they have that can help.”
What can you do about ED after prostate cancer?
Sex and intimacy after prostate cancer can look different for everyone, but there are options to keep your sex life thriving. Exploring new ways to have sexual pleasure and intimacy is essential after treatment and can even be a way of improving your erections.
There are different types of medication and sexual aids that you can try, all with pros and cons.
Everyone is unique so you may need to try out a few options a number of times and perhaps in combination to settle on the best solution for you. Discuss this with your healthcare provider.
To support men and their partners following prostate cancer treatment, Movember has launched an evidence-based online guide
called Sex and Intimacy After Prostate Cancer.
Informed by sexual health experts, it covers ED, dealing with physical changes after surgery, connecting with a partner, restoring intimacy, and coping with stress and anxiety. It also provides practical strategies, such as exercises, information about medication and devices, and how to have conversations with your doctor or care team.
“It’s vital to talk and not to just ignore it”
Chris Pedlar, 56, took early retirement from the Environment Agency in 2022 after 33 years, and lives with his partner in Devon. Nine years ago, Chris became the third generation in his family to bediagnosed with prostate cancer.
“My grandfather died from prostate cancer and my father was treated for it when he was 60. He went on to live for another 25 years, cancer free. He made sure that I started having PSA tests at 45 and I was picked up as having medium-risk cancer at 48.
“I opted for surgery rather than radiotherapy as I knew I would have the option of additional radiotherapy later on.
“Due to my father’s experience, I knew beforehand what to expect. Although I recovered quickly from the surgery itself, I had some of the usual side effects, including erectile dysfunction and some minor urinary problems, which I’ll have for life. I tried all the usual interventions such as injections, which made me feel terrible, and pumps which, while they serve a purpose, are a huge commitment. It didn’t put me off seeking advice though.
“Sex is an important part of a relationship and just because you’ve had a cancer diagnosis, it doesn’t mean that part of your life is over.
“Cancer can put a massive strain on a relationship – it affects both partners and you need to be able to talk about it honestly with each other. My partner and I have found that humour is the best way to deal with the problems we had, and I was determined from day one, this was not going to get me down.
“Because of the stage my cancer was at when it was discovered, I wasn’t able to have nerve-sparing surgery. That meant drugs like sildenafil (Viagra) shouldn’t have worked for me because of the nerve damage caused by the surgery. Everyone’s situation is different, but I never gave up hope, and after three years I asked my doctor if I could give sildenafil a try to see if it would help in any way, and I was pleasantly surprised to find it worked for me.
“From the beginning, I decided to be very open about my cancer. I recognise that not everyone deals with the experience in the same way. A lot of men bury their heads in the sand and won’t ask for help, even though it is having a negative impact on their lives.
“I was comfortable with talking to my doctor about ED because I wanted to find a solution – but a lot of men are reluctant to even mention it and so they just suffer in silence, which can have a negative effect on their mental health and their relationships.
“We need to work harder to break down those barriers that prevent men from talking about problems seeking help and seeing their GP when they need to.”
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