I Can’t Have Sex With My Wife Because of Prostate Cancer. What’s Next for Us?

But there are fixes:

Get wet. A good first step is to start using lube during intercourse. There are a variety of different lubes — water-, silicone- and oil-based. “Through trial and error, find the one that’s best for you. That may be all you need,” says Ana G. Cepin, an ob-gyn at Columbia University Irving Medical Center in New York City.

If you’re also experiencing dryness and burning unrelated to sex, Cepin recommends another over-the-counter product: a moisturizer inserted into the vagina to relieve dryness and itching. “It’s something you can play around with at no risk,” she adds.

Add estrogen. If lube and moisturizers aren’t enough, consider getting a prescription for vaginal estrogen. “The burning and dryness are due to not having enough estrogen in the vagina,” Cepin says. “The best antidote is adding estrogen.”

Vaginal estrogen is safe and well-tolerated, she adds, and unlike systemic hormone replacement therapy, it acts locally and is not absorbed into the bloodstream. One caveat: Some women with hormonally sensitive cancers, like some breast cancers, may not be candidates for vaginal estrogen and should consult their oncologist.

Evelin Dacker, a family physician in Salem, Oregon, who specializes in sexual health, calls vaginal estrogen a “wrinkle cream” for the vagina. She also likes the estrogen ring, which is less messy than the cream and can stay in the vagina for three months. 

And here’s a heads-up: “Taking care of your vaginal tissue is more than just for sex,” according to Dacker. Without estrogen, she says, women are at an increased risk for urinary tract infections, incontinence and, potentially, vaginal pain.

I have prostate cancer and have not been able to have sex with my wife. We used to have a rich sex life. Suggestions? 

After prostate surgery, many men lose the ability to get hard because of injury to the nerves that control erections. For 30 to 40 percent of men, according to urologist Abe Morgentaler, the Blavatnik Faculty Fellow in Health and Longevity at Harvard Medical School, natural erections may return if the nerves were spared during surgery, but it can take one to three years to get hard again.

If you can’t get hard naturally, a variety of treatments can result in an erection even if your nerves were injured or permanently damaged:

• Medicine that the man injects through a tiny needle into the side of the penis that increases blood flow to the penis. “It sounds awful to men, but actually it’s painless,” Morgentaler says. It works more than 80 percent of the time with erections lasting 30 minutes to two hours.
• A vacuum device that causes the penis to fill with blood. Morgentaler says men can start using injections and the vacuum device one to three months following surgery.
• A penile implant that Morgentaler says “looks all the world like a normal erection” with high satisfaction levels for men and their partners. Most urologists will wait at least six months after surgery to place a penile implant.

Morgentaler says it’s also possible for couples to enjoy one another outside of intercourse, adding that nerves injured in surgery do not control sensation or the ability to have an orgasm. 

Radiation for prostate cancer can also affect erections — not immediately but over time, says Morgentaler, author of The Truth About Men and Sex. And some men who’ve been treated with radiation will still respond to meds like Viagra and Cialis.

Urologist Michael Lutz, a partner in the Michigan Institute of Urology, urges men to see a sex therapist or psychological counselor after a prostate cancer diagnosis and postsurgery. 

“Patients have no clue as to what’s on the other side of the treatment coin,” he says. As examples, after surgery, you can no longer ejaculate, and after radiation therapy, ejaculation diminishes. It’s important to treat not just the disease, Lutz says, but the entire patient — including their sexuality.