A-Z

Penile Cancer

Sex and relationships

The impact of penile cancer on a man’s sex life will vary considerably depending on the stage at which the cancer was diagnosed, the extent of the treatment and also how active the man is sexually. It is important to emphasise that a diagnosis of penile cancer does not necessarily mean the end of a sex life.
 
If a man is in a relationship, it can be a great help for him to talk to his partner about his feelings and concerns about sex. In some relationships, where sex is not openly discussed, this can be difficult. Even where a couple has previously been able to talk about sex easily, this new factor may make the conversation uncomfortable for one or both partners. Some men may find it helpful to discuss their concerns about sex in the company of a specialist nurse or counsellor.
 
Treatment of the penile cancer is likely to raise many questions, fears and anxieties for both a man and, if he has one, his partner. Some men we interviewed felt that after surgery to remove part of all of their penis, they could no longer satisfy their partner; for Simon, who had had a total penectomy, this was the worst part of the experience; he said he felt sorry for his wife because he was no longer able to have sex.
 

John Z has had a total penectomy and finds it difficult to respond when his wife shows affection; they no longer sleep together.

John Z has had a total penectomy and finds it difficult to respond when his wife shows affection; they no longer sleep together.

Age at interview: 68
Sex: Male
Age at diagnosis: 64
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And how about in terms of your relationships? Maybe your relationship with your wife, has there been any effect on that?

Yes I think she’s more of a cuddly person and because I can’t perform any acts now I seem to push her away. So in that respect yes, I’m more…I should say colder than I should be really. But I get no satisfaction so... and as I say we’re getting older so... but she’s still a loving person and she wants it returned and I think she understands most of the time but sometimes she gets to the point where yeah she would like to have a cuddle but no we try to minimise that by sleeping [chuckles] in separate rooms so it doesn’t come to any. I think there’d be more arguments if we slept together than being in separate rooms.
 

There are many ways to satisfy partners without engaging in penetrative sex. With time, most couples affected by penile cancer can have fulfilling sex lives. Massage, oral sex and sexual aids, such as vibrators, can provide pleasure for couples. Sex therapists can also provide men, and their partners with advice on how to achieve arousal without the need for full intercourse.
 
Speaking to partners about concerns and anxieties about sex can be a source of great comfort, and many of the men we spoke to who were in relationships talked about their partners being understanding of the changes that had occurred. Whilst Big D expressed concern about the impact of his treatment on his partner, he said his partner was very considerate and tried to ease his concerns. Some men said that their relationship with their wife or partner had actually become closer as a result of their cancer.
 

Big D was advised not to attempt to have sex for a few months after surgery but he says he has a...

Big D was advised not to attempt to have sex for a few months after surgery but he says he has a...

Age at interview: 61
Sex: Male
Age at diagnosis: 60
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Well, obviously it affects your sex life. the doctor did say that I probably wouldn’t have any other sex life for at least 12 months or thereabouts, he did say there would be a period, or a period where he advised you not to try [chuckles] and have a sex life. And yes it has affected that side of it over a period of time but I have a very understanding partner and she tries to put me at ease that way. That’s the only thing I worry about, not being able to satisfy my partner.

For some men who had part of their penis removed (see ‘Types of surger for penile cancer’), their treatments left them with difficulty in achieving an erection. In some, but not all cases, sensation and function can return after a period of time. Sometimes using drugs such as Viagra can help this problem. The swelling of the penis that follows surgery to the lymph nodes in the groin also makes sex difficult (see ‘Lymphoedema and the impact of lymph node removal’). Tom was concerned that after the swelling had reduced he didn’t have any feeling in his penis and he was unable to achieve an erection. After about a year, his penis began regaining normal function. Jordan had difficulty with sex before his operation about a year ago and has been able to have sex once since; whilst it has not been easy, his wife has been very understanding and he is hopeful of improvement.
 

After his penis began to heal up, Tom was not able to obtain an erection and he tried Viagra. A...

After his penis began to heal up, Tom was not able to obtain an erection and he tried Viagra. A...

Age at interview: 71
Sex: Male
Age at diagnosis: 69
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So, gradually the scarring started to heal up. I was a little concerned that, that sort of the, when I say originally that the bodily functions took place, yes, I’d no problem passing water but, a month after when the swelling had disappeared there didn’t seem to be any feeling in my penis at all, it didn’t seem to react if you like, there was no signs of an erection there was nothing that would sort of move it if you like, and this did cause some concern. We made lots of jokes about it and we did all sorts of things and after a, a period of I think it was about six, eight weeks, I did actually phone up the hospital and they said, ‘This is quite normal, that you know you have had major surgery you know. The nerve endings will be, sort of everything will be affected and don’t worry too much about it.’

So then saying that but you do think about it. I’m not a worrier and I didn’t really worry too much but it was, it was a thought in your mind in that ‘will it ever function in that direction again?’ Sex had played a reasonable part in my life up to that point and whilst I can, I can’t say that it’s twice nightly at my age, it isn’t, but on the other hand it, it did play a part and it obviously wasn’t playing the part and eventually I went to my own GP and I said, ‘I’m not functioning in that direction’ and he looked a bit astounded at me that I ought to be even thinking I should be but he did then prescribe the equivalent of Viagra or whatever it was that might help the situation, but unfortunately I couldn’t have them on the National Health so the, we worked it out, I think there was the cost that we were paying was about 15 pounds apiece or something like that so it was - it took some of the urgency out of it, but I did get some, I did try it and we had lots of laughs about it and it did seem to work a little bit. But I think there was only four in the actual packet that we got and to my knowledge we still have actually got some at this moment in time, nearly a year later whereby it started to function normal again and it was probably a bit unnecessary and me being more inpatient than anything else.
 

For many men, and their partners, sex will be different after they have been treated for penile cancer, however, sex can still be enjoyable for men and their partners. About two months after his operation, Tim and his wife began to cautiously engage in sexual activity. Whilst neither Tim nor his wife found sex as satisfying as it had been before surgery, with some imagination they were still able to enjoy fulfilling sex. Jim also talked about how he and his partner adapted to the changes that occurred and how his sex life has been quite satisfactory as a result.
 

Tim and his wife have got used to intercourse not being as satisfying and with a bit of...

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Tim and his wife have got used to intercourse not being as satisfying and with a bit of...

Age at interview: 54
Sex: Male
Age at diagnosis: 53
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And then there’s the sexual side, which we’ve, my wife and I, have both got used to that, the actual intercourse not being as satisfying as it was for either of us, but with a bit of imagination you can make up in other ways, that you don’t expect that bit to be the main part of the sex act. And I think we still have fulfilling sex, and I think, my wife said actually the first time we tried it after the operation, she said, ‘Oh it’s like being a teenager again’ [chuckles]. So, yeah it can have its plus sides.

How long was it after the operation that you were able to engage in sexual activity?

I’m trying to think, it was about the beginning of December. Well I came out of the hospital certainly I found that I wanted to stay – I had the bed to myself for, until after Christmas, for about a month or so, because I was finding it was still very painful; it was quite disturbing at night and... So I didn’t obviously then, and you kind of, yes so it was probably about six weeks to two months before we had, we managed some kind of sex, non-penetrative at that point; and then probably another month after that before we managed what now counts for penetrative sex if you like and it was, it’s and it was very nervous, we were very cautious about it for a while after that. So, probably now coming up to a year afterwards that we’ve, we’re much more relaxed and able to cope with it.
 

 

Jim says he is fortunate to have a very good partner. He is still able to have sex after his...

Jim says he is fortunate to have a very good partner. He is still able to have sex after his...

Age at interview: 60
Sex: Male
Age at diagnosis: 58
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Has there been any impact on your sex life?

I’m very fortunate that I have got a very good partner. And everything is accommodated. We’re…we seem to be quite satisfactory and… there doesn’t seem to be any real issues there. In fact there aren’t any issues as such. Obviously the penis is shorter. But you know you… human beings can... adjust and amend and this is quite... quite amazing actually. It’s been surprising. Quite illuminating and we’re happy on that front.

Are you able to obtain an erection? As you were before?


Yes. Yes. Yes indeed. Shorter but definitely yes. And to add to that it’s thicker than before. So I think really the fact that it’s not as long maybe the pressure has now pushed it out rather along the length. And as a results it’s become thicker.
 

Some men said that they felt ‘less of a man’ after their surgery. However, the majority of the men interviewed who had had surgery, no matter how invasive, did not feel this way. Most men felt that there was more to being a man than simply having a penis.
Most men were still able to experience sexual pleasure in some form. David’s operation hasn’t impacted on his sense of masculinity and he is able to have a relatively normal sex life.
 

Interview 21 was told by his surgeon that he could carry on having sex after the operation. It was approximately two months after the operation before he had sex.

Interview 21 was told by his surgeon that he could carry on having sex after the operation. It was approximately two months after the operation before he had sex.

Age at interview: 74
Sex: Male
Age at diagnosis: 73
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So you’re still enjoying sex after the operation?

Yes. I’m having a sex. I ask my nurse could you please ask the surgeon, how long I [name] sex, he said, there are no problems you can have, enjoy your sex life. Then there is a professor who look after my penis, he gives me treatment right. I ask him again, I said “Mr [name] Do I have to perform sex [name]. He said, “No, you carry on, you can do what you want to do, that’s all.

So how long was it after the operation before you engaged in sex? How long did you have to wait?

A couple of months I think, two months, eight weeks, nine weeks. Something like that. When there was a rule? And here was stitches, I didn’t think about it. After everything’s clear and early in the morning when it’s erect you feel some, some sort of, these kinds of things you see. So then I went to the hospital, I asked surgeon they say you can enjoy your sex life, no problem.
 

 

Despite having had a total penectomy, Mark still feels like he can get an erection. Although that...

Despite having had a total penectomy, Mark still feels like he can get an erection. Although that...

Age at interview: 48
Sex: Male
Age at diagnosis: 46
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I found that I feel like I can still get an erection. The muscles or whatever it is at the back, I still feel like I can... I can get a erection. Obviously I can’t because I haven’t got a penis but… sometime after the operation I actually… I had to phone my surgeon’s understudy and explain as best I could what had happened the previous night. So I was watching something on TV which were a little bit close to the knuckle and I ejaculated. And I thought I’ve done myself irreparable damage here because I don’t know the mechanics of what they’ve had to do to be able to enable me to wee sat down, I don’t understand. And… for all intents and purposes it was exactly the same as any man’s ejaculation. The same feelings, the same build up. I phoned and I said, ‘Is this normal?’. She said, ‘That is fantastic news, absolutely fantastic news. Because that means’ she said ’we were going to leave it with you but we were rather hoping that you were going to make progress and this was going to happen to you. This is just another stage that you were going to encounter’. And she said, ‘You will be able to, Mark’ and she tried to explain what they’d done and I didn’t really understand what they’d done. But she said you will still be able to. It’s not the same, it’s not... it’s a liquid, it’s not the sperm that I would before the operation have ejaculated, it’s not like that. But it’s an ejaculation none the less and that is…that’s a good sign. That’s a good sign. And it does make you feel better. It does make you feel better. It sounds really silly but that’s another step forward towards being… because… I still like women.

Women are lovely. I love, I love women. But right now I can’t... I don’t feel... I don’t feel a full man. There’s no… I can’t get romantically involved. I can’t. But it was nice to feel... have that feeling because I don’t mind telling you that it brought a lot of good memories back for me and it made me feel good. It made me feel good in as much that that was another... another step forward. Albeit small one, it was another step forward. And that’s all that I want to continue making. Little steps, not going to go backwards. Just little ones forward all the time.
 

The majority of men we spoke to were treated with surgery, however some men received radiotherapy, usually in combination with other treatments. Radiotherapy can in some cases result in difficulty achieving an erection (See Cancer Research UK for more details). However, most men who receive radiotherapy are able to have sex afterwards. Some of the men we spoke to who had received radiotherapy told us that they were able to continue their relationships and engage in sexual activity during and after treatment.
 

John talks about continuing his relationship through his radiotherapy treatment. He says it is...

John talks about continuing his relationship through his radiotherapy treatment. He says it is...

Age at interview: 58
Sex: Male
Age at diagnosis: 44
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Meanwhile I have to say that through all of this, talking about moulds and penises and everything is that it’s important to remember that I had a loving relationship, I had a lover all the way through who I’m still great friends with although we’re no longer lovers, but she. We were continuing our relationship, physical relationship, and I found that really helpful and that’s a whole other area. I think it’s good for people to talk about the things I talk to people about and I’m interested in this question of not being isolated by the fact that you’ve got cancer or any sort of illness really. I mean, now, I mean I look, you know, I look ok but it can be frightening if I take my clothes off after all the treatment I’ve had, all the radiotherapy, chemotherapy, surgery and everything. So that’s an important thing for me.

The significance of sex for a man can differ considerably between individuals; relationship status, age and life stage are all likely to have a bearing on the role that sex plays in a man’s life. A diagnosis of cancer can also affect how a man (and his partner) views sex and the level of importance which he attaches to it.
Several men felt as though, in the context of their wider lives and current circumstances, sex was not something which was of the utmost importance to them. Some men were currently single or divorced, others were widowed, and others felt that as an older man sex was not as significant to them as it would be to a younger man. Frank (Interview 3) had a healthy sex life before his cancer and as someone now in his 70s he feels it was the best time in his life to have cancer.
 

Frosty and his wife find sex a little more difficult now but he feels that sex is less important...

Frosty and his wife find sex a little more difficult now but he feels that sex is less important...

Age at interview: 68
Sex: Male
Age at diagnosis: 65
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We’re not how do I say rampant sex addicts if you can put it like that, sex occasionally is still fine. It’s a little bit more difficult but it works if you know what I mean. I mean sex is how, what you make it if you know what I mean and at our age it isn’t the important thing it was when you’re young, if you know what I mean. When you first get married it seems to be the most important thing of your life but you get older and it doesn’t take on that mantle so much.

As a single man, with two grown up children, Mark did not attach great importance to sex. He talked about needing to focus on getting better, psychologically more than physically. Similarly, Frank Z’s main concern was getting back to normality; he felt that sex was not a priority.
 

As a single man with two grown up children Mark says that not being able to have sex isn’t an issue.

As a single man with two grown up children Mark says that not being able to have sex isn’t an issue.

Age at interview: 48
Sex: Male
Age at diagnosis: 46
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I’m a single man anyway. I’m a single man anyway. So... not being able to have sex is... doesn’t register. That’s just not important at all. I have two children from me marriage that that failed and they’re grown up now. So you could say that that part of my life wasn’t important anyway. But and I’m smiling when I say this... you know it’s very difficult to have sex without one. You know it’s not something you can do. But at that point that’s not a consideration. I need to get myself right and get myself fit and well. They… the problems with me have been more… psychological rather than physical. It’s… maybe that, maybe I’m wrong maybe... I mean it’s 50'50. It’s 50'50 the psychological side of it and the physical side of it. Physically I heal very quickly. I healed very quickly. But the psychological part of it became the overriding problem for me.


Last reviewed July 2017.
Last updated January 2015.
 
  
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