Sex and penile cancer
Naturally one of the most difficult issues to address following surgery is the effect that any treatment will have on the appearance of a mans penis and its function including normal sexual intercourse. For some older men this may not be a cause for concern but for sexually active men it raises a number of possible problems.Included in this section is some guidance on what to expect and tips on how to help men adjust to the change in their sexuality. It is very important that both men and their partners are aware of these issues, and work through them together.
If a man has had a wide local incision to remove an area of cancer then the area affected will be swollen and tender following surgery. Once the wound has healed there will be some scarring at the site of the operation and the penis may be a slightly different shape. However men should still be able to have an erection and maintain sexual intercourse as they were prior to surgery.
If a man has had a glansectomy and skin graft then the glans which is the most sensitive part of the penis will not be present.
However the nerves and blood supply which control erections will usually be left intact and men should be able to have sexual intercourse as they did prior to surgery although it will take some time for the swelling from the surgery to resolve. It may also take a while for men to adjust mentally to the appearance of their penis.
If a man has had a partial penectomy (surgery to remove part of the penis) they should still be able to have penetrative sex. Past research studies have suggested that over 50% of men who have had partial penectomy could still maintain an erection. Again it is likely to take some time for men to adjust fully to the appearance of their penis.
If a man has had a total penectomy (surgery to remove the entire penis) then normal sexual intercourse will not be possible. Men may feel less of a man and worry that they will not be able to fulfill their partner’s sexual needs. In this situation it is vital that men talk to their partner and explore other ways of maintaining a satisfactory sex life. Sometimes hugging, kissing or petting can be just as fulfilling as penetrative sex. Men will still have sensitive zones around their body that may allow them to have similar sensations and cause sexual arousal. A man’s penis does not have to be erect for ejaculation to occur.
The use of adult toys such as massagers and vibrators may bring equal pleasure to both men and their partners. Adult films/pictures or role playing may also achieve similar results and fulfilment. Although men may feel that there may be some stigma attached to these types of sexual gratification many people all over the world make use of these methods to enhance their sex life.
Men may find that talking to their partner is difficult or not enough and may need further counselling. There are a number of specialist counsellors (psychosexual counsellors) who can often help in this situation. Men and their partner will both need to participate in this type of counselling. It is likely that the specialist team will know of a local counsellor that a man could be referred to and it is therefore worth discussing this possibility with them.
Treatment for Erectile Dysfunction
Some men who have had penile preserving surgery may associate any change in their ability to get an erection with their treatment for their penile cancer however it is important to understand that there are a number of other conditions and lifestyle factors that can affect this which are not related, such as high blood pressure, diabetes and cardiovascular disease.
Medication such as Viagra and similar tablets may help a man’s erections. However physical sexual stimulation needs to be used to make this successful. Other treatments include injections that can be used to give men an erection. However men who suffer from heart conditions or are on nitrate or anticoagulant medication these treatments may need to be used with caution. They should ask their consultant or specialist nurse if these treatments may be options .
Last reviewed November 2019. Next review November 2020.
References available on request.