Apart from the psychological adjustments, the operation may have made physical changes which can cause problems with sex. It may not be possible to avoid damage to the nerves in the pelvis during the operation, although your doctor will do all they can to prevent nerve damage. If nerve damage occurs it may be difficult for a man to get an erection and women may find that the sensations they have during sex are different, as the vagina is usually smaller.
Men
If men have problems getting or maintaining an erection there are several options which may help. They can be prescribed by your GP or cancer specialist.
Medicines
Tablets of sildenafil (Viagra®) are available which help to give an erection by increasing the blood supply in the penis. The tablets have to be taken at least one hour before lovemaking. They cannot be taken by men who take nitrate-based medicines for heart problems. Vardenafil (Levitra®) is a similar tablet that can be taken 25–60 minutes before sex.
Tadalafil (Cialis®) tablets can be used. They can be taken up to 24 hours before lovemaking. Tadalafil works by increasing the blood supply to the penis. Tadalafil should not be taken by people who are taking certain heart medicines.
Tablets of apomorphine hydrochloride (Uprima®) can be dissolved under the tongue. These usually give an erection within 10–20 minutes. Some men find they cause headaches, feelings of sickness or dizziness.
Small pellets of alprostadil (MUSE®) can be put into the tip of the urethra. The pellet melts into the area around, and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that initially the pellet is uncomfortable.
Alprostadil (Caverject®) or Viridal® can be injected directly into the penis, using a small needle, to cause an erection. Some experimentation is often needed at first to get the dose right.
Pumps and other devices
Vacuum pumps can also be used to produce an erection. The pump is a simple device with a hollow tube that you put your penis into. The pump has a handle which sucks blood into the penis by creating a vacuum. The blood then gets caught in the penis by a rubber ring placed around the base. The ring allows you to make love without losing the erection. Once you have finished making love, the ring is taken off and the blood flows normally again.
The advantage of a vacuum pump is that it doesn't involve inserting anything into the penis, but it does need a bit of practice. It is particularly helpful for people who are not able to take other medicines. The pumps are available on the NHS.
Mechanical devices can be used to produce an erection. These are called penile prostheses and involve the insertion, under general anaesthetic, of flexible rods or thin inflatable cylinders into the penis. Your doctor can give you advice about both these treatments, which may be available from the NHS.
Women
In some women, the vagina may have been shortened or narrowed during the operation to remove the bladder, although the doctor will take care to leave as much of the vagina intact as possible.
This can make sex difficult or uncomfortable at first. One of the best ways of overcoming this problem is to start having sex regularly and gently, as soon as you feel ready. This will gradually stretch the vagina, making it more supple, and will make sex easier and more enjoyable. If you do not have a regular sexual partner, vaginal dilators can be used. Your nurse or doctor can show you these, and explain how to use them.
Some women find that they have different sensations during sex. It may be more difficult to have an orgasm. If the womb has been removed to treat any spread of the cancer, it can make a woman feel that she has lost a part of her female identity. Again, talking to your doctor or specialist nurse about any problems will help to bring fears and worries into the open. If you want, your doctor or nurse can refer you to a specialist in sexual problems, or a trained counsellor, for advice and support.
If you feel that counselling would help, you could contact one of the organisations that offer counselling.
Talking about sex
You may find it difficult or embarrassing to talk about any sexual problems you may have. However, most doctors are very understanding, and even if they cannot help, they can refer you to a doctor or therapist who specialises in sexual problems. These specialists can give emotional support and advice on how to cope with impotence and any related problems.
It can be helpful to remember that they deal with situations like this every day and are used to discussing personal problems. If you have a partner, it may be helpful for them to see the specialist with you so that any fears and worries can be brought out into the open.
Sex is safe
One common fear is that cancer cells can be passed on to your partner during sex. This is not true. Cancer is not infectious and it is perfectly safe for you to have sex as soon as you feel ready.
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