Sexuality, intimacy and fertility

Bladder cancer can affect your sexuality in physical and emotional ways. 

Surgery and other treatments to the pelvic area can cause sexual side effects in both men and women. A person who has a urostomy bag may also feel embarrassed or upset, which can affect their desire for sex (libido). 

The impact of these changes depends on many factors, such as treatment and side effects, your self-confidence, and if you have a partner. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

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Contraception and fertility

If you are able to have sex, you may be advised to use certain types of contraception to protect your partner or avoid pregnancy for a certain period of time. Your doctor will talk to you about the precautions to take.

You will also be told if treatment will affect your fertility permanently or temporarily. If having children is important to you, talk to your doctor before starting treatment.

Sexual changes for men

Nerve damage from cystectomy

A cystectomy can often damage nerves to the penis, but the surgeon will try to prevent or minimise this. Nerve damage can make it difficult for a man
to get an erection. Options for managing erections include:

  • prescribed oral medicines that increase blood flow to the penis
  • injections of medicine into the penis
  • vacuum devices that use suction to draw blood into the penis
  • an implant called a penile prosthesis – under general anaesthetic, flexible rods or thin inflatable cylinders are inserted into the penis and a pump is positioned in the scrotum; the man can then turn on or squeeze the pump when an erection is desired.

Fertility after cystectomy

If the surgeon has to remove other organs, such as the prostate and seminal vesicles, you will also experience an orgasm without semen (dry orgasm) and be unable to father  children. You may find this upsetting and worry about the impact on your relationship. It may be helpful to talk about how you’re feeling with your partner, family or a counsellor.

Changes after radiation therapy

Men who are treated with radiation therapy may also have poor erections, and ejaculation may be uncomfortable for some months after treatment.

Sexual changes for women

Vaginal changes after cystectomy

In some women, the vagina may be shortened or narrowed during a cystectomy. In addition, some nerves that keep the vagina moist can be affected, making the vagina dry. These changes can make penetrative sex difficult or uncomfortable at first. You can manage them by:

  • using a hormonal cream to keep your vagina moist
  • asking a physiotherapist how to use a vaginal dilator to help
    stretch the vagina
  • trying to have sex regularly and gently (when you feel ready)
    to gradually stretch the vagina.

Arousal after cystectomy

A cystectomy can damage the nerves in the vagina or reduce the blood supply to the clitoris, which can affect sexual arousal and the ability to orgasm. Talk to your surgeon or nurse about ways to minimise potential side effects.

Menopause after cystectomy

Some women may have their uterus and other reproductive organs removed during a radical cystectomy. If you have not yet gone through menopause, this will cause menopause and your periods will stop. As your body adjusts to changes in hormone levels, you may experience symptoms such as hot flushes and vaginal dryness. Your medical team can give you advice about managing these symptoms.

Fertility after cystectomy

Menopause means that it will no longer be possible to conceive children. You may feel upset and worry about the impact on your relationship. Try talking about how you’re feeling with your partner, family or a counsellor.

This information was last reviewed in February 2018
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