Your treatment team can give you more information about ways to manage any changes to your sexuality and fertility. You may find these changes upsetting and worry about the impact on your relationships. It may be helpful to talk about how you’re feeling with your partner, family members or a counsellor.
For more on this see Sexuality, intimacy and cancer and Fertility and cancer
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Changes for men
| Nerve damage |
| 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 to get an erection. Options for improving erections include: – oral medicines available on prescription that increase blood flow to the penis – injections of medicine into the penis – vacuum devices that use suction to draw blood into the penis and make it firm – an implant called a penile prosthesis – under general anaesthetic, flexible rods or thin inflatable cylinders are inserted into the penis and a pump is placed in the scrotum; the man can then turn on or squeeze the pump when an erection is desired. |
| Orgasm changes |
| You will not be able to ejaculate after a radical cystectomy if the prostate and seminal vesicles were removed along with the bladder. Many men can still feel the muscular spasms and pleasure of an orgasm even if they cannot ejaculate or get an erection, but it will be a dry orgasm because they no longer produce semen. |
| Fertility changes |
| If the prostate and seminal vesicles are removed, you will no longer produce semen. This means you will no longer be able to have children naturally. If you may want to have children in the future, talk to your treatment team about whether you can store sperm at a fertility clinic before treatment. The sperm could then be used when you are ready to start a family. |
Changes for women
| Vaginal changes |
| In some women, the vagina may be shortened or narrowed during a cystectomy. In addition, some nerves that help 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 hormone cream (available on prescription) to keep your vagina moist – asking a physiotherapist how to use vaginal dilators to help stretch the vagina – vaginal dilators are plastic or rubber tube-shaped devices that come in different sizes – when you feel ready, trying to have sex regularly and gently to gradually stretch the vagina – a water-based or silicone-based lubricant (available from pharmacies and supermarkets) can make this more comfortable. |
| 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. You can also try exploring other ways to become aroused, such as caressing of the breasts, inner thighs, feet or buttocks. |
| Menopause and fertility |
| 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. Your periods will stop and you will no longer be able to conceive children. As your body adjusts to changes in hormone levels, you may experience symptoms such as hot flushes and vaginal dryness. |
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Additional resources
Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; BEAT Bladder Cancer Australia; Dr Anne Capp, Senior Staff Specialist, Radiation Oncology, Calvary Mater Newcastle, NSW; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, and Adjunct Professor, Australian Prostate Cancer Research Centre, QLD; Melissa Le Mesurier, Consumer; Dr James Lynam, Medical Oncologist Staff Specialist, Calvary Mater Newcastle and The University of Newcastle, NSW; John McDonald, Consumer; Michael Twycross, Consumer; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.
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