Sexuality and fertility after 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 to get an erection.

Options for improving erections include:

• oral medicines prescribed by a doctor 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; you can then turn on or squeeze the pump when you want an erection.

If the prostate and seminal vesicles are removed along with the bladder, you will not be able to ejaculate after a radical cystectomy. You can still feel the muscular spasms and pleasure of an orgasm even if you cannot ejaculate or get an erection, but it will be a dry orgasm because you no longer produce semen.

If the prostate and seminal vesicles are removed, you will no longer produce semen. This means you won’t be able to have children naturally. If you might 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. 

Sometimes, the vagina may be shortened or narrowed during a cystectomy. Nerves that help keep the vagina moist can also be affected, making the vagina dry. These changes can make penetrative sex difficult or uncomfortable at first.

Ways to manage these changes include:

• using a hormone cream (available on prescription) or vaginal moisturiser (available at pharmacies) 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 stretch the vagina
• using a water-based or silicone-based lubricant (available from pharmacies and supermarkets) to make sex more comfortable.

A cystectomy can damage the nerves in the vagina or reduce the blood supply to the clitoris, which can affect how you become aroused and your ability to orgasm. Talk to your surgeon or nurse about ways to minimise potential side effects. You can also try exploring other areas of your body that feel pleasurable when touched, such as the breasts, inner thighs, feet or buttocks.

Sometimes, the uterus and other reproductive organs are removed during a radical cystectomy. This will cause menopause if you have not already been through it. Your periods will stop, you will no longer be able to become pregnant, and you may have menopausal symptoms such as hot flushes and vaginal dryness. Talk to your doctors about ways to deal with symptoms of menopause.