Bladder Surgery and Your Sex Life
Understanding how invasive bladder cancer surgery can affect your sex life is the first step to reclaiming it.
By David Craig
Medically Reviewed by Cynthia Haines, MD
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If you have recently been diagnosed with invasive bladder cancer, one of your concerns may be your sex life. Will it continue? Will it end? What concessions or changes will you (and your partner) have to make?
Brad White, MD, a urologist in St. Louis, notes that bladder cancer is the fourth most common cancer among men and the eighth most common among women. And sexual issues that can arise following bladder cancer treatment are not at all uncommon.
Bladder cancer starts on the bladder surface and is described as “invasive” when the cancer has grown into the wall of the bladder. Invasive bladder cancer can mean surgeries and other treatments (like radiation therapy and chemotherapy) that can wreak havoc on your body, your psyche, and ultimately, your sex life.
Bladder Cancer Surgery: How It Can Affect a Man's Sex Life
Getting cancer is certainly not pleasant, and the road to the cure can sometimes seem just as bad. Chemotherapy (involving medicines directed at killing cancer cells) and radiation therapy (which uses high-dose radiation to destroy the cancer) can leave a path of destruction in its wake, leaving you nauseated, tired, rundown. And definitely not in the mood for sex.
In the case of invasive bladder cancer, surgery is often part of the treatment plan. The surgery may involve a partial cystectomy (where only part of the bladder is removed) or a radical cystectomy (the entire bladder is removed). In men, this bladder surgery generally includes the removal of the prostate. This procedure can lead to loss of sexual function, with the critical factor being whether the bladder surgery damages the nerves near the bladder and prostate, according to Dr. White. He says there is about a 50/50 chance that a man’s sexual function will be affected by this surgery.
Patient Dan Martin’s bladder cancer was not invasive, but he had the radical cystectomy and prostate removal. He says that his surgery was nerve-sparing and that, while “things aren’t 100 percent the way they were, they are close.”
If the nerves are spared and merely bruised, drugs such as sildenafil (Viagra) may be useful in restoring sexual function. But if the nerves are cut (transected), Viagra will not help. In those cases, White says, a patient may be prescribed an injection to produce a natural erection.
Another option for men who have had bladder surgery: penile implants. Roni Olsen of Colorado says her husband, Ben, had a penile prosthesis implant. “Other than a few minor maintenance issues, the prosthesis continues to work great. You might lose a bit of spontaneity, but you can still have great sex!” she says.
Bladder Cancer Surgery: Women Are Affected, Too
In women, a radical cystectomy for bladder cancer can include the removal of part of the vagina. In some cases, the vagina can be reconstructed using a piece of the intestine, although pain during intercourse may result due to reduced vaginal depth. Still, many patients are able to have pain-free intercourse and orgasms after bladder surgery.
Having regular, gentle sex, as soon as you feel ready, will help stretch the vaginal area and make sex easier and more enjoyable for you over time. Vaginal dilators, devices that are inserted into the vagina to stretch the space, can also be used for this purpose.
As with men, nerves can be damaged in women who have bladder surgery, too. This can lead to decreased sensation — and sometimes pain — during sex. Talking with your doctor about what can be done to preserve your sex life is important both pre- and post-surgery.
Bladder Cancer Surgery: Additional Considerations
Removal of the bladder sometimes means that the collection of urine must occur outside the body, which can negatively affect a person's body- and self-image and how confident they feel sexually.
Psychologically, because the bladder is in the lower abdomen area near the genitals, some patients may be concerned that sexual activity can adversely affect the treatment of the disease. Others may feel that having cancer in this area somehow makes them less attractive to their partner.
Tips that can help include opening the lines of communication with your sexual partner and talking with a therapist who specializes in sexual health, with or without your partner present, when needed. You are not alone, and you should not feel ashamed if you and/or your loved one are having sexual issues after bladder cancer treatment … help is available. A healthy sex life is part of living your best life. Don’t suffer in silence. Speak up: In doing so, you take the first step towards fully reclaiming a healthy sex life post-cancer.
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