Radiation Therapy and Sexual Function

Nerves and Vasculature

The network of nerves and blood vessels that supply the organs that control erectile function run along the sides of the prostate. After radiation therapy, changes to these structures may reduce erectile function, but often not immediately. In the first five or more years after treatment, radiation therapy tends to have less of an effect on erectile function compared to surgery. However, over the long term, there is typically a similar decline in function as in men who had surgery.

Important factors associated with preserved sexual function after radiation therapy include:

• Pretreatment Sexual Function: The level of your sexual function before treatment strongly predicts how well you may maintain   it afterward.
• Age: Younger individuals at the time of treatment often have a higher likelihood of retaining sexual function.
• Healthy Lifestyle: Engaging in regular exercise, maintaining a balanced diet, and keeping a normal body weight are crucial for preserving sexual health and function.

Thankfully, improvements in radiation therapy over time now allow for more precise radiation delivery, and side effects are now less common and less intense than they have been in the past.

Hormone Therapy

Not all men who receive treatment with radiation therapy for prostate cancer require hormone therapy (or androgen deprivation therapy, ADT).

For those with more aggressive features, however, ADT may be offered as a shorter duration (4 – 6 months) or longer duration (18 – 24 months) treatment. ADT works by reducing the levels of male hormones, particularly testosterone, which slows prostate cancer growth and improves outcomes when combined with radiation therapy.

Testosterone also plays an important role in sexual function. Decreased levels can lead to a reduction in sexual desire (libido) and a diminished ability to achieve or maintain an erection. Sexual drive may return once your testosterone recovers. The recovery time varies. Some men recover quickly, whereas others may have delay in their recovery or remain low.

Erectile Dysfunction Treatments

You and your partner have many options to manage the side effects of radiation therapy. By far the most common treatment are oral medications such as sildenafil, tadalafil, and vardenafil. The medications relax the blood vessels in the penis, improving blood flow. There are many other options, including medicated pellets, penile injections, vacuum erection devices, and others.

Fertility

If you undergo surgery, radiation therapy, or hormone therapy, natural fertility is unlikely. Should you wish to have children in the future, it’s important to discuss this with your doctor before starting treatment.

To learn more about sexual and urinary side effects, check out our articles on Radiation and Bowel Function and Radiation Therapy and Urinary Function.