How Cancer Can Affect Erections
Certain kinds of cancer and cancer treatment can affect your ability to have an erection. This is called erectile dysfunction (ED). It can include problems getting an erection or keeping one long enough to have sex with penetration.
Learn more about how cancer and its treatment can affect erections, and the different options for managing erectile dysfunction.
- Why does cancer treatment sometimes cause erectile dysfunction?
- Cancer surgery and erections
- Pelvic radiation therapy and erections
- Erection problems after radiation therapy or surgery for prostate cancer
- Hormone therapy and erections
- Chemo, targeted therapy, immunotherapy, and erections
- Stem cell transplant and erections
- How emotions can affect erections
- Managing erection problems
- Learn more
Why does cancer treatment sometimes cause erectile dysfunction?
There are two main ways cancer treatment can affect your ability to have an erection.
- Damage to nerves and blood vessels: Certain nerves and blood vessels that go to your sexual organs must work correctly for you to have an erection. These nerves and blood vessels are most likely to be damaged during surgery or radiation treatment to organs in your pelvis, such as your prostate, penis, bladder, colon, or rectum.
- Decreased testosterone: Other types of cancer treatment can decrease your testosterone levels. This includes hormone therapy, certain types of chemotherapy, targeted therapy, immunotherapy, and stem cell transplant. You need enough testosterone to get and keep an erection.
The information below describes common sexual problems faced by adult men (or people with male reproductive organs*) after certain types of cancer treatment. You might have problems or needs that aren’t addressed here. Your cancer care team can help you manage your specific situation.
*To learn more about the gender terms used here, and how to start the conversation with your cancer care team about gender identity and sexual orientation, see Gender Identity, Sexual Orientation, and Cancer Treatment.
Cancer surgery and erections
Some types of cancer surgery can change your ability to have erections.
- Radical prostatectomy: Removal of the prostate and some surrounding tissue, including the seminal vesicles. Sometimes nearby lymph nodes are also removed. (For prostate cancer.)
- Radical cystectomy: Removal of the bladder, prostate, seminal vesicles and nearby lymph nodes. Because the bladder is removed, a new way of collecting urine is needed, either into a bag through an opening on the belly (urostomy) or by building a new “bladder” inside the body. (For bladder cancer.)
- Abdominoperineal (AP) resection: Removal of the lower colon, rectum and anus. This surgery may require a colostomy, an opening in the belly (abdomen) where stool can leave the body. (For colorectal cancer.)
- Total mesorectal excision (TME): ?Removal of the rectum and nearby lymph nodes. The colon is then connected to the anus so stool (poop) can pass in the usual way. (For rectal cancer.)
- Total pelvic exenteration: Removal of the rectum and nearby organs that the cancer has reached. This might include the bladder, prostate, and seminal vesicles. After this surgery, new openings may be needed for both urine and solid waste to leave the body. (For a large tumor of the colon.)
Most men who have these types of surgeries might have some trouble with erections.
This is because these operations can damage the nerves needed for an erection. Some men will be able to have erections firm enough for penetration, but probably not as firm as they were before surgery. Others may not be able to get erections at all.
If any of these surgeries are part of your treatment plan, talk to your cancer care team before the procedure. Ask how surgery might affect your erections and how to manage any problems.
Nerve damage from surgery
The most common reason people have erection problems after cancer surgery is because the nerves needed for an erection were removed or damaged. These nerves are next to the rectum and surround the back and sides of the prostate gland. That makes it easy for them to get damaged during an operation.
Nerve-sparing surgery
If the size and location of a tumor allow for it, surgeons try to avoid the nerves needed for erection. When possible, surgeons use “nerve-sparing” methods in radical prostatectomy, radical cystectomy, AP resection, and TME operations.
More men recover erections after nerve-sparing surgery than men who have surgery in which nerve sparing isn’t possible.
Regaining erections after surgery
Even with nerve-sparing surgery, it can take some time to regain erections. Nerves can be injured during the operation and need time to heal before erections return. This healing can take up to 2 years.
It’s not known why some men regain full erections after surgery and others do not. But when nerves on both the left and right sides of the prostate are spared, men are more likely to regain erections.
Other things that affect erections after surgery
There are other factors that can affect whether you are able to get erections after cancer surgery, such as:
- Age: The younger you are, the more likely you are to regain full erections after surgery. Men under 60, and especially those under 50, are more likely to recover their erections than older men.
- Strength of erections before surgery: If you had strong erections before cancer surgery, you are far more likely to recover your erections than if you had erection problems.
- Other health problems: If you have other health conditions that can affect erections, you may have more trouble regaining erections after surgery. This includes diabetes, hypertension, heart disease, obesity, low testosterone levels, or depression, or if you smoke or take certain medicines.
Pelvic radiation therapy and erections
Radiation therapy to the pelvis is used to treat some kinds of prostate, bladder, colon, and rectal cancer. Because the male sex organs are in the pelvis, radiation to this area might cause problems with erections.
Radiation is done in one of two ways: external beam radiation (aimed from outside the body) or brachytherapy (placed inside the body). Either type of radiation can cause damage to the nerves and blood vessels your body needs to have erections.
As the treated area heals after radiation, scar tissue may form and keep the blood vessels from stretching like they should. This can cause trouble in having a firm erection. Radiation can also cause hardening (arteriosclerosis), narrowing, or even blockage of the pelvic arteries.
How soon after radiation do erection problems start? Are they permanent?
Trouble with erections comes on more slowly with radiation therapy than with surgery.
- If erection problems happen, they usually start between 6 months to 2 years after radiation ends.
- Some men will still have full erections but lose them before reaching orgasm.
- Other men will no longer get firm erections at all.
Erection problems are not always permanent. They might get better after 2-3 years.
Does radiation therapy always cause erection problems?
Not all men have erection problems after radiation therapy. The higher the total dose of radiation and the larger the section of the pelvis treated, the greater the chance of erection problems later.
If radiation therapy to your pelvis is part of your treatment plan, talk to your radiation therapy team before it starts. Ask how your arteries and nerves might be affected by radiation therapy, so you know what to expect.
Other things that affect erections after radiation
- Age: The older you are, the more likely you are to have problems with erections after radiation therapy. This is because as you age, your blood vessels can lose some of their ability to stretch and allow blood to flow into them.
- Damaged blood vessels: If your blood vessels have been damaged by heart or blood vessel disease, diabetes, or heavy smoking, you are also at greater risk for erection problems.
Doctors are looking at whether early penile rehabilitation could help after radiation therapy, too.
Erection problems after radiation therapy or surgery for prostate cancer
If you have early-stage prostate cancer, you may have a choice between radiation and surgery to treat your cancer. You may wonder which treatment is more likely to cause erection problems. Studies don’t show much long-term difference between surgery and radiation.
- Radiation for prostate cancer: Men who had radiation may see a general decrease in the firmness of their erections over time (up to several years after radiation).
- Surgery for prostate cancer: After surgery, most men have erection problems right away and then have a chance to recover erections in the first 2 years following surgery.
About 4 years after either treatment, the percentage of men reporting erectile dysfunction is about the same. Treatments can often help men get their erections back after prostate cancer treatment, regardless of whether they had surgery or radiation.
Hormone therapy and erections
Some prostate cancer treatments are designed to lower the amount of the male hormone testosterone that your body makes. This is called androgen deprivation therapy (ADT).
ADT can cause low sex drive, problems with erections, and problems with having an orgasm.
Your erections may or may not recover when you stop ADT. If you are younger, you are more likely to regain erections because your body already makes more of its own testosterone. But you may still need to take medicines for a full erection. Erectile dysfunction medicines may not work though, if you have lost your desire for sex.
Chemo, targeted therapy, immunotherapy, and erections
Some chemotherapy, targeted therapy, and immunotherapy medicines can reduce the amount of testosterone your body releases. This can cause decreased sexual desire and problems with erections.
Testosterone levels usually return to normal after treatment ends. You might lose the ability to get an erection, but this usually comes back with time. Ask your cancer care team about the possible sexual side effects of any medicine that is part of your cancer treatment.
Some types of chemo can also cause short-term or long-term infertility. For more information, see How Cancer and Cancer Treatment Can Affect Fertility in Men.
Stem cell transplant and erections
Before you get a stem cell transplant (also called bone marrow transplant), you will be given high doses of chemotherapy and radiation therapy in preparation. Both treatments can lower the amount of testosterone your body makes, which can lead to problems with erections.
Graft-versus-host disease is another side effect of stem cell transplant. Men who get graft-versus-host disease are more likely to have a long-lasting loss of testosterone. If this happens, you may need testosterone replacement to regain sexual desire and erections.
How emotions can affect erections
Cancer and cancer treatment can affect your emotions, energy level, and how you feel about yourself. Your ability to have and keep erections could be affected by feelings like:
- Fatigue (low energy)
- Distress from pain
- Not feeling good about your body
- Fear that you might not be able to get and keep an erection
- Depression
- Anxiety
These symptoms can make it harder for you to relax and feel excited about intimacy.
Many men report feeling disappointed when they have trouble with erections. You may feel that something important is missing. These feelings are a natural part of coping with erection problems.
For most men, finding effective treatments for erections or figuring out other ways of being intimate with a partner can help them feel better.
If you have erection problems caused by these emotions, a therapist or other mental health professional can often help. There are mental health professionals who specialize in helping people with cancer who are having sexual issues.
Managing erection problems
You’ll have a number of options for dealing with erectile dysfunction and will likely need to use more than one. How well each works can vary greatly. You may have to try a few to find the ones that works best for you.
Many of these treatments are used during penile rehabilitation.
Medicine is often the first type of treatment offered for erectile dysfunction (ED). These medicines are called PDE5 inhibitors. They can help you get an erection and keep it for long enough to have sex.
PDE5 inhibitors include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Stendra)
These ED medicines come in pill form. They are most often taken 30 to 60 minutes before you want to have sex. Some can also be taken every day. Be sure to take them as they are prescribed. For example, some need to be taken on an empty stomach and given enough time to work.
Taking ED medicine after cancer surgery
If you had a surgery that might damage the nerves needed for an erection, ED medicines may not work for you right away. Your nerves need to heal first, which can take up to 2 years.
By 18 to 24 months after surgery, these medicines might be more helpful in getting a firm erection.
Possible side effects and complications from ED medicine
Be sure your urologist and cancer care team know about all medicines you take, including supplements, over-the-counter medicines, and vitamins. Some of these can interact with ED medicines and cause complications such as very low blood pressure.
You should not take ED medicines if you take nitroglycerin or other nitrate medicines such as isosorbide mononitrate or isosorbide dinitrate.
If you are prescribed an ED medicine, make sure you understand all of the side effects and when to get help for any of them.
Watch out for counterfeit ED medicines
You should only take ED medicines that are prescribed by your doctor and come from a legitimate pharmacy. Don’t buy medicines that claim to treat ED but don't need a prescription. There is a large counterfeit market for ED medicines. These pills are usually not effective for helping erections and may be dangerous.
Vacuum erection devices (VEDs) can help some men with erectile dysfunction or penile shortening after cancer treatment. To use a VED, you put your penis into a plastic cylinder and pump out air to create a vacuum. The suction draws blood into the penis, filling up the spongy tissue and making it firmer.
When your penis is firm, take the pump off and slip a stretchy band onto the base of your penis to help it stay erect. The band should not be left on for more than 30 minutes.
Some men use the pump before starting sexual contact. Others find it works better after some foreplay has produced a partial erection. It may take some practice to learn how to use a VED and be comfortable with it.
Most vacuum devices are prescribed by doctors, but some are available over the counter.
Another option is to give yourself a shot into your penis with a medicine that causes erections. Alprostadil, also called Caverject or Edex, is the medicine approved in the U.S. for this purpose.
A very thin needle is used to put the medicine into the side of your penis a few minutes before starting sexual activity. The combination of sexual arousal and medicine helps to produce a firmer and longer-lasting erection.
Penile injections work for many men who try them. The first injection is usually done in the doctor’s office, so the doctor or staff can teach you how to do them yourself at home.
Possible side effects of penile injections
Many men feel nervous about having a penile injection and giving it to themselves. If you are thinking about trying penile injections, be sure to understand both the short-term and long-term side effects.
Priapism:
- When an erection lasts longer than you need for sexual activity.
- This side effect happens in a small number of men who use penile injections.
- If you have an erection for more than 4 to 6 hours, seek medical care as soon as possible.
- If this isn’t treated quickly, you could end up with more erection problems.
Urethral pellets are another option to help with erections. You might also hear this called a medicated urethral system for erection (MUSE).
Using an applicator, you put a tiny pellet of medicine (called a suppository) into your urethra. Your urethra is the opening at the tip of your penis. As the pellet melts, the drug is absorbed through the lining of your urethra and enters the spongy tissue of your penis.
You should urinate before putting the pellet in, so the lining of your urethra is moist. After the pellet is in, massage your penis gently to help absorb the medicine. This system may be easier than injections, but it doesn’t always work as well.
If you're thinking about using urethral pellets, be sure you understand all possible side effects.
Pelvic floor muscle training
Pelvic floor muscle training is done to strengthen the muscles in your genital area. These exercises are usually done at home after you are taught how to do them. They have helped some people regain erections when used along with other treatments.
These exercises can also help you better control your bladder and bowel if you are having trouble with incontinence.
It can take up to 2 years to recover erections after surgery. But there are early steps you can take to increase your chance of regaining erections. These steps are called penile rehabilitation.
Research shows that if a man doesn’t have an erection during the recovery period after surgery, the tissues in his penis may weaken. If this happens, he probably won’t be able to get an erection naturally.
To try and prevent this, some experts and doctors suggest using different methods to promote erections and help some men recover sexual function.
Penile rehabilitation starts in the weeks or months after surgery. It might include:
- Medicines for erectile dysfunction
- Vacuum constrictive device (VCD) to help pull blood into the penis
- Pelvic floor muscle training
- Penile injections
If you undergo penile rehabilitation, you might use one or more of these techniques. What works best will be different for everyone.
A penile implant may be an option if other treatments haven’t worked well for you. Penile implants can help you get an erection firm enough for sexual activity. Most men who have implant surgery are pleased with the results.
There are two different kinds of penile implants. Both are placed during surgery by a urologist. The one that is best for you depends on your age, body size, penis size, and preferences.
Inflatable penile implants
Inflatable implants work by pumping liquid into tubes that are placed inside your penis. This liquid causes the tubes to expand, creating an erection. These implants can have either 2 or 3 pieces.
- A 3-piece implant includes tubes put inside the penis, a pump placed inside the scrotum and a reservoir (storage tank) that holds fluid. The reservoir is placed behind the groin muscles. Squeezing the pump moves the fluid from the reservoir into the tubes, creating an erection. When the pump is released, the fluid goes back into the reservoir, emptying the penis again.
- For a 2-piece inflatable implant, most of the fluid is in the back of the tubes, and the pump is put into your scrotum.
Semi-rigid or non-inflatable implants
Semi-rigid or non-inflatable implants are less common. This type of implant uses semi-rigid rods that are implanted in your penis. When you want an erection, you bend the rods up. After sex, you bend them down. This is simpler to use than an inflatable implant, but it is less like a normal erection.
Before making your decision, learn as much as you can and ask your urologist questions about the pros and cons of each type of implant.
If you have low testosterone levels, you may have lower sexual desire and trouble with erections. Testosterone supplements may help restore your desire and erections. However, testosterone is not right for everyone.
If you think you might have low testosterone, talk to your urologist or cancer care team. Tests can be done to find out your testosterone level, and you can discuss possible treatment options.
Testosterone is not usually given to men who have had certain types of cancer. For example, prostate cancer can grow faster with higher levels of testosterone. Men with prostate cancer will most likely not be able to get testosterone treatment.
Many herbal and dietary supplements sold over the counter and on the internet claim to be “natural” cures for erection problems. These supplements have not been proven to help men regain erections, and some may even be dangerous.
It’s important to know that supplements are not strictly regulated in the United States like medicines are. Supplement makers don’t have to prove their products are effective (or even safe) before selling them.
Some supplements might not even contain the ingredients on their labels. Other supplements might contain extra (and potentially harmful) ingredients not listed on the label.
Talk to your urologist or cancer care team about any supplement or other over-the-counter treatment you are thinking about trying.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Society of Clinical Oncology. Sexual Health and Cancer Treatment: Men. Cancer.net. Content is no longer available.
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Last Revised: April 15, 2025
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