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🔴 THE TRUTH ABOUT PROSTATE CANCER AND SEX — WHAT NOBODY TELLS YOU
(This is the conversation most doctors skip. I am not going to skip it.)
Right.
I am going to talk about something today that most men — and most health coaches — avoid completely.
Not because it is not important. But because it is uncomfortable. Because we have been conditioned to keep certain things private. Because admitting that something has affected us in this area feels like admitting weakness.
I am done with that.
Because the silence around prostate cancer and sexual health is one of the most damaging things in men’s health. Men do not get the information they need before treatment. They are not prepared for what happens after. And they suffer alone — in silence — when they do not have to.
I know this because I lived it.
And today I am going to tell you the truth. All of it. 👇
🤐 FIRST — LET’S TALK ABOUT WHY NOBODY TALKS ABOUT THIS
Here is the irony.
The prostate gland — the very gland at the centre of all of this — plays a direct role in male sexual function. It produces the fluid that makes up the majority of semen. It is located directly in front of the rectum, wrapped around the urethra, and sits just below the bladder.
It is anatomically inseparable from the systems that govern sexual function in men.
And yet when most men get a prostate cancer diagnosis, the conversation about what treatment might mean for their sex life is rushed, minimised, or skipped entirely.
I sat in that chair. I heard the diagnosis. And in the weeks that followed — during all the conversations about treatment options, procedures, side effects, and recovery plans — the impact on my sexual health was mentioned almost in passing.
Almost as an afterthought.
It was not an afterthought. It changed my life. And I want you to be prepared in a way that I was not.
⚕️ LET’S START WITH THE BASICS — WHAT DOES THE PROSTATE ACTUALLY DO?
The prostate gland is a walnut-sized gland that sits just below the bladder in men. Its primary functions are:
▸ Producing prostatic fluid — the alkaline fluid that makes up 20-30% of semen and helps protect and nourish sperm
▸ Helping control urinary flow — the prostate surrounds the urethra, so its size and health directly affects how easily you can urinate
▸ Playing a role in ejaculation — the muscles of the prostate contract during orgasm to help propel semen
When the prostate is healthy — everything works as it should. When it is affected by cancer, enlarged, infected, or treated — things change. Sometimes temporarily. Sometimes permanently.
Understanding this before anything goes wrong gives you power. Power to ask the right questions. Power to make informed decisions. Power to take action early — when your options are greatest.
💊 WHAT TREATMENT DOES TO SEXUAL FUNCTION — THE HONEST VERSION
Different treatments affect sexual health in different ways. Here is the honest breakdown that most men never get.
Surgery (Radical Prostatectomy)
Surgical removal of the prostate is one of the most common treatments for localised prostate cancer. The nerves responsible for erections run on either side of the prostate — and depending on whether nerve-sparing surgery is possible, erectile dysfunction after prostatectomy affects between 25% and 80% of men depending on age and surgical technique.
Ejaculation after prostatectomy is no longer possible in the traditional sense — because the prostate and seminal vesicles have been removed. This is called dry orgasm. Sensation and pleasure can still be experienced — but this is a significant change that men deserve to know about before they make treatment decisions.
Radiotherapy and Brachytherapy
This was my treatment. Brachytherapy involves implanting radioactive seeds directly into the prostate to destroy cancer cells from within.
I want to be completely honest with you about what this was like.
In the months following my brachytherapy, intimacy became something I dreaded. The side effects were severe and deeply personal. Pain during ejaculation. It felt like boiling water coming out of my body , when it should have been pleasure it was pain. Changes in the sensation of orgasm. A period where sexual function felt like something my body had simply withdrawn from me without warning.
I am not sharing this to frighten you. I am sharing it because I was not fully prepared for it. And the lack of preparation made it significantly harder to cope with.
Recovery does happen. Sexual function does return for many men — sometimes fully, sometimes partially. But the timeline is different for everyone and the journey is rarely discussed honestly.
Hormone Therapy (ADT — Androgen Deprivation Therapy)
ADT works by reducing testosterone levels — starving the cancer of the hormone it needs to grow. It is highly effective. But the side effects on sexual health are significant and immediate.
▸ Loss of libido — often dramatic and rapid
▸ Erectile dysfunction
▸ Changes in body composition — loss of muscle mass, increase in body fat
▸ Mood changes, fatigue, and emotional shifts that men are rarely warned about
▸ Hot flushes — yes, men on ADT experience hot flushes similar to those women experience during menopause
These side effects are real. They are significant. And they need to be part of every conversation about treatment options.
🧠 THE PSYCHOLOGICAL IMPACT — THE PART THAT IS ALMOST NEVER DISCUSSED
Here is what I want to spend a moment on. Because in my experience this is the piece that hits men hardest — and the piece they are least prepared for.
Prostate cancer and its treatment does not just affect physical sexual function. It affects identity.
For many men — particularly men of our generation — sexual function is deeply tied to how we see ourselves. Our confidence. Our sense of masculinity. Our feeling of being present and capable in our relationships.
When that changes — even temporarily — the psychological impact can be profound.
I have spoken to men who describe the loss of sexual function after prostate treatment as a grief. A genuine mourning process. And they felt ashamed of that grief. As if they were not supposed to care. As if they should just be grateful to be alive.
You are allowed to care. Both things are true at the same time. You can be grateful for your diagnosis being caught. And you can grieve the ways your body has changed. That is not weakness. That is being human.
💬 WHAT NOBODY TELLS YOUR PARTNER EITHER
This does not just affect you.
If you are in a relationship, your partner is navigating this alongside you — often without any information or support of their own. They may not know what to expect. They may be frightened of hurting you. They may misread your withdrawal as rejection. They may be carrying their own grief and fear with nowhere to put it.
The couples who come through prostate cancer treatment with their relationships intact — and many do — are almost always the ones who talked about it. Who named what was happening. Who gave each other permission to be honest.
That conversation starts with you.
✅ WHAT YOU CAN ACTUALLY DO — PRACTICAL AND PROVEN
Here is the part I really want you to take away from this post.
Because this is not hopeless. There is a great deal you can do — both to protect your sexual health proactively and to support recovery if you have already been through treatment.
Before treatment — ask these questions:
▸ What is the likely impact of this treatment on my sexual function?
▸ Is nerve-sparing surgery possible in my case?
▸ What is the realistic timeline for recovery of sexual function?
▸ What rehabilitation options are available to me after treatment?
▸ Can I speak to a specialist in sexual health rehabilitation?
Do not let these questions go unasked because you feel embarrassed. You have every right to this information.
Lifestyle factors that protect sexual health:
▸ Pelvic floor exercises — genuinely one of the most powerful things a man can do both before and after prostate treatment. Strong pelvic floor muscles support erectile function and urinary control. Do them every day. Three sets of ten. Morning, afternoon, evening.
▸ Cardiovascular exercise — blood flow is fundamental to erectile function. Men who walk thirty to forty minutes most days maintain significantly better erectile health than sedentary men.
▸ Testosterone-supportive lifestyle — good sleep, reduced alcohol, stress management, resistance training, and a diet low in processed food all support healthy testosterone levels which underpin sexual health.
▸ Reduce alcohol — alcohol is a vasodilator and a nervous system depressant. Regular heavy drinking is one of the most direct lifestyle contributors to erectile dysfunction.
▸ Quit smoking — smoking damages blood vessels throughout the body, including those essential for erectile function. The impact is direct and significant.
After treatment — rehabilitation options:
▸ Penile rehabilitation — a recognised medical approach that involves using medications, vacuum devices, and other interventions to maintain blood flow to penile tissue during recovery. Ask your consultant about this specifically.
▸ Sex therapy and relationship counselling — incredibly effective and vastly underused by men. A specialist can help both you and your partner navigate the changes with far less distress.
▸ PDE5 inhibitors — medications like sildenafil (Viagra) and tadalafil (Cialis) can be part of a rehabilitation plan under medical supervision.
▸ Talking to other men who have been through it — which is exactly what this community is here for.
🔥 THE BOTTOM LINE
Prostate cancer is the most common cancer in men.
Its treatments — surgery, radiotherapy, brachytherapy, hormone therapy — all have the potential to affect sexual function.
And yet the vast majority of men go into treatment without a full understanding of what might change, without a rehabilitation plan, and without anyone to talk to honestly about what they are experiencing.
That changes in this community.
You are allowed to ask these questions. You are allowed to talk about this. You are allowed to want answers.
And if you are going through something right now — or if someone you love is — please know that you are not alone and that there is support available.
💬 THIS IS A SAFE SPACE — DROP YOUR THOUGHTS BELOW:
Has prostate cancer or its treatment affected you or someone you know in this way?
What do you wish you had been told before treatment?
Or if you are pre-diagnosis — what questions does this raise for you that you want answered?
No judgment. No embarrassment. Just honest conversation between men who get it.
That is what this community is built on. 💙
Darryl Wright — Prostate Cancer Survivor and Men’s Health Coach
Instagram: @DarrylWrightHealth
Join our free Prostate Health community: skool.com/mens-health-tips-9377
The Prostate Health Essential Programme — 12 weeks of complete guidance including sexual health, pelvic floor rehabilitation, hormone health, and everything in between.
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Helping men reduce the risk of Prostate Cancer. By science-backed actions and my experiences of living with Prostate Cancer
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