All treatment for penile cancer will alter the appearance of the penis and may affect sexual function. It is very important that both you and your partner are aware of these issues, and work through them together.

Men may feel less masculine and worry that they will not be able to fulfil their partner’s sexual needs. In this situation it is vital that men talk to their partner and explore other ways of maintaining a satisfactory sex life. Sometimes hugging, kissing, or petting can be just as fulfilling as penetrative sex. The use of adult toys such as massagers and vibrators may bring equal pleasure to both men and their partners. Adult films/pictures or role playing may also achieve similar results and fulfilment. Although men may feel that there is stigma attached to these types of sexual gratification, many people all over the world make use them to enhance their sex life. There are also other sensitive zones throughout the body that may allow men to have similar sensations of sexual arousal, for instance stimulation of the prostate gland or nerves behind the scrotum.

Effects of surgery on sex

Circumcision and wide local excision
The penis will be swollen and sore after these types of surgery but will heal and function normally. Following a wide local excision (to remove an area of cancer on the surface of the skin) there may be some scarring and a slight change of shape in the appearance of the penis. You should still be able to have an erection and maintain sexual intercourse as you did before surgery.
Glansectomy
The head of the penis (glans) is the most sensitive part. If it has been removed and a skin graft has been used to make it look as normal as possible there will be some initial swelling and inflammation. Once this has settled the penis should function normally but the sensation in the end may feel different. It may take some time for you to adjust to the appearance of your penis. The penis will be slightly shorter.
Partial penectomy
Men who have had a partial penectomy should still be able to maintain an erection and 4 cm of penis is enough for penetrative sex. They will still be able to ejaculate but it is likely to take some time for men to adjust to the appearance of the penis and they may need help in dealing with how their body looks. In this situation psychosexual counselling (below) will often help.
Total penectomy
Normal sexual intercourse will not be possible following a total penectomy and although men should be able to orgasm (sometimes by touching sensitive areas where the penis used to be), they will not be able to ejaculate.

Psychosexual counselling

Following treatment for penile cancer men may often feel isolated and self-conscious, unable to speak up about how they are feeling or talk to their partners. The aim of psychosexual counselling is to help you talk openly about how you are feeling to improve physical intimacy, and help you feel more comfortable about changes with your body. Psychosexual Counsellors are qualified counsellors or health care professionals who can help you come to terms with conditions that may cause sexual problems. Many treatment centres will have both cancer counsellors and psychosexual counsellors and it is a good idea before or after your treatment to ask about these services and how you can be referred for counselling.

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