Prostate, bowel and testicular treatment all change sex, and the conversation about it is usually the one nobody has. Recovery is real, it is measured in months, and it starts with someone actually asking.
Most of the men I see about this have not been asked, and have not asked. That is extremely common, and it is not because it does not matter. A busy cancer clinic is rarely a room where sex feels possible to raise. Coming to it a year or two later is not too late, and it is not a small thing to want back.
It can usually be treated, though the approach is different from other causes and recovery is measured in months rather than weeks. It often combines medication, devices, injections and psychological support, and the right mix depends on the surgery or radiotherapy you had and on what function matters most to you. That last part is a real question rather than a formality, and it is worth answering honestly.
Where a partner is involved, that is often the part which needs the most attention and gets the least. Illness reorganises a couple, sometimes into patient and carer, and sex is usually the first thing to stop and the last thing anyone mentions. Where that is what has happened, some of the work is better done together, and I can do that here rather than refer you on for it.
Cancer treatment is also one of the places EMDR fits most naturally. A diagnosis, a surgery, a catheter, months of appointments where your body was something being worked on: any of that can leave the body braced in a way that talking about it does not reach. It takes the charge out of a memory rather than erasing it, and where sex has become associated with the illness rather than with pleasure, it is often what lets the rehabilitation start to move. It is not right for everyone, and I would say so.
Erections most obviously, through nerve and vascular effects that depend on the surgery or the radiotherapy you had. Desire can change too, particularly on hormone treatment, and so can ejaculation and orgasm. Some of it recovers on its own over months, some of it needs active rehabilitation, and knowing which is which is most of what an assessment is for.
In ways that rarely get discussed. Insertive and receptive function are affected differently and both matter. Receptive sex after radiotherapy raises its own questions about pain and what is comfortable. Urology and oncology clinics are mostly built around a heteronormative picture of sex, and the rehabilitation conversation tends to assume penetrative sex with a female partner, which leaves a great deal unasked. You can ask here.
Rehabilitation after cancer treatment sits across the medical and the psychological, and it is usually split between people who do not speak to each other. I am a GP and a physician, a sexual medicine specialist and a registered psychosexual therapist, so the erections, the desire and what has happened between you and a partner get looked at together, in the same hour.
An hour, and most of it is talking. What treatment you had and when, what has changed since, what you have already tried, and what you actually want back. Examination is sometimes useful and always optional. Then I tell you what I think is realistic and over what sort of timescale, rather than leaving you to guess.
The clinic is at Central Health London, 23 Devonshire Place, Marylebone, a quiet and discreet address a short walk from Regent’s Park. Most men arrive anxious and leave relieved. You will be welcomed by reception, offered tea or coffee, and given time to settle before we start.
A first consultation is usually an hour. We go through your symptoms, your medical and family history, and your sexual experience, relationships and lifestyle: the medical, psychological and relational picture together rather than one at a time.
I will ask you a lot of questions. You do not have to answer any of them: saying "I would rather not answer that" is a complete answer and nothing follows from it. A physical examination is sometimes useful, particularly for erection problems, and it is always optional. You stay in control of the appointment throughout.
If you have had recent blood tests, send them ahead. If not I will arrange them, and I will tell you which ones need taking before 11am.
If you are in your fifties or sixties, have no GP you know well, do not much like going to the doctor, but recognise it is time to take your health seriously, this is a reasonable place to start. I often find things that matter and have been missed.
If you want help but are wary of seeing someone who is not comfortable talking about gay or queer sex, you can come to someone who does not need it explained, and who will not judge or shame you.
Men who have tried quick fixes, or had a purely medical or purely therapeutic approach that did not help. I see a lot of men for second opinions. And men of any age and in any kind of relationship who want to understand what is going on rather than be handed a prescription.
I am a GP, a sexual medicine specialist and a COSRT-registered psychosexual therapist, working at 23 Devonshire Place, Marylebone, central London, alongside NHS general practice in Hackney.
Most men reading a page like this arrived from a search rather than my homepage, so this is probably the first you have heard of me. The short version: I hold the medical, the psychological and the relational picture together in one appointment, rather than sending you to three people who each see a third of it.
More about how I workThese rarely arrive on their own. If one of these sounds closer to what you’re dealing with, start there instead.
If something doesn’t feel right, it’s worth understanding why, before deciding what, if anything, to treat.
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