This handout explains how bladder cancer and its treatment may affect sex, urination, and daily life. It is normal to have questions or worries. The Iris care team is here to help explain your options, answer sensitive questions, and support you in managing side effects.  

Bladder cancer symptoms can include blood in the urine, pain, sudden urges to urinate, or needing to urinate often. If you notice new or worsening symptoms, contact your care team so they can explain what may be causing them and what steps may come next.

 Sex and Early Bladder Cancer Treatment 

• If the cancer has not grown into the bladder muscle, treatment often starts with TURBT. During TURBT, the doctor passes a thin tool through the tube that carries urine out of the body and removes the tumor from inside the bladder. 

• After cystoscopy or TURBT, some men notice weaker erections for a short time, but long-lasting sexual problems are less common. 

• Some men also receive medicine placed directly into the bladder, such as BCG or chemotherapy. This treatment can help lower the chance that the cancer will come back or grow deeper into the bladder wall. 

• These side effects are usually short term. They can include fever, flu-like feelings, bladder pain, needing to urinate often, and blood in the urine. 

 Surgery to Remove the Bladder 

Radical cystectomy is surgery to remove the bladder when cancer has grown into the bladder muscle. The surgery usually removes the bladder, prostate, seminal vesicles, and nearby lymph nodes. Sometimes the tube that carries urine out of the body also needs to be removed. This can feel overwhelming, and your care team can help you understand what to expect, review your options, and answer your questions. Some surgeons use laparoscopic or robotic methods, which may reduce blood loss or shorten the hospital stay, but they have not clearly been shown to improve cancer control or erection recovery.  

After the bladder is removed, the surgeon must create a new route for urine to leave the body. The best choice depends on your health, daily routine, and what matters most to you. Your care team can explain each option in simple terms.  

There are several ways to create a new path for urine after bladder removal. Each option affects daily routines differently, so it can help to compare how urine leaves the body, whether a bag or catheter is needed, and how leaks may be managed. 

Ileal conduit: This is the most common option after bladder removal. A small piece of intestine is used to connect the kidneys’ drainage tubes to an opening on the belly called a stoma. Urine drains into a bag worn outside the body. It is important to empty the bag before it gets too full. At night, a larger bedside container may help collect urine while you sleep.  

Continent ostomy: A continent ostomy is a pouch made inside the body. The surgeon also creates a small opening on the belly. This option does not use an outside bag. 

Urine does not drain all the time. Instead, you empty the pouch with a thin tube several times a day. Urine leaks can still happen, especially at night. 

During sex, a pad or support wrap over the stoma may help if you are worried about leaking. 

Neobladder: A neobladder is a new bladder made from part of the intestine. It is placed inside the body, and urine leaves the body through the usual tube and through the penis. 

A neobladder is only an option if the urethra can stay in place. If the urethra must be removed, a neobladder is usually not possible. 

A neobladder does not empty on its own like the original bladder. You will need to empty it on a schedule. Some men also need to use a catheter to empty it fully. Urine leaks are common, especially at night. 

Sex after Bladder Surgery 

Sexual changes are common after bladder surgery. Erections may be weaker or may take time to return. Medicines, counseling, and support from your partner or care team can help many men adjust and continue to have a satisfying sex life after treatment. 

If the tube that carries urine out of the body also needs to be removed, firm erections after surgery are much less likely. Your care team can talk with you about what this may mean for sex and what support options may be available. 

After this surgery, orgasms are usually dry because the prostate and seminal vesicles have been removed. A dry orgasm means little or no semen comes out during orgasm. If you may want children in the future, ask your care team about sperm banking before surgery. 

Some men feel uncomfortable about scars or worry about urine leaks during sex. These concerns are common. Counseling, mental health care, partner support, and practical tips from your care team can help you feel more comfortable and confident. 

You do not have to handle these changes alone. If you have questions about sex, fertility, bladder care, urine leaks, body changes, or stress, talk with your care team. Help and support are available. 

Related Iris Handouts 

• Erection Problems: Causes and Treatments 

• A Guide to Treatments for ED 

• Dealing with Urine Leakage during Sex for Men