Treatment for bladder cancer can result in side effects that can affect both urination and sexual health function. 

Sexual Issues with Noninvasive Bladder Cancer 

When the tumors are not invasive, they can be removed in an outpatient surgery called a transurethral resection of the bladder (TURB). Tumors, along with some muscle from underneath them, are removed through the cystoscope. Although having a cystoscopy does not have lasting effects, many men notice that their erections are weaker for a few days. 

Men who have repeated cystoscopies and intravesical therapy also sometimes develop new sexual problems. Although these treatments do not damage the nerves or blood vessels involved in erection or orgasm, having bladder pain and urinary frequency can interfere with a desire for sex. Others notice it hurts when they have an orgasm, probably because of inflammation in the bladder, urethra, or prostate. It may help to avoid sexual activity for a few days after a cystoscopy or intravesical chemotherapy when pain and other symptoms are most severe. It is important to ask your doctor when it is safe to return to sexual activity.   

Sex after Cystectomy 

A modified radical cystectomy is a procedure attempting to spare the neurovascular bundles (tissue containing nerves) next to the prostate. These nerves are needed to direct blood into the penis to produce an erection. Even if both nerves can be spared, the percentage of men who recover good erections is somewhat lower than for radical prostatectomy. It is difficult to give statistics, since it depends on a man's age, how strong his erections were before surgery, and the surgeon's ability to spare both neurovascular bundles. As with radical prostatectomy, recovery of erections, or ability to have a good result from PDE5-inhibitor pills like Viagra® or Cialis is more likely if both neurovascular bundles can be spared.   

After a radical cystectomy a man will have dry ejaculation. This is because the body's semen factory (i.e., the prostate and seminal vesicles) are removed as part of surgery. Sperm cells still develop in the testicles but have nowhere to go. They are absorbed into the body without any ill effects on health. If a man would like the option of having biological children in the future, he can attempt to cryopreserve sperm before having radical cystectomy.  

The nerves that help a man feel pleasure with caressing on and around the penis are not damaged in radical cystectomy. An orgasm could still feel satisfying, although men's experiences vary quite a bit, with some saying orgasms are weaker, others saying they feel the same. 

Sex After Urinary Diversion 

Depending on the type of urinary diversion, a man may fear that he will leak urine during sex from an ostomy appliance or from a neobladder (new bladder built inside the body), or that a partner will be turned off by his need to be hooked up to a drainage device to collect urine during sleep. Having an open conversation about this with your partner is important.   Counseling with a trained mental health professional may help couples cope with these issues in their sex lives. The need for troubleshooting during sex can depend on how self-regulated your urinary diversion type is. Some individuals can control when they urinate while others cannot. Here are some considerations:  

• Learn how to self-manage care of your urostomy as this can help you regain a sense of health and independence. 

• Consider wearing a smaller pouch during sexual activity. These small pouch covers need to be emptied more often, however are more discrete for short term situations where this is preferred. 

• To lessen the chance of a leak or odor during sex, always empty urine from the pouch before initiating sex. If you think you will have sex later on, avoid eating foods like asparagus or some processed meats that give urine a strong odor. 

Although having a continent ostomy sounds much more convenient than having to wear a pouch and faceplate, many continent ostomies can leak. If you have a continent ostomy, you do not have an appliance that can move around, leak, or even fall off during sex. On the other hand, continent ostomies do sometimes still leak. If you have leaks during sex, you may want to put a pad over the stoma and wear a wrap belt around it.