Colorectal cancer is one of the more common cancers in men. While the risk increases with age, it can also occur in young adults.  Treatment can also impact your sex life, particularly after rectal cancer treatment. You may notice changes like less interest in sex, difficulty with erections, changes in ejaculation, or less pleasure. It’s also common to have concerns about bowel control or living with an ostomy, which can affect how you feel about intimacy. 

Colon Surgery 

Colon cancer surgery usually removes part of the colon and nearby lymph nodes, which are small glands that help fight infection. Sexual side effects are less common when cancer is higher in the colon. Surgery closer to the rectum can sometimes affect ejaculation. Some men may notice dry orgasm or less pleasure with orgasm. If you may want children in the future, ask your care team about sperm banking before surgery. 

Rectal Surgery and Sexual Side Effects 

 Rectal cancer surgery depends on where the tumor is located. Some men can have the bowel reconnected. Others need a permanent colostomy, which is an opening on the belly that lets stool leave the body into a bag. Side effects can include loose stools, urgency, leakage, erection changes, or dry orgasm, which means feeling orgasm but having little or no semen come out. Even with these changes, many men are still able to have a satisfying sex life, and support from the care team can help. 

 This surgery can also affect urination and erections because important nerves are nearby. Some men may have trouble starting urine flow, holding urine, or may need a catheter, a thin tube that drains urine, for a short time. These problems can improve, and your care team can help you manage them. 

Erection changes can be common after rectal cancer surgery, but the risk is different for each man. It depends on the type of surgery, age, and overall health. If this happens, there are treatments that may help. 

Radiation and Sexual Side Effects 

Radiation, which uses high-energy rays to treat cancer, can raise the risk of bowel or bladder leakage, erection problems, and dry orgasm. The risk may be higher when radiation is used with surgery. If these side effects happen, your care team can talk with you about ways to help.

FAP Surgery 

 FAP is a rare condition passed down in families that causes many colon polyps, which are small growths in the colon. Without treatment, the risk of colon cancer is very high. Surgery often removes the colon and rectum. A pouch may be made from the small intestine, so stool can still pass through the body.  

Living with FAP Surgery  

After FAP surgery, bowel movements may be more frequent and looser. Some men may have leakage or need a temporary ileostomy, which is an opening on the belly that lets waste leave the body into a bag, while the bowel heals. Yearly checkups are important to find problems early.   This surgery can be a big life change for young men. The good news is that erection changes and dry orgasm are not common when nerves can be protected. If you may want children in the future, ask your care team about sperm banking before surgery. 

 Major Pelvic Surgery  

Major pelvic surgery is sometimes used for advanced cancers in the pelvis, the lower part of the belly between the hip bones. It may remove the bladder, prostate, a gland below the bladder that helps make semen, colon, and rectum. After surgery, some men have two stomas, which are openings on the belly that let stool and urine leave the body into bags. Erections often do not return, but feeling in the penis and pleasure with orgasm may remain. If needed, men can ask about treatment options such as injections, a vacuum device, or a penile implant, a device placed inside the penis to help create an erection.  

Other Handouts That May Help  

• Treatment Options for Erection Problems 

• Help for Urine Leakage During Sex 

• Staying Sexually Active with an Ostomy 

Tips for Managing Erectile Dysfunction

Erection Problems: Causes and Treatments Cancer Related Urinary Incontinence