Medical Oncologist
CION Cancer Clinics
Sexual function after rectal surgery in men | CION Cancer Clinics
The nerves that control erection and ejaculation run along the outside of the rectum, so removing the rectum can bruise or cut them. Many men notice weaker erections, dry orgasm or both afterwards. Bruised nerves recover slowly over months, and tablets, a vacuum pump or injections work while they do. This page explains what changes, why, who tends to recover less, and how to raise it with your team. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why does rectal surgery affect sex in men?
- The four changes men describe, and what causes each
- What can actually be done about it?
- The words the urologist uses, in plain language
- What men and their wives are often told, and what is true
- Who recovers less, and what this page cannot tell you
- Common questions about sex after rectal surgery in men
The short answer
Why does rectal surgery affect sex in men?
The nerves that control erection and ejaculation run along the outside of the rectum, so removing the rectum can bruise or cut them. Many men notice weaker erections, dry orgasm or both afterwards. Bruised nerves recover over months, and there are treatments that work while they do.
What the surgeon is trying to protect
Two sets of nerves. One set, high in the pelvis, controls ejaculation. The other set, lower down beside the prostate, controls erections. A surgeon removing a rectal cancer works right next to both. Where the cancer allows, the nerves are peeled away and left in place. Where the cancer sits against them, taking them is the safer choice, and your surgeon should tell you before the operation if that is likely.
Why radiotherapy adds to it
If you had radiotherapy before surgery, it also affects the blood vessels and nerves in the pelvis, and its effect can build slowly over the following years. Men who had both surgery and radiotherapy usually have more trouble than men who had surgery alone, and recovery is slower.
Erection and ejaculation are separate systems. It is common to lose one and keep the other.What men notice
The four changes men describe, and what causes each
Erections that are weaker or do not come
The commonest problem. The nerves that open the blood flow into the penis have been bruised. Morning erections and the response to touch may be reduced or absent for a while, then slowly return.
Dry orgasm
Orgasm happens but little or no semen comes out. Either the semen is going backwards into the bladder, or the muscles that push it out are no longer getting the signal. It is not harmful. It does mean natural fathering of a child may not be possible.
Less desire
Tiredness, a stoma, chemotherapy, low mood and fear of leaking all lower interest in sex. This is not a nerve problem and it usually lifts as recovery and confidence return. It deserves to be said out loud rather than blamed on the operation.
The stoma and the body
A bag on the belly changes how a man feels about being seen. Most couples find their way through this with time and a little planning.
What helps
- Emptying or changing the bag beforehand
- A small stoma cover or a fitted vest
- Telling the partner what you are worried about
Not sure whether this applies to you?
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What can actually be done about it?
Say it at the follow-up visit
Surgeons expect this question and most will raise it themselves. If yours does not, ask. Nothing below can start until someone knows there is a problem, and waiting a year in silence loses recovery time.
Give the nerves time, but not only time
Bruised nerves take months to recover. Using tablets or a pump early keeps blood flowing into the penis while that happens, which is thought to protect the tissue. Ask whether starting early makes sense for you.
Tablets first
Sildenafil (Viagra, Manforce) and tadalafil (Cialis, Tadalis) help many men once some nerve signal has returned. They are prescribed, not bought on advice from a chemist, because they are not safe with nitrate heart medicines. The prescribing doctor sets the amount and how often.
Devices and injections if tablets do not work
A vacuum pump draws blood into the penis and a ring holds it. A small injection into the side of the penis works even when the nerves are cut. A urologist teaches both. Implants exist for men where nothing else works.
Words you will hear
The words the urologist uses, in plain language
- Nerve-sparing
- An operation where the surgeon peels the pelvic nerves off the rectum and leaves them in place. Possible only when the cancer is not growing into them.
- Erectile dysfunction
- Erections not firm enough or not lasting long enough for sex. After rectal surgery it is usually a nerve problem.
- Retrograde ejaculation
- Semen flowing back into the bladder at orgasm instead of out. Harmless, and the urine may look cloudy afterwards.
- PDE5 inhibitor
- The family name for sildenafil and tadalafil. They do not cause an erection on their own; they make the response to arousal stronger.
- Penile rehabilitation
- Using tablets, a pump or both early after surgery to keep blood flowing into the penis while the nerves recover.
- Sperm banking
- Freezing a semen sample before surgery or radiotherapy so that a child is still possible later through assisted conception.
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Did you know
Orgasm does not need an erection. Many men are surprised to learn that the sensation and the climax come through a different nerve pathway from the one that fills the penis with blood, so both partners can still have pleasure while erections are recovering.
Commonly believed
What men and their wives are often told, and what is true
"At his age it does not matter any more."
It matters to the man, whatever his age, and it matters to the marriage. Doctors sometimes skip the subject with older patients. If it matters to you, say so at the visit, and ask for the same treatments a younger man would be offered.
"Sex could bring the cancer back or spread it."
It cannot. Cancer does not pass between partners and sexual activity does not affect whether it returns. Once your surgeon has said the wound and the join have healed, there is no medical reason to wait.
"If the tablets have not worked, nothing will."
Tablets need some working nerve to act on, so they often fail in the early months and work later. A vacuum pump and injections work by a different route and help most men for whom tablets did nothing. Ask for a urology referral rather than giving up.
"Dry orgasm means he is now infertile for good."
Sometimes, but not always. Sperm can often be collected from the urine after orgasm or taken directly, and used with assisted conception. If children are wanted, ask about this before surgery so that a sample can be frozen.
Being straight with you
Who recovers less, and what this page cannot tell you
Recovery is least likely where the nerves had to be removed with the cancer, where the whole rectum and anus were taken, and where radiotherapy was given as well. Older men, men with diabetes and men who had erection problems before the operation also tend to recover less. If several of these apply to you, ask about a pump or injections early.
What should be said before the operation
Whether the nerves are likely to be spared, whether a child is still wanted, and whether a semen sample should be frozen before surgery or radiotherapy. These are not questions to leave for afterwards. If the operation is already done, the urologist can still say what is possible.
What this page cannot tell you
It cannot tell you whether your own nerves were spared or how much they will recover. Only your surgeon, who knows what was done in the pelvis, can say that. It does not replace a check for other causes such as low testosterone or diabetes.
A counsellor at CION can see you and your partner together. Many couples find one conversation with a third person easier than the first one alone.Questions we are asked
Common questions about sex after rectal surgery in men
How long after surgery can I have sex again?
Once your surgeon has said the wound and the join have healed and you feel ready. There is no fixed date. If you have a stoma, empty the bag first. If a new perineal wound is still healing, some positions will be uncomfortable, so go slowly and stop if it hurts.
Will my erections come back on their own?
Where the nerves were bruised rather than removed, they often do, gradually, over the first year or two. Using tablets or a pump during that time is thought to help rather than hinder it. Where the nerves were removed, natural erections are unlikely, but injections and devices still work.
Is dry orgasm dangerous?
No. Semen that goes backwards into the bladder simply leaves with the next urine, which may look cloudy. Sensation and climax are usually unchanged. The one thing it affects is fathering a child naturally, which is why the subject should come up before the operation if a child is wanted.
Can I just buy sildenafil from the chemist?
Please do not. These tablets are unsafe with nitrate medicines for the heart and need care with some blood pressure drugs. A doctor should check what else you take, set the amount and say when to try. If the first attempts fail, that is common and does not mean the tablet is useless.
Will my wife be affected in any way?
Not physically. Nothing in surgery, radiotherapy or the medicines above passes to a partner. What partners feel is the silence. Most say they would rather be told what is happening than be left to guess why things have changed.
Does the stoma make sex unsafe?
No. The stoma has no feeling and is not damaged by normal sexual activity, though it should not be used for sex. Empty the bag beforehand, and a small cover or a snug vest keeps it out of the way. A stoma nurse can suggest products that suit you.
We want a child. Is it too late?
Ask before any treatment if you can, so that a semen sample can be frozen. After surgery, sperm can sometimes be retrieved from urine or directly and used with assisted conception. A fertility specialist can say what is possible in your case. Do not assume the answer is no.
Who do I talk to at CION about this?
Start with your surgeon at follow-up, or call the helpline and ask to speak to someone about sexual recovery after surgery. You can be referred to a urologist and to a counsellor, and you can bring your partner. It is an ordinary part of aftercare, not a special request.
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Sources
- National Cancer Institute — Sexual Health Issues in Men with Cancer
- Cancer Research UK — Bowel cancer: living with
- Macmillan Cancer Support — Bowel cancer
- NHS — Erectile dysfunction (impotence)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Sexual Function After Rectal Surgery in WomenThe same nerves, a different set of changesBladder Problems After Rectal SurgeryThe bladder shares the nerves that were bruisedTotal Mesorectal Excision: Why It MattersThe operation in which the nerves are peeled off the rectumRadiation Before Rectal Surgery: How It Changes ThingsWhy radiotherapy adds to the effect on sexual functionThe Emotional Side of Cancer SurgeryMood, confidence and talking to your partner
Talk to us
Want to talk to someone about this?
Tell us what operation was done and when. A surgical oncologist can explain what was seen in the pelvis and refer you to a urologist or counsellor. One helpline serves every CION centre.