Long-Term Side Effects of Penile Cancer Treatment

Penile cancer and its treatment can sometimes lead to long-term, life-changing side effects. Penile-sparing treatments are used whenever possible to limit these changes, but in some cases they can't be avoided.

Urination

Most men can still control the start and stop of urine flow after surgery. They're still continent because the ring of muscle (called the sphincter muscle) that controls urine flow is close to the bladder and is not affected by penile surgery. But if the surgery removes part of the penis (partial penectomy) or the entire penis (total penectomy), how a man urinates might change. In some cases, a partial penectomy leaves enough of the penis to allow relatively normal urination. But men who have had a total penectomy often must sit to urinate.

Sexuality

If cancer of the penis is diagnosed early, treatments other than penectomy can often be used. Conservative techniques such as circumcision, local therapy other than surgery (laser ablation, topical chemotherapy), or Mohs surgery may have little effect on sex and sexual pleasure once you have fully recovered.

Some of the changes caused by treatment affect the way a man thinks about sex. Though he may be physically able to have sex, thoughts and feelings may keep it from happening. For example, changes in the way the penis looks can cause decreased interest and problems having sex due to shame or embarrassment, Many men worry that they won't be able to satisfy their partner. And sometimes depression and anxiety can cause them to avoid sex.

Removing all or part of the penis can have a huge effect on a man’s self-image and ability to have sex. You and your sex partner may wish to consider counseling to help understand the impact of penile cancer treatment and to explore other methods of sexual satisfaction.

Satisfying sex is possible for many, but not all men after partial penectomy. The remaining shaft of the penis can still become erect with arousal. It usually gets enough length for penetration. The most sensitive area of the penis (the glans, or “head”) is gone, but a man can still reach orgasm and ejaculate normally. His partner should also still be able to enjoy sex and often reach orgasm.

Intercourse is not possible after total penectomy. Some men give up sex after this surgery. Since cancer of the penis is most common in elderly men, some are already unable to have sex because of other health problems. But if a man is willing to put some effort into his sex life, pleasure is possible after total penectomy. He can learn to reach orgasm when sensitive areas such as the scrotum, skin behind the scrotum, and the area around the surgical scars are caressed. Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement.

A man can help his partner reach orgasm by caressing the genitals, by oral sex, or by stimulation with a sexual aid like a vibrator.

After total penectomy, surgical reconstruction of the penis might be possible in some cases. If you're interested in this, ask your doctor if this might be an option for you.

Removing all or part of the penis can also have a devastating effect on a man’s self-image. Some men might feel stressed or depressed, or might not feel “whole” after the operation. These are valid and understandable feelings, but they can often be helped with counseling or talking with others. For more information, see Sex and the Man with Cancer.

Lymphedema

The lymph nodes in the groin and the vessels that connect them help fluid drain out of the groin and lower part of the body and back into the bloodstream. If the groin lymph nodes are removed or treated with radiation, it can sometimes lead to problems with fluid drainage in the legs or scrotum, causing abnormal swelling. This condition is called lymphedema. The chances of it developing vary greatly.

This problem was more common in the past because more lymph nodes were removed to check for cancer spread. Today, fewer lymph nodes are usually removed, which lowers the risk of lymphedema. But lymphedema can still happen, even with less treatment. And it can be a life-long risk. For more on this, see our Lymphedema section.