Where Does This Leave You
Increasing availability of these previously expensive drugs is a tremendous help for men who have undergone radical prostate surgery. Despite the uncertainty regarding penile rehabilitation, there is no doubt that real-time erections often improve while on Viagra and so straightforward access to these drugs is essential for a speedy return to a functioning sex life after cancer, for those who want it.
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Alastair Lamb and Altan Omer have nothing to disclose.
Altan E. Omer MD FEBU is a Pelvic Uro-Oncology and Robotic Surgery Fellow at the Churchill Hospital, Oxford.
Emotions And Sexual Problems
Emotions about cancer and treatment can affect your interest in sex and your ability to be intimate with your partner. Concerns that you might need to talk about with your doctor include:
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Fear that the cancer will come back
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Feeling sad, frustrated, or powerless
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Feeling bad about changes in your body
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Being stressed, depressed, or anxious
Your partner might also feel these emotions. Talk with each other about your feelings and concerns, including how they can affect sexual health. Having these feelings without talking about them can get in the way of being intimate, both physically and emotionally.
Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
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Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
Pde5 Inhibitors: Viagra Levitra And Cialis
Approved by the FDA in 1998, sildenafil revolutionized the way we think about and treat erectile dysfunction, largely because it is so easy to use and effective. Since then the FDA has approved three closely related drugs, vardenafil , avanafil and tadalafil .
All four drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, its important to realize that none of these drugs is an aphrodisiac. Youve got to feel sexually stimulated in order for them to work.
The main differences between the drugs have to do with timing: how quickly they begin to work, and how long their effects last . Levitra may start working slightly faster than Viagra although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who dont respond to Viagra. And while some doctors are skeptical about this claim, theres no harm in trying Levitra or Cialis if Viagra doesnt work for you.
Cialis has also been approved to treat men with both erectile dysfunction and BPH. The dose is lower, usually 5 milligrams per day.
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Nerve Damage From Chemotherapy
Some chemo drugs like cisplatin, vincristine, paclitaxel, bortezomib, and thalidomide can damage parts of the nervous system, usually the small nerves of the hands and feet. These drugs have not been found to directly injure the nerve bundles that allow erection. But some people have concerns because the drugs are known to affect nerve tissue, and there are many nerves involved in sexual function.
Can Masturbation Cut Prostate Cancer Risk
In this area of interest, a study that took information from 32,000 men looked at whether regular ejaculation helps to prevent prostate cancer.
The researchers published their work in the journal European Urology and reported that more frequent ejaculation might lead to a lower risk of prostate cancer.
Among men aged 2029 years old who had 21 or more ejaculations a month, there were 2.39 fewer in every 1,000 who developed prostate cancer when the researchers compared them to those ejaculating 47 times a month.
Among men who were aged 4049 years old, there were 3.89 fewer people per 1,000 who developed prostate cancer.
The reasons for these results are unclear, but one theory refers to prostate stagnation. This means that less frequent ejaculation allows prostate secretions to build up, possibly contributing to cancer.
An earlier study threw light on other potential aspects of prostate cancer, indicating that frequent sexual activity in younger life increased the risk of prostate cancer. However, the study also indicated that this activity seemed to give protection against the disease when people were older.
While many men experience sexual issues following prostate cancer treatment, these issues are not often due to prostate cancer itself.
More active treatments for cancer, such as surgery, radiation therapy, or hormone therapy, may lead to sexual dysfunction.
Treatment options with a risk of erectile dysfunction include:
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The Real Reason You Cant Get An Erection
A lot of men come to me who are convinced they have erectile dysfunction .
Theyve gone to their doctors and gotten prescriptions for Viagra, Trimix, and Cialis. They think their sexual function is broken, and are looking for treatment options to bring erectile function back.
But Im not so sure.
These men need some kind of erectile dysfunction treatment, sure. But their problem might not be physical in nature. Their erectile dysfunction might not have anything to do with hormones or testosterone or use of alcohol or blood flow
There is an important difference.
Chemotherapy Targeted Therapy And Immunotherapy Effects On Erections
Other types of treatment for other types of cancer sometimes affect sexual desire and erections because certain drugs slow down testosterone output. Whether chemotherapy, targeted therapy, or immunotherapy drugs cause problems with erections depends on the type of cancer being treated and the type of drug or drugs being given. Some of the medicines used to prevent nausea during chemo can also upset a mans hormone balance. But hormone levels should return to normal after treatment ends.
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What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
What Can I As A Partner Expect
One of the effects of prostate cancer treatment is erectile dysfunction or impotence. This means that your partner may not be able to have erections that are hard enough for him to have sex with you or that he may not be interested in sex because of the medicine he is taking to treat his prostate cancer. This affects not only the man, but you, too, as his intimate partner. If you are the partner of a man with erectile dysfunction, it can be difficult to cope with changes in your sexual relationship. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in him staying away from intimate situations where he may feel under pressure to make love. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. This may not have anything to do with his feelings for you, but is a result of his cancer treatment. Erectile dysfunction can be difficult for both of you. You may want to reassure your partner that:
- Sex is not as important as long as he is healthy and that he is no less of a man to you
- You will work through it with him
- You understand his feelings
- He is important to you
It may help if you explain to your partner how important nonsexual touching and intimacy such as kissing and cuddling is to you.
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Tips For Maintaining A Healthy Sex Life
If loss of sexual function occurs after prostate cancer treatment, several options can help a person find pleasure in sex again or return to normal sexual function.
Researchers and counselors offer advice to those who wish to pursue an active sex life during and after prostate cancer.
Here are some of their tips.
Chemotherapy & Hormone Therapy
Chemotherapy does not often cause erectile dysfunction, though it may affect the desire for sexual activity. Your desire may change over the course of treatment. Hormone therapy, a common treatment for prostate cancer, can lead to a loss of desire for sex, erectile dysfunction, and difficulty achieving orgasm, which tends to develop slowly over the first few months of hormone therapy.
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Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
Sexual Desire With Prostate Cancer
Desire plays an important part in the initiation of sex, as well as thought life even without sex. Yes, prostate cancer can affect desire in many ways. Some of these include:
- Worry about performance
- The psychological impact of a cancer diagnosis
- Fatigue
- Self-image after prostate surgery
- Fear of recurrence, progression, and death
- Low testosterone levels due to treatment
Desire is more difficult to quantify than erection and less spoken of in general. Yet without this step, the others often go unaddressed as well. This is a good time for men to do something some men hesitate to do. Have a heart to heart with your partner and your doctor.
What is getting in the way of your desire? Is it fatigue? What can be delegated to someone else to allow you more time to dream? Are the emotions of cancer filling that place in your mind? Consider a support groupand if you don’t feel like driving and sitting in a room with other men, there are some excellent online prostate cancer communities.
Perhaps seeing a counselor would help? I’ve heard it argued that every single person could benefit from talking with a therapist during cancer treatment. Self-image? Many men are relieved to hear that their partners are very interested in helping – but may feel uncomfortable initiating the conversation. If it feels physical, talk to your doctor about coping. Approaches such as oxytocin treatments have helped some men, and other options are available.
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Does Sex Affect The Risk Of Prostate Cancer
In 2016, a study that appeared in European Urology looked at whether frequent ejaculation protects against prostate cancer.
The investigation involved almost 32,000 men and looked to build on previous research, which had found that more regular ejaculation seemed to lower prostate cancer risk.
This new research also concluded that ejaculating more often lowered the chances of prostate cancer.
However, the authors called for further research because other factors, aside from ejaculation, could account for the results. They could not confirm that ejaculation protects against prostate cancer.
One theory, which is known as prostate stagnation, suggests that ejaculating less often allows potentially cancer-causing secretions to build up.
It often helps people to hear about the experiences of others, which can make them feel less alone in their situation.
On healthtalk.org, men talk on camera about their experiences of sexual dysfunction and prostate cancer.
Questions To Ask Your Doctor Or Nurse
- How could my prostate cancer treatment affect my sex life?
- How soon after treatment can I masturbate or have sex?
- Which treatments for erection problems would be best for me? Can I get them on the NHS?
- Is there anything I can do to prepare myself before I start my prostate cancer treatment?
- What happens if the treatment doesn’t work? Are there others I could try?
- What other support is available to me?
- Can my partner also get support?
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Your Thoughts And Feelings
Changes to your body and your sex life can have a big impact on you. You may feel worried, unsatisfied, angry and some men say they feel like they’ve lost a part of themselves. There are ways to tackle these issues and find solutions that work for you.
Getting support
If you are stressed or down about changes to your sex life, finding some support may improve how you feel. There are lots of different ways to get support.
You are not alone. A lot of men, with and without prostate cancer have sexual problems. Talking to other men who have had similar experiences can help.
- Our sexual support service is a chance for you, or your partner, to talk to one of our Specialist Nurses with an interest in helping with sexual problems.
- Our one-to-one support service is a chance to speak to someone who’s been there. They can share their experiences and listen to yours.
- Our online community is a place to deal with prostate cancer together. You can talk about whatever’s on your mind. Anyone can ask a question or share an experience.
- Our Specialist Nurses can answer questions and explain your treatment options. You can also email or chat online with our nurses.
- Get in touch with your local prostate cancer support group.
Trained counsellors
Counsellors are trained to listen and can help you find your own ways to deal with things. Many hospitals have counsellors or psychologists who specialise in helping people with cancer – ask your doctor or nurse if this is available.
Sex After Prostate Cancer Radiation Treatment
A radiation oncologist is likely to administer radiation treatments. External beam radiation is a treatment delivered through a machine used to aim high-energy rays from outside the tumor into the tumor. Brachytherapy or seed implant treatment places small radioactive seeds within the prostate itself, giving the prostate gland localized radiation therapy. Forty percent of men report ED after radiation treatment.
A clinical study was conducted to determine if tadafil preserved erectile function in men treated with radiotherapy for prostate cancer. Among 221 participants it was observed that daily use of tadafil did not improve sexual activity. The findings did not support the use of Cialis to prevent ED. While men may not have positive results with Cialis, penile injections and erectile dysfunction pumps are usually successful treatments.
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What Can I Do Rehabilitation And Aids
Studies suggest that starting a program to promote erections about six weeks after surgery can help some men recover sexual function. Different methods are available, depending on your particular case, your level of motivation and the judgment of your surgeon. These penile rehabilitation programs focus on increasing blood flow to the area to encourage healing and help men have regular erections that are hard enough for penetration. Having two to three erections a week, even if there is no sexual activity, helps keep the tissues in the penis healthy.
There are different options to treat ED, and they may or may not be part of a rehabilitation program:
- Oral medication: sildenafil/Viagara®, tadalafil/Cialis® or vardenafil/Levitra MUSE
- Vacuum erection devices
- Penile self-injection with a prostaglandin: alprostadil/Caverjet/Edex
Talk to your provider in Roswell Park’s Genitourinary Center about the options available to you.
How Will Treatment Affect My Libido
Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.
Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive. Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge. If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal. This depends on your overall cancer treatment plan.
2013 study , about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy. The men said their smaller penis affected their relationships and their satisfaction with life.
For men who do experience this, the change in size is generally half an inch or less. This decrease in size may be due to tissues shrinking in the penis. These tissues may shrink because of nerve and blood vessel damage.
If youre concerned about this side effect, ask your doctor about taking a drug for an erectile dysfunction , such as Cialis or Viagra. The increased blood flow from these drugs may help prevent your penis from getting smaller. Theyll also help with acquiring and maintaining an erection.
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