How To Return To An Active Sex Life After Prostate Cancer Treatment
No matter the cancer, treatments often cause side effects that affect patients quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patients sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.
Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery, says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta. The degree of dysfunction depends on many factors, including the patients overall health, co-existing medical problems, as well as the patients level of sexual function and ability before treatment.
Urine Leakage During Ejaculation
Climacturia is the term used to describe the leakage of urine during orgasm. This is fairly common after prostate surgery, but it might not even be noticed. The amount of urine varies widely anywhere from a few drops to more than an ounce. It may be more common in men who also have stress incontinence.
Urine is not dangerous to the sexual partner, though it may be a bother during sex. The leakage tends to get better over time, and condoms and constriction bands can help. If you or your partner is bothered by climacturia, talk to your doctor to learn what you can do about it.
Causes Of Prostatitis Past Bacterial Infections
If you have experienced bacterial infections before, whether they are urinary tract infections or other bacterial infections, this can affect whether or not you have prostatitis in the future. This type of prostatitis is more difficult to treat as it is harder to tell the exact cause of your infection. If you have experienced a past bacterial infection, especially when your reoccurring urinary tract infection never seems to disappear, go to sit your doctor immediately. It is very important for you to follow the doctors instructions and complete the treatments in order to ensure that all of the symptoms are gone away.
In fact, they are also common causes of prostatitis, so you should try to treat these infections completely as soon as possible to reduce the risks of developing prostatitis.
Its Complicated: Enlarged Prostate And Sex
BPH and sexual function
Prostate enlargement, also known as benign prostatic hyperplasia , and erectile dysfunction are separate problems. Both increase with age, but one causes problems in the bathroom and the other in the bedroom. However, the two are somewhat linked.
BPH happens when your prostate becomes enlarged, but cancer isnt the cause. A mans prostate continues growing throughout most of his adult life. This is why many older men are affected by the condition.
ED is the inability to get or maintain an erection. It can be caused by physical conditions such as:
It can also be caused by psychological issues.
These two conditions dont necessarily seem linked, but certain treatments that relieve BPH can cause ED and other sexual side effects. On the other hand, treating ED can improve enlarged prostate symptoms.
- inability to empty the bladder
- a weak urine stream
A surgery called transurethral resection of the prostate can help relieve these symptoms. Men who have this procedure often experience sexual side effects after surgery.
Between 50 and 75 percent of men experience retrograde ejaculation after TURP, according to Harvard Medical School. This means that semen released during orgasm enters the bladder rather than exiting the penis. Retrograde ejaculation is sometimes called dry orgasm. Its not harmful but can affect male fertility.
What Are Common Prostate Problems What Are The Symptoms And Signs
Here are some examples of non-cancer prostate problems:
Benign prostatic hyperplasia, or , means your prostate is enlarged, but is not cancerous. It is very common in older men. An enlarged prostate may make it very difficult to urinate or cause dribbling after you urinate. You may feel the need to urinate a lot, often at night. See your family doctor for an exam. Treatments for BPH include:
- Watchful waiting, also called active surveillance. If your symptoms are not too bad, your doctor may tell you to wait before starting any treatment to see if the problem gets worse. Your doctor will tell you how often you need to return for checkups. You can start treatment later if your symptoms worsen.
- Medications. There are medicines that can help shrink the prostate or help relax muscles near your prostate to ease your symptoms. Talk with your doctor about possible side effects.
- Surgery. If nothing else has worked, your doctor may suggest surgery to help urine flow. There are many types of BPH surgery. Talk with your doctor about the risks. Regular checkups are important after surgery.
- Other treatments. Sometimes radio waves, microwaves, or lasers are used to treat urinary problems caused by BPH. These methods use different kinds of heat to reduce extra prostate tissue.
Will Treatment Cause Erectile Dysfunction
When youre sexually excited, nerves cause tissues in your penis to relax, allowing blood to flow into the organ. The nerves that control erection are very delicate. Surgery or radiation for prostate cancer may damage them enough to cause ED. When you have ED, you cant get or keep an erection.
Radical prostatectomy is a surgery to remove the prostate gland. When your surgeon removes the gland, they may damage the nerves and blood vessels that run along it. If theyre damaged enough, you wont be able to get an erection following the procedure.
Today, doctors can do nerve-sparing surgery, which helps prevent permanent ED. Your surgeon can still touch those nerves and blood vessels, causing ED as a temporary side effect. Many men have trouble getting an erection for a few weeks, months, or even years after their procedure.
Radiation therapy also damages blood vessels and the nerves that control erection. Up to half of men who have radiation for prostate cancer experience ED afterward. In some men, this symptom will improve with time. Sometimes radiation side effects dont appear until a few months after the treatment. If ED starts late, it may not be as likely to go away.
A few treatments can help with ED until youre able to have erections on your own again.
Additional treatments include the following:
Treatment For Urinary Problems
If your urinary problems are caused by infection or enlargement of the prostate gland, treatment may include:
- a long course of antibacterial medication because infection is difficult to get rid of, the antibacterial medication will need to be taken for many weeks
- medication to improve urine flow and other symptoms
- surgical procedures the type of surgery required depends on the size of the prostate and the condition of the urethra. Types of procedures include:
- transurethral resection of the prostate
- transurethral incision of the prostate
- laser resection of the prostate
- open surgery prostatectomy
- removal of prostate tissue using water jets or steam
What Causes Prostate Cancer
Experts have not been able to pinpoint the reason that cells within your prostate become cancerous. However, a number of factors appear to play some part in triggering the process.
Your cells have specific instructions regarding what theyre supposed to do: when to grow, when to divide and form new cells, and when to die. They get those instructions from your genes, which you inherit from your parents, and which are made up of DNA, a chemical within your cells. That DNA can be damaged, causing genes to send the wrong instructions to your cells. For example, genes that normally help prevent cells from growing out of control may stop working properly. And that may lead to cancer.
Why does this happen? In some cases, you inherit faulty genes from one or both of your parents, or you have a family history of other types of cancers.
Causes Of Prostatitis Immune Responses
When it comes to common causes of prostatitis, you should not forget immune responses. Many patients are intrigued with the immune system and it can be a cause of the symptoms of prostatitis. This may make this disorder similar to rheumatoid arthritis, diabetes, asthma, lupus, allergies and a few other diseases.
Why Does Erectile Dysfunction Happen With Prostate Cancer Treatment
To help you understand why prostate cancer treatment may cause you to have erectile dysfunction, it is good for you to learn how your body may be changed by your treatment. Usually when a man is sexually aroused :
The prostate is a gland that is about the size of a walnut. It sits around the urethra like a donut. The urethra is the tube that carries urine and semen to the outside of your body. Located near the prostate gland are the nerves, blood vessels and muscles needed to have an erection and to control your bladder. When you have a radical prostatectomy, you have surgery to remove your prostate gland. These nerves, blood vessels, and muscles may be weakened when you have surgery for your prostate cancer.
Radiation therapy may damage the nerves near your prostate gland that help you have erections. Over time, you may notice that you are not having as many erections as you used to. Some men start having erectile dysfunction six months or more after their radiation therapy. If this happens, the erectile dysfunction usually does not improve.
Erectile Dysfunction Recovery After Treatment
You may be offered an ED recovery package soon after treatment. This is usually called penile rehabilitation. You regularly use one or more treatments, such as tablets or a pump, to encourage blood flow to the penis after surgery or radiotherapy. This is to help the penis recover it is not just for sex. When you are ready to start having sex, you should have a better chance of getting an erection. Your doctor or nurse can tell you more about this.
We have more information on managing ED.
Does Having More Ejaculations Lessen The Chance Of Prostate Cancer
For reasons not fully known, ejaculating more may lower the risk of prostate cancer.
Ejaculating after all, based upon some studies, through sexual intercourse or masturbation, does not seem to protect against higher risk prostate cancers. The studies do not sort out between ejaculating during sexual intercourse or masturbation, and the effect of each on prostate cancer.
One study followed 32,000 men for 18 years. It found men who ejaculated the most had a 20% lower chance of prostate cancer vs. those who ejaculated 4 to 7 times a month. The more the number increased per month, the lower their risk. Other studies have found ejaculation rate has no impact on prostate cancer rates.
Ejaculation may protect the prostate by flushing out harmful chemicals that build up in semen. It is also possible ejaculation does not actually protect against prostate cancer. Men who ejaculate more may have healthier lifestyle habits that decrease their odds of being diagnosed with the disease. Additionally, ejaculating may only reduce the risk in men in certain age groups.
The bottom line is more research is needed before we know for sure whether more ejaculation reduces the risk of prostate cancer.
Dr. Anne Calvaresi is the chair of the Urology Care Foundation’s Prostate Health Committee. She works in Philadelphia and specializes in urology and prostate health.
At What Age Should Men Be Screened For Prostate Cancer
Here’s what the American Cancer Society says about when to pursue prostate cancer screening:
Beginning at age 50, the organization recommends that you discuss the pros and cons of screening with your doctor.
If youre at higher risk of prostate cancer, this discussion should take place:
At age 45 for African American men, and for men who have a first-degree relativemeaning, a father or brotherwho has or had prostate cancer.
At age 40 for men who have more than one first-degree relative diagnosed with prostate cancer, and for men with a family history of either breast or ovarian cancers linked to the BRCA gene mutations.
Men over 70, and those who are not expected to live more than 10 more years due their current health or age, should not be screened. Even if they have prostate cancer, the disease likely wont cause symptoms during the remainder of their lives.
Are There Things I Can Do To Help Myself If I Have Erectile Dysfunction
Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.
Some changes you may want to consider are:
- Try to exercise on a regular basis.
- Try to eat a healthy diet.
- Drink responsibly. Long-term, heavy drinking lowers your ability to have an erection.
- Stop smoking. Research studies show that smoking can harm your ability to have sex. If you need help to stop smoking, speak with your doctor or healthcare team.
- Practice your Kegel exercises. Kegel exercises help strengthen your pelvic floor muscles, which support your bladder and bowel. These muscles also help with erections. For more information, please see the IMPACT booklet, Kegel Exercises for Men.
How Do Doctors Know If Prostate Cancer Has Spread
If you are diagnosed with prostate cancer, you may need to undergo further testing to determine whether it has metasticized beyond your prostate to other parts of your body.
Computed tomography scans. This type of scan uses X-rays to create detailed images from multiple angles. It can be used to determine the size of tumors on your prostate. You also may undergo this if your doctor suspects that your cancer has spread beyond your prostate to nearby lymph nodes.
Bone scans. When it spreads, prostate cancer often affects the bones. To see if this has happened, you will be injected with a small amount of radioactive material that will allow a special type of camera to pick up signs of cancer in your bones.
Additional MRI scans. MRI images can help your doctor determine how far your prostate cancer has progressed, including whether it has spread beyond your prostate to other parts of your body.
How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.
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At the start, prostate cancer does not cause symptoms. As the cancer grows, you may have trouble urinating. Some men need to urinate often, especially at night. Others have pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.
To find out if these symptoms are caused by prostate cancer, your doctor will ask about your past medical problems and your family’s medical history. He or she will perform a physical exam. During the exam, your doctor will put a gloved finger into your rectum to feel your prostate for hard or lumpy areas.
Your doctor may also do a blood test to check the prostate-specific antigen level. PSA levels can be high in men with an enlarged prostate gland or with prostate cancer. You may also need an ultrasound exam that takes computer pictures of the prostate.
If tests show that you might have cancer, your doctor will want to confirm this with a biopsy. He or she will take out tiny pieces of the prostate to look for cancer cells. Your doctor may want to do a biopsy again to re-check the results.
Treatment for prostate cancer depends on whether cancer is in part or all of the prostate or if it has spread to other parts of the body. It also depends on your age and overall health. Talk with your doctor about the best treatment choice for you. You may want to ask another doctor for a second opinion.
Can Too Much Sex Cause Prostate Cancer
I am a 52-year-old man who is reasonably fit and healthy.
Like most men approaching their fifties, I have begun to hear more about the prostate.
I have no idea what it is, and how to look after the prostate for the future.
I understand that prostate symptoms will result in dribbling, slow flow and nighttime urination. Thankfully, I have none of these symptoms.
However, I must confess I am somewhat worried about the sexual mischief of my youth, and perhaps over-indulgence in sex which may result in prostate cancer in later years. I am hoping you can clarify a few things for me.
What exactly is the prostate? What does it do?
How do I know whether my prostate is in a good state of health?
Can I self-examine my prostate?
Who exactly is at risk of getting prostate cancer? Any prevention?
Is it true that a sedentary lifestyle can cause prostate cancer?
Is there a link between prostate cancer and sex?
Would too much sex induce cancer in the prostate?
Most men would experience some degree of urinary symptoms by the age of 50, as the occlusion of the urinary flow may cause slowness in urine flow. This can also result in the incomplete voiding, causing frequent urination in the day and night. The enlargement of prostate is also commonly associated with erectile dysfunction. Around 60% of men with urinary symptoms commonly reported erectile dysfunction, and similarly about half of men with erectile dysfunction also complain of obstructive urinary flow.
Less Sex For Prostate Cancer Prevention
Another study published more recently in the same journal found that men who have lots of sex in their twenties and thirties are more likely to get prostate cancer, especially if they masturbate a lot.
This study, done at the University of Nottingham in England, also relied on questionnaires. The study participants included 431 men with prostate cancer diagnosed before age 60 and 409 men without prostate cancer. Among its findings were that men with prostate cancer are more likely to have had female partners, more likely to have had a sexually transmitted disease, and more likely to masturbate.
Lifestyle And Diet Root Causes Of Bph And Ed
The root cause of erectile dysfunction, whether it comes as a result of BPH or not, is almost always a blood circulation issue.
To achieve a satisfactory erection, a man must have relatively decent blood circulation throughout his body. The penis becomes erect through a series of neurological and physical processes.
The neurological process occurs in the brain when the man becomes sexually aroused. It initiates physical, sexual arousal, which then triggers the process of inflating the penis with blood to achieve a sufficient erection.
However, if arteries are clogged with plaque deposits, they certainly cannot deliver adequate blood flow to the penis for an erection. Thus, the erection is either weak, subsides quickly, or is non-existent. The most common circulatory issues that cause ED include but are not limited to the following conditions:
- High Blood Pressure
- Excessive alcohol use
- Cardiac Insufficiency.
Any effort to improve symptoms of either BPH or ED must address the circulation issue if there is to be any degree of improvement. Note that BPH is not included on the list above because it usually occurs in a combination of one or more of the other listed items.
Contrary to popular belief, erectile dysfunction is not a benign condition. An erection is wholly dependent on good blood circulation. The penis requires unimpeded blood circulation to produce an erection for sexual activity.
If You’re A Gay Or Bisexual Man
To be the active partner during anal sex you normally need a strong erection, so erection problems can be a particular issue. You could try using a constriction ring around your penis together with another treatment like PDE5 inhibitor tablets, to help keep your erection hard enough for anal sex.
If you are receiving anal sex, a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find that their experience of sex changes if they have their prostate removed .
If you receive anal sex, then bowel problems or sensitivity in the anus may be an issue after radiotherapy. Its best to wait until your symptoms have settled before trying anal play or sex. If youve had permanent seed brachytherapy there is a risk in the first few months that your partner might be exposed to some radiation during sex. Talk to your doctor or nurse for further advice.
With all sexual changes you may be able to find ways to work through this.
Watch Martin’s story below for one gay man’s experience.
Watch other men’s personal stories about sex after prostate cancer.
How Are Prostate Cancer Stages Determined
Once all testing has been completed, your doctor will tell you the stage of your cancer, or how much it has progressed and whether it has spread beyond your prostate. The stage will help your medical team decide which treatment is best for you. The higher the stage, the more advanced your cancer. The most common way to stage prostate cancer is the TNM system, developed by the American Joint Committee on Cancer, which hinges on three important factors:
T : How much of your prostate the tumor affects
N : Whether the cancer has spread beyond your prostate to nearby lymph nodes
M : Whether your cancer has metastasized, or spread far beyond your prostate to your bones, to nearby organs such as your bladder or rectum, or to more distant organs like your lungs, liver, or brain.
The TNM system also includes your PSA level and your Grade Group, based on your Gleason score. With your stage designated, which is labeled in a range of T1 to T4 , a treatment plan can be developed.
Connection Between Ejaculation And Prostate Cancer
The amount of ejaculations included those from sexual intercourse, masturbation and nocturnal emissions . The one study found that men who ejaculated 21 or more time a month had a 33% decreased chance of developing prostate cancer compared to those who ejaculated 4-7 times a month. The second study showed that men who averaged 4-7 ejaculations a week showed a 36% decreased chance of developing prostate cancer, before the age of 70, as compared to men who ejaculated less than 2-3 times a week.
It’s not known how this increased rate of ejaculation leads to a decreased risk of prostate cancer. The theory behind it is that ejaculation expels potentially harmful or irritating substances from the prostate, thereby decreasing the chances of the occurrence of a malignancy.