Changes To Orgasm And Ejaculation
After prostate cancer treatment you will still have feeling in your penis and you should still be able to have an orgasm, but this may feel different from before. Some men lose the ability to orgasm, especially if they’re on hormone therapy.
If you’ve had radical prostatectomy, you will no longer ejaculate when you orgasm. This is because the prostate and seminal vesicles, which make some of the fluid in semen, are both removed during the operation. Instead you may have a dry orgasm – where you feel the sensation of orgasm but don’t ejaculate. Occasionally, you might release a small amount of liquid from the tip of your penis during orgasm, which may be fluid from glands lining the urethra.
If you’ve had surgery for an enlarged prostate called TURP or radiotherapy you may get retrograde ejaculation. This is where the semen travels backwards into the bladder when you orgasm, rather than out through your penis. The semen is then passed out of the body when you next urinate. It isn’t harmful and shouldn’t affect your enjoyment of sex but it may feel quite different to the orgasms you’re used to.
Some men leak urine when they orgasm, or feel pain. Others find they don’t last as long during sex and reach orgasm quite quickly.
Surgery Effects On Erections
Some types of cancer surgery can affect erections. If any of these surgeries are part of your treatment plan, talk to your doctor before the procedure. Ask doctor about how your erections might be affected by surgery and what may be the best way to manage the problem.
- Radical prostatectomy: Removal of the prostate and seminal vesicles for prostate cancer
- Radical cystectomy: Removal of the bladder, prostate, upper urethra, and seminal vesicles for bladder cancer. Removal of the bladder requires a new way of collecting urine, either through an opening into a pouch on the belly or by building a new bladder inside the body.
- Abdominoperineal resection: Removal of the lower colon and rectum for colon cancer. This surgery may require an opening in the belly where solid waste can leave the body.
- Total mesorectal excision : Removal of the rectum as well as the tissues that support it for treating rectal cancer
- Total pelvic exenteration: Removal of the bladder, prostate, seminal vesicles, and rectum, usually for a large tumor of the colon, requiring new openings for both urine and solid waste to leave the body.
Most men who have these types of surgeries will have some difficulty with erections . Some men will be able to have erections firm enough for penetration, but probably not as firm as they were before. Others may not be able to get erections. There are many different treatments for ED that can help many men get their erections back.
A New Treatment Option For Bph
Experts at University Hospitals now offer a new, minimally invasive approach to treat BPH called UroLift®.
Instead of removing prostate tissue, this procedure implants a device that pulls the prostate away from the urethra on both sides and holds it in place. This widens the urethra and restores normal urine flow.
Its like opening a curtain, says UH urologist Irina Jaeger, MD.
This procedure is a nice alternative, because the side effects are very minimal, it can be done in the doctors office in 15 minutes or less and very little sedation is required, she says. And the results are pretty instant.
UroLift®has been in use for six years. Studies have shown that the procedure is safe, effectively relieves symptoms and does not affect sexual function.
The only side effects are a little irritation immediately after the procedure. Patients are typically back to their normal routines within a day or two.
How Effective Is Injection Therapy With Each Type Of Treatment
If oral erectile dysfunction drugs fail, injections into the penis can be an effective form of treatment for men who have undergone surgery or who have received radiation therapy for prostate cancer.
Overall, up to 80% of men will regain erections with the use of injection treatments. Side effects include occasional pain due to one of the drugs used for injection therapy, and the development of scar tissue.
Hormone Therapy Effects On Erections
Hormone treatment is commonly given for prostate cancer. Men given androgen deprivation therapy are at a high risk for sexual problems, including loss of sexual desire and erectile dysfunction. Erections may or may not recover when ADT is stopped. Erectile dysfunction drugs do not usually work in these cases because they don’t help with the loss of sexual desire.
Can I Have An Orgasm Without An Erection
Yes. An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm.
Treating Ed After Prostate Surgery
There are a few treatment strategies that may help you regain the ability to have an erection following prostate surgery, as long as you have at least one nerve bundle intact.
Some doctors may recommend a treatment strategy known as penile rehabilitation or penis rehab. Many health experts believe that the sooner youre able to get an erection after surgery, the more likely youll be able to gain better control of this side effect over time. Most doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal . The goal of penile rehabilitation is to preserve as much erectile function as possible through the use of medications and/or devices .
For some people, PR may involve the use of prescription medications. Oral medications known as PDE5 inhibitors are common treatments for erectile dysfunction. The most common one is sildenafil . Other PDE5 inhibitors include tadalafil , vardenafil , and avanafil .
In some cases, a specific type of device may be helpful in restoring normal erections. Known as vacuum therapy , this kind of treatment uses a vacuum pump to draw blood into the penis. Because a vacuum pump can lead to erections regardless of nerve disturbance, VT may be an important part of PR to help restore erections .
Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
Early Penile Rehabilitation After Surgery
As mentioned before, the recovery time for erections after surgery can be up to 2 years. If a man does not have an erection during this time period, the tissues in his penis may weaken. Once this happens, he will not be able to get an erection naturally. Some experts and doctors recommend different methods to promote erections starting within weeks or months after surgery to help some men recover sexual function. You may hear this called penile rehabilitation, or erectile rehabilitation.
Penile rehabilitation has 2 parts:
Making sure you are getting regular erections that are hard enough for penetration. Its best if you can have an erection 2 to 3 times a week. This will help keep the tissue in your penis healthy.
Using a low-dose pill to help the blood flow around the nerves and help the nerves heal.
Medicines to help produce erections pills such as sildenafil , tadalafil , or vardenafil are typically used in combination with other therapies or devices. Since the drugs might not produce an erection because they need the nerves responsible for erections to be healthy, penile injections or vacuum devices might be offered. See Managing Male Sexual Problems Related to Cancer to learn more.
Surgical Treatments For Bph
While many doctors claim to treat prostate enlargement with surgery, such claims are almost always related to improving urinary function. Since the prostate surrounds the urethra, symptoms of BPH almost always involve urinary function. If a man has severe urinary issues or blockage, surgery may help.
Some doctors recommend removing the prostate to resolve the urinary issues in severe cases. The prostatectomy will likely resolve the urinary issues, but the surgerys side effects will surely deteriorate the mans quality of life.
Surgery should never be the first choice to relieve problems associated with BPH. Any urologist recommending surgery as a first-line treatment for BPH is not providing patients with the best advice. Every surgery has side effects. Some can be minor and others life-altering. Many solutions can make BPH more tolerable without destroying a mans quality of life.
How Is Erectile Dysfunction Treated
Current treatment options for erectile dysfunction for men who have received treatment for prostate cancer include:
- Oral medications, such as tadalafil , vardenafil , avanfil , orÂ sildenafil
- Injections of medicine into the penis before intercourse
- Use of a vacuum constriction device to draw blood into the penis to cause an erection
- Drugs taken as a suppository placed in the penis prior to intercourse
- Penile implants
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.
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.
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.
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.
Safer Than Penetrative Sex
Are there any known health risks to masturbation?None of significance, Mutambirwa said. As any form of sex is exercise, the act of masturbation will have a protective role in preventing cardiovascular disease and depression.
When compared to penetrative sex, masturbation is safer as penetrative sex can lead to sexually transmitted infections.
According toMedical News Today, most negative effects associated with masturbation focus on how someone feels about the act itself, rather than the physical implications on the body.
Mutambirwa said if masturbation was causing psychological problems, the person should seek professional help from a mental health expert.
Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
Prostate Cancer And Occurrence Of Sexual Dysfunction
Although the prostate is close to the penis, there has been no report of sexual dysfunction caused directly by prostate cancer. However, if a growing prostate tumor causes lower urinary tract symptoms, such as prostate hypertrophy, it could decrease sexual function. That would be a secondary reduction in sexual function caused by severe lower urinary tract symptoms, rather than a direct effect of the prostate cancer. That is, prostate cancer does not directly cause abnormalities of the corpus cavernosum.
A sudden reduction in sexual function in patients with prostate cancer frequently occurs because of psychological instability caused by the occurrence of the cancer, and, in particular, depression., The occurrence of prostate cancer also often has a negative effect on the mental status of the female partner, causing a decrease in sexual function in the female partner. Because a diagnosis of prostate cancer simultaneously causes fear and anxiety in married couples regarding the effects of prostate cancer on their lives, it also creates an unstable mental status in their sex life, resulting in reduced sexual activity.
Enlarged Prostate And Erectile Dysfunction
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland. The prostate gland continues to grow throughout a manâs life, so, commonly when men get into older age, they may start experiencing urinary issues due to this enlargement. The enlargement of the prostate itself is unlikely to cause ED problems, but some of the medications or therapies used to treat it may lead to erectile disruptions.
âCertain medications like alpha-blockers or 5-alpha reductase inhibitors are commonly used to treat BPH, and they may have the side effect of erectile dysfunction in users.
If you are using these medications for your BPH and developed ED after starting your treatment, you may be able to speak with your doctor about other treatment options that have less risk of ED.
If oral medications fail to help with your BPH symptoms, a doctor may perform a surgical resection of the prostate to help with your BPH. Sometimes this procedure can lead to ED in a small percentage of men.
Getting Treatment And Support
Speak to your GP or doctor or nurse at the hospital.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether it’s for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.
Talking about sex
It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.
You can ask about sexual problems at any stage – before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they don’t then you may need to bring it up yourself.
Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic – they will be used to talking about sexual problems.
Our sexual support service
How Soon After Having Radiation Therapy Are Men Likely To Have Ed
Even with the most precise radiation therapy, men may experience some ED for the first few months after treatment. Many of the sexual side effects of radiation are slow and gradual, and may take as long as six months to several years to appear. Unfortunately, radiation-induced ED is usually permanent.
There are a number of treatments available like early post-treatment evaluation and early institution of a trial of drug treatment as soon as the patient experiences any trouble with his erectile function. Besides these various therapies can also be applied:
- First line therapy includes management of related medical conditions and psychological support combined with oral therapy.
- Second line includes vacuum erection device therapy, penile injection therapy, and transurethral prostaglandin suppository administration.
- Third line therapy is penile implant surgery.
Providing Your Medical History
At first, the doctor will probably ask you about your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer from depression? Are you under a lot of stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner?
As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when youve had erectile dysfunction. Your doctor may conduct a written or verbal screening test.
If the cause is clear a recent operation for prostate cancer, for example the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.
Psychological Effects Of Cancer Treatment On Erections
Many men report disappointment, fear, and distress when they have trouble with erections. They report they feel that something important is missing. Men may report a general unhappiness with life and depression when they have problems with erections. These feelings are a natural part of coping with erection problems. And most men, if they are able find effective treatments to help with their erections, will start to feel better. If these feelings are severe or persist, most men find it very helpful to see a mental health professional who specializes in sexual issues or a psychiatrist who can help address these feelings.
Worries about self-image and performance can sometimes lead to erection problems, too. Instead of letting go and feeling excited, a man may focus on whether he will be able to function, and fear of failure might make it happen. He may blame the resulting problem on his medical condition, even though he might be able to have an erection if he were able to relax.
A therapist or mental health professional who specializes in helping patients with sexual issues can often assist in the treatment of erection problems caused by anxiety and stress. Any treatment for an erection problem should be based on the results of a thorough exam, which should include both medical questions and certain medical tests.
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 Prostatitis And Other Prostate Problems Can Ruin Your Sex Life
4 min Read Time
You hear a lot about sex when it goes right you hear practically nothing about sex when it goes wrong.
For men struggling with prostatitis a condition where the prostate becomes inflamed or irritated or other prostate problems, the implications for your sex life can be startling.
How Common Is Prostatitis?It’s the most common urinary tract condition for men under 50. 2 million US men visit healthcare providers about prostatitis every year.
The prostate gland helps sperm travel during ejaculation and is part of the male reproductive system, explains the National Library of Medicine .
Common prostate problems, according to the National Institute on Aging, include:
- Acute bacterial prostatitis: Starts with a bacterial infection in the prostate
- Chronic bacterial prostatitis: A recurring infection
- Benign prostatic hyperplasia: Enlarged prostate but not cancerous
- Prostate cancer
When something goes wrong with the prostate, it can wreck your sex life. For example, chronic symptoms of prostatitis can lead to sexual dysfunction, including painful ejaculation or even a drop in libido, says the National Cancer Institute.
Here are other ways prostatitis and other prostate problems can put a cramp in your sex life and what treatment options are available.
What Will I Learn By Reading This
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect . Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
- What erectile dysfunction is
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate relationship.
Erection And Your Sex Life
There are three cylindrical bodies that make up the penis. The first one is the corpus spongiosum . It contains the urethra, which includes the head of the penis or glans. The others are the two corpora cavernosa or erectile bodies that extend from the pubic bones to the head of the penis. The structure is a sponge-like tissue and has irregular blood-filled spaces. For a firm erection to occur, this penis anatomy needs to function optimally.
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.
The Basics: How An Erection Occurs
At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.
Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis .
As the arteries relax, the thousands of tiny caverns, or spaces, inside these cylinders fill with blood. Blood floods the penis through two central arteries, which run through the corpora cavernosa and branch off into smaller arteries. The amount of blood in the penis increases six-fold during an erection. The blood filling the corpora cavernosa compresses and then closes off the openings to the veins that normally drain blood away from the penis. In essence, the blood becomes trapped, maintaining the erection.