Dealing With Erectile Dysfunction: For You And Your Partner
The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
Cut Back Or Change Antidepressants
Another thing to think about is any other medications youre taking, notes Dr. Kacker. Many men are, unknowingly, taking medications that suppress orgasm. By far the number one offender is the SSRI class of antidepressants, which include fluoxetine and Paxil . By reducing the dose of these drugs or eliminating them entirely, or switching to a non-SSRI like bupropion , many men see an improvement in their ability to orgasm.
Why Is Rehabilitation Important
Whether you are single, or in a relationship, you should have the opportunity to discuss penile rehabilitation with your doctor or specialist nurse. Self pleasuring is important for many people and this can play a part in rehabilitation. This might help to give you confidence and to become aware of the changes that your treatment might have caused.
It might still be worth talking to your doctor even if you are not sexually active, or dont plan to be. This is because penile rehabilitation has benefits in terms of keeping the penis healthy.
Ideally, rehabilitation should start soon after your prostate cancer treatment, or in some situations before treatment. For example, you should start rehabilitation within 3 to 6 months of starting hormone therapy or radiotherapy. Or within the first 3 months of surgery to remove the prostate gland.
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Physical And Psychological Effects Of Prostate Biopsy And Cancer Diagnosis
The incorporation of prostate-specific antigen measurement and the transrectal ultrasound biopsy probe into standard urologic practice had a dramatic impact on the incidence of prostate cancer in the United States and resulted in a trend toward earlier-stage disease at presentation. No longer were men presenting with late-stage disease or undergoing painful perineal biopsies. The biopsy no longer required an anesthetic or a hospitalization. Within a 7-year period , the annual number of cases diagnosed doubled. Most cases are now detected by PSA elevation, rather than by digital rectal examination.
Though generally well-tolerated when done under a local anesthetic, the TRUS biopsy is not without side effects or complications. In a prospective study of 211 men undergoing prostate biopsies, intraoperative pain was considered severe in 20% of the biopsy events. Preoperative anxiety was reported in 64% of biopsy events and was predictive of intraoperative pain. Anxiety continued post-biopsy and peaked before result disclosure. ED attributed to anxiety in anticipation of biopsy was reported in 7% of cases. The ED incidence doubled to 15% at days 7 and 30 after the biopsy, well after the anxiety associated with the biopsy resolved.
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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Getting Ready For Your Surgery
You and your care team will work together to get ready for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you arent sure.
- I take a blood thinner, such as:
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these complications, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling .
About sleep apnea
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device for sleep apnea, bring it with you the day of your surgery.
Ask about medications
Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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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.
Can You Get An Erection Without Testes
To understand the can penis get hard without testicles subject, we need to take a few moments to address the importance of testosterone. This male hormone plays an essential role in erectile function and the sexual and reproductive health of every guy.
Therefore, when production and concentration of testosterone are in decline, its obvious some changes will occur.
Generally speaking, removing one testicle can change hormone levels , but the body still continues to produce enough testosterone to make up for the missing one. Therefore, a man with one testicle can still have hard and firm erections. He can also have children.
But what about the removal of both testicles?
Can you get an erection without testes?
Upon the removal of both testicles, the body is unable to produce testosterone on its own. As a result, a man experiences reduction in his sex drive and impaired erectile function. Also, men who had both testicles removed become infertile and are unable to father children. Of course, nowadays, there are ways to preserve sperm before the removal of testicles.
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How Long Does Erectile Dysfunction Last After Prostate Surgery
Is erectile dysfunction a possibility after prostate surgery?
Many patients are concerned about it and prefer other prostate cancer treatments.
However, they should know that most erectile issues are temporary and improve after a while.
These patients usually recover from this problem after a few months.
In this article, we cover sexual function after prostate cancer surgery thoroughly, tell you how long ED can last, and how to cope with erectile problems.
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High Intensity Focused Ultrasound Or Cryotherapy
Treatments such as High Intensity Focused Ultrasound or cryotherapy may cause fewer erection problems. Researchers are still looking into these treatments and their long term side effects. There is still a risk of erection problems with these treatments. For example, to treat your cancer properly, the doctor may not be able to avoid the nerves.
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Sex After Prostate Surgery
When first diagnosed with prostate cancer, its common for men to wonder what the future will hold. Certainly, a prostate cancer cure is a top priority, but then what?
Dr. David Samadi understands that men want to know:
Will I have sex after prostate cancer?
How will sex after prostate cancer be different?
For many men, prostate cancer treatment choice determines these answers.
If you select robotic prostate surgery your chances of enjoying sex after prostate surgery are very high. Robotic prostatectomy is a minimally invasive prostate removal. It is considered one of the best treatment options for prostate cancer due to its success rate and fast recovery rate.
The da Vinci robotic prostate cancer surgery system enables the surgeon to make precise movements. This ensures cancer-removal efficiency and sparing of the nerves and muscles that are responsible for the sexual function.
However, it is absolutely critical to choose a robotic surgeon with a high case volume and extensive prostate surgery experience. The robot does not perform the surgery and technology is no guarantee of success. Enjoying sex after prostate surgery is only possible if the procedure was performed by an experienced, highly-trained robotic surgeon.
Dr. Samadi explains how the preservation of sexual function is possible:
Prostatectomy And Sexual Issues
As a man, your prostate gland plays several important roles in your bodys sexual and urinary function.
During sex, your prostate gland is responsible for releasing seminal fluid, or semen, into your urethra. As you reach orgasm and ejaculate, the muscle tissue of your prostate forces semen and sperm out from your penis.
The nerves that surround your prostate also play an important role in allowing blood to flow to the erectile tissue of your penis when youre sexually aroused.
Because prostate surgery involves removing the prostate gland, its normal to lose some parts of your normal sexual function after the surgery.
For example, radical prostatectomy involves cutting the connection between your urethra and your testicles. This means that sperm is no longer able to flow down your urethra and out the tip of your penis during sex.
As a result of this, men who undergo radical prostatectomy surgery can still reach orgasm, but arent able to ejaculate.
Several different approaches are used to remove your prostate gland during surgery. Some of these approaches particularly those used to treat prostate cancer may result in damage to the nerves that surround your prostate gland, testicles and penis.
Nerve damage caused by prostatectomy surgery may affect your erectile health. If your nerves need to be cut during the procedure , you may find it difficult or impossible to get and/or maintain an erection after surgery.
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Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
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Options After Initial Pde
The options for nonresponders to PDE-5 inhibitors include injection therapy, intraurethral prostaglandin, vacuum erection devices, and penile implants. The concomitant use of the PDE-5 inhibitors is discouraged in the regulatory documents for all 3 PDE-5 inhibitors. Nonetheless, there is a rationale for combination therapy. Corpus cavernosum smooth muscle relaxation, and hence penile erection, is regulated in part by increases in smooth muscle synthesis of the second messengers cyclic adenosine monophosphate and cyclic guanosine monophosphate . Intraurethral or intracorporeal prostaglandin E1 increases both second messengers. Therefore, in men with failure of PDE-5 inhibition or prostaglandin therapy, a synergistic effect might occur with combination therapy.
Along those lines, in my practice, I also combine sildenafil with intracorporeal injections in men after radical prostatectomy who are experiencing failure of intracorporeal injection therapy. The combined use of sildenafil with injection or MUSE therapy, though logistically cumbersome, has allowed some patients to avoid implant therapy.
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Restoring Erectile Function After Prostatectomy
In todays world, the overall mortality for almost every cancer is falling. In many cases, the incidence of various cancers is also declining.
However, for prostate cancer, the incidence has been steadily rising since the advent of the Prostate Specific Antigen test. 1
Considering that the American Cancer Society lists the 10 year survival rate for prostate cancer at 98 percent, this poses a problem. Is the 10 year survival rate due to excellent early detection and treatment, or was treatment not needed?
For many years, the medical paradigm for all cancer, including prostate cancer, has been to find and treat it early to effect a cure. It is well-known that prostate cancer can be very slow-growing and that some prostate cancer is of an indolent type that may never rise to a level of a significant problem.
Early detection and treatment of indolent prostate cancer that will likely never become life-altering are often more damaging than allowing natural disease progression. This is especially true regarding a mans quality of life.
In autopsy studies of men that died from causes other than prostate cancer, many were found to have long-term, undetected cancer in their prostates. This overdiagnosis and overtreatment can cause more harm to a man than living with the disease.
Sex When You’re Single
Being sexually active and feeling attractive can be just as important if you are a single man. All the treatments described here are available to you if you’re single – whether you want to be able to masturbate, have sex, or want to start a new relationship.
If you are starting a new relationship, sexual problems and other side effects like urinary or bowel problems could be a worry. Some men worry that having problems with erections will affect their chances of having a new relationship. Fear of rejection is natural, and everyone has their own worries, whether or not they’ve had cancer. If you’re single, you may want time to come to terms with any changes prostate cancer has caused before you start having sex or dating.
Try talking over your worries with someone you feel comfortable with, such as a friend. Counselling or sex therapy may also help if you would prefer to talk to someone you don’t know.
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Tips For Great Sex After Prostate Cancer
Its very likely that whichever prostate cancer treatment you choose prostatectomy surgery, hormone therapy, brachytherapy, external beam radiation, or HIFU will impact your sex life. Exactly how depends on which method you choose and your dedication to getting back in bed.
Once patients are assured that they will have sex after prostate removal surgery, they can shift their focus to enjoying sex as soon as possible, encourages Dr. David Samadi, creator of the SMART robotic prostate removal surgery.
While his innovative surgical technique and experience give men a tremendous leg up in sexual recovery after prostate cancer, men have to play an active role as well.
Known Side Effects Of A Radical Prostatectomy
So, what happens to a man when he has his prostate removed? There is a multitude of effects that occur to men after they have had prostate removal surgery.
The procedure is major pelvic surgery, and, as such, it carries along with it many potential risks. In addition to the immediate effects of the surgery, the removal of the prostate causes long-term side effects that are generally permanent.
Until recently, these side effects about what happens to a man when he has his prostate removed have not been relatively well-classified.
Most side effects are those reported by urologists that are performing the surgery. This reporting has been, in past years, rather poorly detailed and sparse due to the surgeons not anxious to publicize the failures of a procedure, they have attached a gold standard label.
The most reported side effects are erectile dysfunction and urinary incontinence.
Unfortunately, even though doctors have filed reports, the bias of the doctors filing them is questionable.
For example, one report details one of the significant side effects, postoperative erectile dysfunction, occurs between 14 and 90 percent of patients. This is a relatively wide range.
Based on my many years of practice, it is a very optimistic estimate. And it is likely provided by urologists who either do not want to admit their procedure causes such harm or deny the side effects and results.
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Erection After Prostate Cancer Treatment
Following prostate cancer treatment of any kind, it is a possibility that you will no longer be able to have an erection. If you are unable to have an erection following treatment, this condition may last only for a short time or could be permanent.
All of the currently available, potentially curative treatment options for prostate cancer can result in temporary or permanent erectile dysfunction , though many men who undergo treatment for prostate cancer see little or no ill effects to their erectile function. Radiation therapy, prostate surgery, cryotherapy, hormone therapy, and others can all result in ED.
Unfortunately, there is no definitive way to determine which men will have ED following treatment. In general, men with vascular conditions, diabetes, obesity, or pre-existing erectile problems are at greater risk for ED.
Studies that have sought to determine the chance of men having ED following prostatectomy, radiation, and other prostate cancer treatments have resulted in widely varying numbers. Some studies seem to show that only a small percentage of men have long-standing issues with ED, while others have shown much higher numbers.
For men who have undergone prostatectomy, long-term ED has been seen in up to 67% percent of men, but some studies have shown that using medications such as Viagra may help to achieve erectile functioning.
Additionally, for men being treated with hormone deprivation therapy, the symptoms of ED often end after stopping the treatment.