The Importance Of Quality Of Life
Its only normal to want to drive into the practicalities. Before you go any further, I want you to understand a key metric, which is particularly challenging to standardize.
Its called Quality of Life, usually shortened to QoL in the medical literature.
With Prostate Cancer, its a particularly important one, due to the high rates of survival for those with localized prostate cancer .
Thats why its so important to understand the impact that various surgeries or treatments will have on you.
Quality of Life is how they assess the suitability of any treatment.
Those sort of difficult questions is why QoL is a factor. If youre a sexually active man in your sixties or seventies and they are offering you preventative surgery after a biopsy, you need to ask yourself about the impact it will have, what alternatives are available to treat prostate cancer.
Furthermore, you should always ask what the quality of life after that surgery or treatment will be like.
Thats why we put together this quick guide to erectile function, mens health and sex after prostate surgery.
Its not exhaustive by any means, but should certainly give you a jumping off point to better make these decisions that will have a serious impact on a really key aspect of your life.
One last note before we get into it. If the cancer is malignant, surgeons will always push you for a radical prostatectomy, to prevent the cancer from spreading to your lymph nodes.
How Will Prostate Cancer Affect My Sex Life
Prostate cancer can affect your sex life in three overlapping ways – your mind, body and relationships.
Mind
Finding out you have cancer can make you feel down or anxious, changing your feelings about sex.
Body
Treatment can damage the nerves and blood supply needed for erections. Hormone therapy can affect your desire for sex.
Relationships
Coping with cancer can change your close relationships, or your thoughts about starting one.
Some common worries
- You cant pass on cancer through sex.
- Having sex won’t affect how well your treatment works.
- Having sex has no effect on your cancer or the chance of it coming back after treatment.
- It’s safe to have an erection if you have a catheter in.
Management Of Erectile Function
Whats the secret to having a good sex life after prostate cancer? In an interview with the Prostate Cancer Foundation Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. summed it up this way You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Theres also the vacuum pump.
Erectile Dysfunction Medications Viagra® , Cialis® , and Levitra® work by relaxing the muscles in the penis which allows blood to rapidly flow to achieve an erection. About 75% of men who undergo nerve-sparing prostatectomy or radiation therapy can successfully achieve erections with these medications.
Muse® is a medicated pellet about half the size of a grain of rice that when inserted into the urethra through the opening at the tip of the penis stimulates blood flow into the penis. About 40% of men have reported successfully achieving erections after using this drug.
End to End nerve grafting is a new technique recently reported to be effective in improving erectile function.
Injection therapy requires sticking a tiny needle into the base of the penis so Tri-mix which contains three drugs can be injected. The success rate is between 70 and 80% and each shot costs about $7. The specific formulation of drugs is based on the type of erection achieved with test dosages in the doctors office and the doctor teaches the patient how to self-inject.
References:
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Day Before Your Surgery
Follow a light diet
Follow a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, theyll call you on the Friday before. If you dont get a call by 7:00 pm, call .
The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.
Do your bowel preparation
The night before your surgery, use a saline enema as instructed on the box.
Shower with a 4% CHG solution antiseptic skin cleanser
The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.
Sleep
Erectile Dysfunction After Prostate Cancer Treatment
Erectile dysfunction is the most common side effect after prostate cancer treatment irrespective of precision dose and delivery of radiation therapy or if the nerves were spared during surgery. Sexual dysfunction occurs because the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma or stress to them can result in temporary or permanent damage.
Within one year after treatment, most men with intact nerves that were not significantly damaged will see a substantial improvement in sexual function. The skill of the surgeon or radiation oncologist can have a significant impact on long term sexual function, so its important to select your treatment and team very carefully.
When selecting treatment make sure your doctor explains the type and probability of side effect from their treatment facility. Sometimes treatment selection will depend on which side effects are most tolerable for you age and lifestyle.
Age, obesity and the ability to spare the nerves are the major determinants of the type and severity of side effects. In general, it is more challenging to spare the nerves in men with higher risk disease because the prostate cancer may have already spread past the nerves outside the prostate capsule.
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Theme : Importance Of Intimacy
Intimacy, both physical and emotional, was a priority for men and their partners. Participants discussed the importance of non-penetrative sex. Most men and their partners felt that non-penetrative sex was a helpful way to maintain intimacy. Some participants felt the relationship was stronger after prostate cancer treatment. The participants said the following:
Man 21: I was fortunate to find this woman and it just enhances every single aspect, whatever, if youre going to a social event, youre going on a vacation, you are just being intimate around the house, youre sharing thoughts and dreams. It just encompasses what life is all about. Some people dont care about it, but for the men that do its devastating.
Partner 5: Anything I could tell anybody going through this is like, If you guys are not intimate, and able to talk with each other now you’d better get that straight before the surgery. Better get it straight because you’re gonna need each other, and you’re gonna need the intimacy more than you’ve ever had it
Man 15: I miss the holding of hands. I miss hugging and things like that. I dont thats not sex in the definition of this survey. But thats what is available to me in my current physical conditionand so yes, its important.
Other Medications And Devices
Although medications like sildenafil and tadalafil are effective for many men with post-surgery erectile dysfunction, they arent the best choice for everyone.
If your prostatectomy causes damage to the nerves near your penis, or if you take medication for hypertension, angina or other health conditions, using an oral ED medication may not be a suitable option for you.
In this case, your healthcare provider may recommend a different type of medication or a device to help you achieve an erection. Your options may include:
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Penile injection therapy. This involves using injectable medications to stimulate blood flow and improve your erections. These medications are typically administered using a very small needle to minimize discomfort.Although this treatment method may sound unpleasant, its relatively simple to use and has a success rate of 70 percent to 80 percent.
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Vacuum constriction devices . Also known as a penis pump, a VCD works by creating a vacuum around your penis. This draws blood into your penis and allows it to become erect.
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Availability Of Data And Materials
The datasets generated and/or analyzed during the current study are not publicly available due to the large size of the transcripts from each interview and sensitivity and specificity of some of the information from the interviews, but the demographic information and some of the de-identified descriptions can be made available upon reasonable request to the corresponding author.
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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Who Has Nerve Preservation
Patient who are potent are understandably keen to retain this and so are we. As well as allowing erections following surgery, nerve preservation also allows an earlier return to continence so we always practice nerve preservation whenever the cancer control allows it, which is in about 80% of men. When the cancer is close to one of the nerves we might partially nerve preserve on that side if it is safe to do so and will discuss this with you beforehand if this seems likely.
The decision to nerve preserve is taken after considering the patients existing erections, PSA level, biopsy report, MRI scan, rectal examination under anaesthetic immediately before the operation starts and the way the NVB looks and feels during the operation. It is always discussed with patients before surgery.
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.
- Try to lower your stress and fatigue . Being diagnosed with prostate cancer and working in all the changes it brings to your life can be stressful. Stress and the tiredness caused by your prostate cancer treatment, can make it difficult for you to get in the mood. Many men going through prostate cancer treatment feel this way. Talking with your partner might help lower your stress. You may also speak to your doctor or healthcare team about how you are feeling. They are there to help you through this time.
- 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.
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Achieving Orgasm After Radical Prostatectomy
Men worry about erectile dysfunction after radical prostatectomy, the operation that involves removing the prostate gland as a way to treat prostate cancer. Its a legitimate concern. Men, their spouses and partners, and their surgeons should talk about erectile dysfunction before and after the surgery. Almost all men will experience erectile dysfunction for several months to a year after a radical prostatectomy, although todays nerve-sparing operation has decreased the number of cases when its permanent.
But orgasm after radical prostatectomy? Its often even not on the radar screen. Dr. Ravi Kacker thinks that should change.
Sometimes orgasm gets forgotten because everyone is so focused on erectile dysfunction, says Dr. Kacker, a urologist and fellow in male sexual medicine at Harvard-affiliated BethIsraelDeaconessMedical Center. But for somemaybe mostmen and their partners, achieving orgasm can be as important as erectionsor even more so for having a healthy sex life.
And, says Dr. Kacker, theres good news. Orgasms after radical prostatectomy may feel qualitatively different for most men, but they dont need to be any less pleasurable or satisfying.
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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Penile Rehabilitation How It Works
Prostate removal can interfere with the function of the cavernosal nerves due to their very close proximity to the prostate, as well as the arterial blood supply into the penis as some of it travels through the penis. This effect is less in younger, fitter men with robust erections who have had nerve-preserving surgery and maximal when the nerves cannot be preserved because of the proximity of prostate cancer and in older patients.
The concept of penile rehabilitation stems from the theory that if penile blood flow and erections can be encouraged soon after surgery, the recovery of erections will be faster and more complete. Even so, it can take up to 3 years for recovery to be complete. The initial research into penile rehabilitation was with injection therapy and found that men who regularly used it had a much higher rate of potency 6 months after surgery than those that did not: 67% versus 20%.
In the modern era, penile rehabilitation is done with PDE5is . It typically starts 4 weeks after surgery, and appears to be as effective as injection therapy 64% of patients who took Viagra being potent at 18 months after surgery compared to 24% of men who did not.
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.
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Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery:
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