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.
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.
Sex After Hormone Replacement Therapy Or Chemotherapy
Doctors who treat cancer with medicines such as chemotherapy or hormone therapy are typically medical oncologist. Both of these treatments come in the form of drugs and/or chemicals. Often hormone replacement therapy and chemotherapy are useful when other prostate cancer treatments have failed or the cancer has spread.
Seminal vesicles invasion means the tumor has spread to the seminal vesicles which are attached to the prostate gland. To prevent the spread of cancerous tumors Seminal Vesicle-Sparing procedures are often employed.
Hormone replacement or chemotherapy are sometimes used to complement other prostate cancer treatments and are not necessarily treatments of last resort in all cases. Because of the variety of drugs and chemicals, the impact on sexual function differs tremendously.
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Limit Prostate Cancer To Just Another Part Of Your Evolving Sex Life
The reality is that sex changes for every man as he goes through each decade of his life. For some men, prostate cancer is part of that progression, says Dr. Samadi who works closely with men and their partners before and after prostate cancer. With dedication, eighty-five percent of his patients regain sexual potency in just 12-24 months.
Learn precisely how SMART robotic prostatectomy surgery protects sexual function and read more about your sexual recovery options after prostate cancer surgery. Dr. David Samadi has performed more than 7,000 successful robotic prostatectomy procedures as Urologic Oncologist and Chief of Robotic Surgery at Lenox Hill Hospital, in New York City.
Hormone Adjustments Can Help With Orgasm
Sometimes hormone levels contribute to orgasmic problem. Many men with low testosterone have problems with orgasm, but treating prostate cancer patients with testosterone is still very controversial. Other hormones can also play a role. For example, a low thyroid hormone level or a high prolactin level can make it more difficult to reach orgasm. Even if you have a normal hormone levels, there are a few hormonal medications that may be able to help.
Another hormone that plays a role in orgasm is oxytocin. The level of oxytocin increases in both men and women during sexual arousal. Taking an under-the-tongue formulation of oxytocin five to 10 minutes before sexual activity can help some men achieve orgasm. Its safe and no side effects have been reported, says Dr. Kacker. You need a prescription for oxytocin, and its available only through special compounding pharmacies, not through retail pharmacies.
Cabergoline is another medication that can help with orgasm problems. It blocks the release of prolactin, a hormone that appears to play an important role in the refractory period after orgasm when men cant have another orgasm for a while.
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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.
How Soon After Prostate Cancer Treatment Can You Be Sexually Active Again
Different Prostate Cancer treatments have various periods before one can resume sexual activity. Its also down to an individuals recovery time, which has to factor in age.
A man who has had a prostatectomy in his eighties will find that it will take him a lot longer to resume any sexual activity than a man in his fifties who has had external beam therapy.
The individuals general health and genetics all play a part in the healing process. With a prostatectomy, studies tend to show that it is at least several months before erectile function returns, but it can be up to a year.
For more limited surgery, such as TURPs, one can expect to be sexually active again within 4 6 weeks if that is the only surgery and treatment. Often it happens in conjunction with other treatments, such as hormone or radiotherapy, which have much longer recovery times.
There are still options that are open to men before that. If a man still feels sexual desire, then sexual activity is still possible.
There are three parts to orgasm, and while the sensation of fullness or ejaculate may no longer be present, the mental part of orgasm which takes place in the brain is just as possible as before surgery. Plus theres absolutely nothing stopping a man from being more focused on his partners sexual pleasure.
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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.
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Restoring Sexual Function After Surgery
Erections are controlled by nerves and blood vessels that run along both sides of the prostate. Because theyre very delicate, any trauma to these nerves or blood vessels can affect erectile function, says the Prostate Cancer Foundation. And if cancer is growing near the nerves, the surgeon might need to remove them.
Even if you dont have ED before surgery, you may experience it afterward. While ED usually lasts at least two to three months after surgery, it can last for up to two years.
To restore sexual function, your doctor may suggest:
- Oral medicine, such as Viagra® or Cialis®
- Penile injections that you use before having sex
- A vacuum device that draws blood into the penis to create an erection
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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.
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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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.
The Purpose Of Prostate Surgery
Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.
It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.
Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:
Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.
The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.
Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.
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How Will Treatment Affect My Ability To Orgasm Or My Fertility
Surgery for prostate cancer can affect both your orgasms and your ability to have children. The prostate gland normally adds a fluid called semen to sperm to nourish and protect it. Youll no longer make semen after surgery, which means your orgasms will be dry. Radiation therapy can also reduce the amount of fluid you ejaculate. Without semen, you wont be able to father children. If youre concerned about fertility, you can bank your sperm before your surgery.
After surgery, orgasms will also feel different. You wont have that normal buildup of sensation before you have an orgasm. Youll still be able to feel pleasure, though.
Can I Have Sex During Treatment
There are a few factors that determine if sexual activity is safe during treatment.
- In general, sexual activity is fine during treatment as interest, energy, and comfort levels allow. While you may not feel up to sexual intimacy after surgeries or during chemotherapy and radiation hugging, kissing, holding hands, and massages may feel good and be comforting.
- If you had surgery involving the pelvic area , you may need to allow extra time for healing before having sex that involves penile stimulation or vaginal or rectal penetration . If you are being treated for oral cancer, use caution during oral sex.
- If you have a low white blood cell count or low platelet count , you may need to refrain from any sexual activity that involves vaginal or anal penetration. This is because there is an increased risk of infection or bleeding when your counts are low.
- If you have mouth sores , you should not perform oral sex.
- Do not have vaginal intercourse if you have open sores on your genitals.
- Do not have receptive anal sex if you have sores in the rectal area, rectal bleeding, or tears in the rectal tissue.
- If you received brachytherapy for prostate cancer , be sure to follow your oncology teams guidance about limiting close physical contact to avoid exposing your partner to radiation.
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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.
How Does Prostate Surgery Affect You Sexually
If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.
While the prostate isnt directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.
The prostate is next to a dense group of nerves and the seminal vesicles .
There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.
For men who have had an open prostatectomy, they will find that they can no longer ejaculate. This is known as a dry orgasm and can still be pleasurable.
Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.
However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.
Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.
According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.
For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.
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How To Maintain Your Sex Life After Prostate Surgery
Although prostate surgery can affect your sexual experience and performance, getting surgery to remove part or all of your prostate doesnt mean that you can no longer have sex or enjoy a satisfying sexual life.
However, it does mean that you may need to make some changes to how you and your partner have sex. These may include using ED medications, erection-promoting devices or engaging in penile rehabilitation exercises to keep your penis stimulated and healthy.
If youve recently had prostate surgery, its important to talk to your healthcare provider before you make any changes to your health habits. Theyll be able to inform you about what you can do to restore and improve your sexual function after surgery.