The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
Pain During Erection Or Ejaculation
Some men find that erections and ejaculating is painful after surgery, or during and after their course of radiotherapy.
Painful erections following surgery could be due to internal bruising caused by the operation. The tube which carries urine from the bladder to the outside of the body gets inflamed by the radiotherapy treatment.
This side effect should disappear a few weeks after you finish radiotherapy or as you recover from surgery. Talk to your specialist nurse for specific advice. If masturbation and sex is important to you, its important to keep stimulating the penis to keep it healthy. On the other hand, if erections are very painful, you might need to avoid ejaculation for a while and try again later.
The penile injections to stimulate an erection can cause painful erections in some men. This pain might lessen with continued treatment.
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.
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How Fast Will I Become Totally Continent After Prostate Surgery
During surgery for prostate cancer, the urethra is also affected and, depending on the experience of the surgeon, more or less of the continence function will be preserved. Due to the high precision of robotic surgery, the patient will have a catheter for roughly one week and the trauma to the urinary function will be minimum.
The discomfort that patients feel during this time is minimum, but you should expect the removal to make you feel uneasy. The catheter will be removed during a visit to your doctor, so do not try to do this at home, as it could cause infections. The degree of which the urinary function will be affected depends on how normal the function was before surgery, age and weight.
It is worth noting that most men will experience some degree of incontinence after prostate surgery, but control can be regained within several weeks or months to a year.
Effects On Orgasm And Ejaculation
A number of factors involved with prostate cancer may change how a man feels about sex. Understanding the risks may help people deal with these consequences.
Removing a prostate gland entirely for cancer treatment means that ejaculation will no longer be possible. Instead, the man may have a dry orgasm.
Some surgical treatments may lead to a disorder called retrograde ejaculation. With this condition, the semen does not leave the body during orgasm. Instead, it goes into the bladder and leaves through urination.
Other prostate cancer treatments may result in smaller ejaculations. Hormone therapy may also reduce the intensity of orgasm sensations.
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How Prostate Removal Can Cause Unwanted Side Effects
Disruption of nerves, blood vessels, and muscular tissue during surgery can compromise erectile function and urinary continence. Generally patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer, and the risk of rectal injury. However, there are other complications that can dramatically affect your quality of life that are often glossed over or not mentioned at all, perhaps because they are not considered that important in the grand scheme of cancer care, with quantity of life being the primary concern.
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.
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Sexual Performance After Prostate Cancer And Getting Back To Enjoyable Sex After Prostate Surgery Is Possible Heres How:
1. Masturbate solo sex is a great way to help you relax, build confidence, and find out how your body will respond after surgery.
2. Kegel exercises mastering these pelvic floor exercises before surgery can actually improve your orgasm after surgery. They may even help you achieve multiple orgasms. Bonus they help strengthen urinary control, too.
3. Involve your partner remember that sex is best as a team sport so the sooner you work together, the better. Use physical and emotional intimacy to build up to penetration.
4. Stay ahead of Erectile Dysfunction oral medication for ED is a great way to speed sexual recovery. Using prescriptions such as Viagra or Cialis, even for a short time, can give you the confidence and sexual potency you need.
5. Have sex the more sex you have, the more sex youll have. Meaning, penile rehabilitation through touching, intimacy, and erection practice will actually get you back in the game faster.
What You Never Lose: The Good News About Sexual Function
While regaining erectile functiom is not possible for all men, it is important to remember that erection is just one part of a satisfying sex life. The other parts remain intact despite prostate cancer surgery. Sexual feelings, sexual fulfillment, climax and the sensation of orgasm are still available without erection.
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Where Does The Sperm Go After Prostatectomy
You no longer ejaculate semen if you have had a radical prostatectomy . This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm . Your testicles will still make sperm cells but they will be reabsorbed back into your body.
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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Here Are Some Common Side Effects Of Radical Prostatectomy
Ejaculation of Urine During Sexual Climax After Prostatectomy
After radical prostatectomy, ejaculations are typically dry because of the removal of the prostate gland and the seminal vesicles, as well as the clipping of the sperm ducts, the structures that supply the contents of the ejaculate. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to decrease with time.
Urinary Incontinence at the Time of Sexual Stimulation Due to Prostate Surgery
Urinary leakage is not always restricted to the moment of ejaculation, as some patients can experience it during foreplay. Once again, this is a potential great bother and embarrassment to both the patient and his partner. Like ejaculation of urine, this issue is most commonly experienced the first year after radical surgery and thereafter tends to improve.
Altered Sensation During Sexual Climax Due to Prostatectomy
The majority of men after radical prostatectomy experience an altered perception of orgasm. Some men experience decreased pleasure with orgasm, often with a feeling of diminished orgasm intensity. Some men are bothered by the dry orgasms. On occasion a man may be unable to experience an orgasm at all. In rare instances, a radical prostatectomy patient notices an increase in orgasm intensity.
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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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.
After Prostate Removal The Sperm Has To Go Somewhere But Where
Men who are facing prostate removal due to cancer will surely wonder where their sperm will go after removal of the prostate gland. Its fair to wonder about this.
First of all, sperm is produced in the testicles.
The testicles continue to make sperm, but because the vas deferens is clipped and cut, and because there is no prostate or seminal vesicles, there is no ejaculate, explains Michael Herman, MD, director of urologic oncology at South Nassau Communities Hospital in Oceanside, NY.
People can continue to have orgasms, though, because the nerves that have to do with climax are unaffected, and are actually not related to whether or not someone ejaculates.
The sperm gets broken down and reabsorbed by the body. This is the same process as if someone were abstinent or had a vasectomy.
In short, prostate removal will not affect sperm production or quantity. It only affects what happens to the sperm once its produced.
Unfortunately, removal of the prostate may be more of an issue to a woman than to the man, if she believes she cant enjoy intimate relations without ejaculations.
Men who have partners like this should focus on all that can be done to treat their prostate cancer and prevent a recurrence.
Women who feel deprived without the ejaculate need a harsh lesson in priorities.
Prostate cancer affects one out of six men as a lifetime risk, and the number it kills every year in the U.S. averages in the high 20,000s.
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When Can I Return To Sexual Activity
Let the surgery heal for three to four weeks before attempting anything. After one month after the robotic prostatectomy, it is recommended that you resume sexual activity. Stimulation of the nerves is thought to be a first step on the journey back to potency. Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections. The average time to recovery for erections adequate for intercourse is 6-12 months, but in some men it is even longer. You should also be performing kegel exercises regularly to help your return to potency.
Talking About Orgasm Problems Is Important
Men and their partners have become much more open about talking erectile dysfunction, in general and as a consequence of prostate cancer treatment, notes Dr. Kacker.
Whatever you think about all those ads for Viagra and Cialis, they have made it easier to talk about ED and helped remove some of the stigma around the condition.
We should be having the same frank, open discussions about orgasm, says Dr. Kacker. Orgasms can bring a couple together and allow them to maintain sexual intimacy in the difficult period around diagnosis and treatment of prostate cancer.
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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.
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Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
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Surgery Effect On Ejaculation
Surgery can affect ejaculation in different ways. For example, if surgery removes the prostate and seminal vesicles, a man can no longer make semen. Surgery might also damage the nerves that come from the spine and control emission . Note that these are not the same nerve bundles that pass next to the prostate and control erections . The surgeries that cause ejaculation problems are discussed in more detail here.