Sex after Prostate Cancer

Friday, April 28, 2017

Dear Patrick: I am about to get surgery for prostate cancer. Depending on how the surgery goes, I may be getting radiation treatments or hormone therapy or both. My cancer is aggressive, so all of this will be happening very quickly. My family is being supportive. All my children have arrived to help me and my wife to deal with this. But of course they are worried, and I am not sure how to be reassuring when the truth is, this disease could shorten my life.

I have not had a lot of privacy to discuss certain things with my wife, and I need more information before I can do so. I feel that my doctor is not being honest with me about what will happen to my sexual functioning as a result of this surgery and the other treatments. He actually commented that sex stops being important when you get older. I don’t know what his marriage is like, but my wife and I enjoy a really good sex life, and neither one of us will be very happy if that stops.

Can you give me the truth? I will get the treatment no matter what, but I need to prepare for life after cancer. I can’t do that if I am being kept at arm’s length with euphemisms and half-truths.

-On the Block

 

Dear On the Block: You need a new doctor, someone you feel you can trust to be honest with you and answer your questions without making stupid statements about how you didn’t really need your penis to work anyway. One of the things that dramatically impacts the sexual functioning of patients after treatment for prostate cancer is the experience and skill of their physician. If you don’t start this process with a doctor who understands that sex is important to you, this could negatively impact your treatment outcomes. Even if your doctor is successful at treating you, the added stress this is causing you is not worth it. Get a second opinion!

There are a couple of web sites where you can go to get updated information about prostate cancer, how it is treated, and what the options are for maximizing sexual functioning after treatment. One is http://www.urology.ucla.edu. Search for an article called “Dealing with Erectile Dysfunction.” It includes an excellent diagram that shows you why it’s so hard for doctors to treat prostate cancer. The prostate, if it’s healthy, is about the size of a nut. It is situated at the base of the bladder and is almost wrapped around the urethra. It contributes most of the liquid expelled during an ejaculation. It is centrally located near all the nerves that signal certain muscles to relax so the erectile chambers on either side of the penis can fill with blood. These nerves may also affect sensation. There are also arteries that provide oxygen-rich blood to the penis, which is necessary to keep that organ healthy and also to create the firmness of an erection that can be used for sex.

A second article, “Prostate Knowledge,” is on the Harvard Medical School website. Go to http://www.harvardprostateknowledge.org to see this material. There are detailed explanations here of various forms of treatment for prostate cancer, their outcomes in terms of ED, and ways to help prostate cancer patients regain sexual functioning. The author of this article points out that there are also risks for ED associated with radiation therapy and the drugs that reduce testosterone, since this hormone can cause cancer to grow more quickly.

It’s important to remember that anything that goes wrong with the prostate, including an infection or inflammation, can affect urination or cause erectile dysfunction (ED). Cancer, if left untreated, will also cause ED and incontinence. So you are wise to pursue treatment. In the past, doctors prioritized getting rid of the cancer at the expense of sexual functioning. Without modern imaging technology, they didn’t have much choice.

Surgeons have recently developed procedures called “nerve-sparing” surgeries for prostate cancer. Not all patients are good candidates for this type of procedure. Much depends on where the cancer is located, what type of tumor it is, how big the tumor is, and whether the entire prostate gland needs to be removed. Because this is a delicate area, and all surgery is traumatic, virtually all prostate cancer patients experience some loss of sensation and sexual functioning after surgery. Some recuperate and are able to have sex again without any further treatment.

If a patient experiences ED, there are several options for treatment. The “little blue pill” and its cousins are often helpful to produce firm erections. Unfortunately, these drugs cannot be used if you have low blood pressure or take nitrates for heart problems. Another medication causes the sphincter of the corpora cavernosa, the flexible chambers that run alongside the penis on both sides, to open and let blood in, thus creating a firm erection. These medications can be administered in various ways. Sometimes it is used by being injected directly into the penis, but few men can tolerate this as a long-term method of administration. A suppository of the drug, smaller than a grain of rice, can be placed in the urethra with the use of a small, sterile, hollow plastic tube.

If medications are not effective, some patients find that using a vacuum sleeve will draw blood into the penis and make intercourse possible. There are also surgically implanted devices that will mimic an erection.

Sex will be different after removal of the prostate, even if erections are not a problem. Your orgasms will look and probably feel different because they will be “dry.” Without the prostate, the quantity of ejaculate is dramatically decreased. You will be infertile (sperm will no longer be secreted into the urethra before orgasm). This is why some patients bank their sperm before treatment. For others, it can be a useful form of birth control. Remember that you can have an orgasm even without an erection. As long as you have normal skin sensation, it’s possible to experience the cycle of growing arousal, followed by release, that we call an orgasm. There are also a lot of ways to please your partner without a hard cock. You might want to explore sex toys. Vibrators are not simply for girls—the same toy that can give her a clitoral orgasm can also help a penis with “issues” to feel more excitement and pleasure.

It’s important to know that if a man experiences problems with getting or maintaining an erection, this could be a symptom of various medical problems, including cancer of the prostate. So it’s important to consult a physician so you can be properly diagnosed and treated. Prostate cancer is diagnosed with a blood test that looks for Prostate-Specific Antigen (PSA). A manual rectal exam is also performed to assess the size and shape of the gland.

The quality of your current sex life has a lot to do with recovery from all forms of prostate cancer treatments. In fact, there is evidence that a penis that is deprived of the release of an orgasm will experience irreversible physical changes. Muscle cells begin to resemble scar tissue, which is not flexible enough to support the changes involved in getting hard. Men who are not partnered or are not having sex with their partner are advised to make sure to “use it or lose it.” A daily orgasm with self-stimulation will keep your equipment in good order just in case your luck changes.

I hope this information is helpful to you and your wife. I’m sorry to hear that you are facing such a scary health crisis. Please write back if you need further info or support.