Prostate cancer and its treatments can significantly impact a man’s sexual health. While changes in sexual function are common, maintaining an active sex life is often still possible. Understanding these potential changes and available management strategies can help men navigate recovery.
Prostate Cancer Treatments and Sexual Function
Different treatments for prostate cancer impact sexual function in varying ways. Radical prostatectomy, the surgical removal of the prostate gland, often results in immediate erectile dysfunction (ED). This occurs because nerves and blood vessels essential for erections, located near the prostate, can be damaged or removed. While nerve-sparing techniques aim to preserve these structures, some nerve injury is possible, leading to initial ED for most men, with recovery potentially taking up to two years. Additionally, prostate and seminal vesicle removal means men will experience “dry orgasms,” where no semen is ejaculated.
Radiation therapy, using high-energy rays to destroy cancer cells, can also cause ED, with effects often more gradual. Erectile difficulties may emerge months or years after treatment as radiation can damage pelvic blood vessels and tissues. Similar to surgery, radiation therapy can reduce ejaculate fluid. Hormone therapy lowers testosterone levels, which are necessary for prostate cancer growth. This reduction in male hormones can significantly decrease sex drive (libido) and contribute to ED, as testosterone plays a role in both desire and erection.
Sexual side effects of hormone therapy can persist as long as treatment continues and may take time to resolve after cessation. Chemotherapy, while less directly impacting erectile function, can cause general fatigue and temporary libido changes. These effects are usually transient and improve once chemotherapy concludes. Each treatment carries a risk of sexual side effects varying in onset and duration, depending on the therapy and individual factors.
Navigating Common Sexual Challenges
Erectile dysfunction is a common challenge after prostate cancer treatment, but various strategies exist to manage it. Oral medications, known as PDE5 inhibitors (e.g., sildenafil or tadalafil), are often a first-line approach. These medications increase blood flow to the penis, facilitating an erection with sexual stimulation. They are effective for men who have undergone nerve-sparing surgery but may be less beneficial for those with significant nerve damage or on hormone therapy.
Vacuum erection devices (VEDs) offer a non-invasive option by creating negative pressure around the penis, drawing blood into the erectile tissue. A constriction ring can be placed at the penis base to maintain the erection. VEDs can also be used without the ring to promote penile tissue health by increasing oxygenation and preventing shrinkage. For men who do not respond to oral medications or VEDs, penile injections are an effective treatment. These involve injecting medication directly into the penis, causing blood vessels to relax and fill, leading to an erection.
Urethral pellets, small medicated pellets inserted into the penis opening, stimulate blood flow. When other treatments are ineffective, surgically implanted penile prostheses offer a reliable solution. These devices, either malleable rods or inflatable cylinders, are placed inside the penis for erections suitable for sexual activity. While orgasm ability is largely preserved after prostate cancer treatment, men may experience “dry orgasm” (no semen ejaculated) due to removal or damage of semen-producing glands. Some men also report reduced intensity or altered sensation during orgasm.
Urinary incontinence during sexual activity can occur, particularly after prostatectomy. Strengthening pelvic floor muscles through Kegel exercises can help improve bladder control and support sexual function. These exercises involve repeatedly contracting and relaxing the muscles supporting the bladder and bowel, which also play a role in penile blood flow.
Psychological and Relationship Considerations
Prostate cancer treatment can influence a man’s body image and self-perception. Changes in sexual function may affect self-esteem and confidence, potentially leading to anxiety or depression. Addressing these emotional responses is an important part of recovery. Partners also experience these impacts, making open and honest communication essential for both individuals.
Discussing concerns and adjusting expectations together can help maintain intimacy and strengthen the relationship. Psychosexual counseling provides a supportive environment for men and their partners to explore changes, learn coping strategies, and find new ways to express intimacy. Therapists can guide conversations about adapting sexual routines and focusing on broader aspects of connection beyond traditional intercourse.
Rehabilitation and Ongoing Support
Sexual rehabilitation is an important aspect of recovery after prostate cancer treatment, aiming to restore or improve sexual function. This process often involves early intervention with therapies to optimize blood flow to penile tissues and prevent permanent damage. Penile rehabilitation programs may include consistent use of medications or devices, starting soon after treatment, to encourage the return of natural erectile function.
Lifestyle modifications, such as a balanced diet and regular exercise, can support overall sexual health. These habits contribute to cardiovascular well-being, important for erectile function. Consulting specialists, including urologists and sexual health therapists, provides personalized guidance and support throughout recovery. These professionals offer tailored treatment plans and strategies for managing specific challenges.
Recovery is a gradual process requiring patience and consistent effort. Exploring resources like support groups can also provide emotional encouragement and practical advice from others with similar experiences.