A prostate cancer diagnosis often brings concerns about sexual function for many men and their partners. This article provides an overview of how prostate cancer treatments can influence sexual health.
How Prostate Cancer Treatments Affect Sexual Function
Radical prostatectomy, a surgical procedure to remove the prostate gland, can affect sexual function due to the close proximity of the prostate to the cavernous nerves. These delicate nerve bundles control erections and run along the sides of the prostate. Even with nerve-sparing surgical techniques, the nerves can experience trauma, stretching, bruising, or mild damage during the dissection process. Such injury can lead to changes in penile tissue, impairing the erectile mechanism.
Radiation therapy, which uses high-energy rays to destroy cancer cells, can also impact sexual function by damaging nerves and blood vessels in the pelvic area. The effects of radiation on these structures often appear gradually, sometimes months or even years after treatment. Radiation can cause changes in blood vessels, reducing blood flow to the penis, and may damage the cavernous nerves. This impairs the signaling and blood supply needed for an erection.
Hormone therapy, also known as Androgen Deprivation Therapy (ADT), works by reducing the levels of male sex hormones, primarily testosterone. Since testosterone plays a direct role in regulating libido, lowering its levels can significantly decrease sexual desire. This reduction in testosterone also contributes to erectile dysfunction. The side effects from hormone therapy often manifest within the first four to six weeks of treatment.
Common Physical Changes to Sexual Function
Erectile dysfunction (ED) is a common concern following prostate cancer treatment, characterized by the persistent inability to achieve or maintain an erection firm enough for satisfactory sexual activity. This condition can range in severity and is influenced by the specific treatment received and the extent of nerve or vascular damage. Even with nerve-sparing surgery, ED can occur, with reported incidences varying widely.
Changes in orgasm and ejaculation are also frequently reported after prostate cancer treatment. A “dry orgasm,” where orgasm occurs without the release of semen, is a common experience after radical prostatectomy because the prostate and seminal vesicles, which produce semen, are removed. Some men may also experience climacturia, which is the leakage of urine during orgasm.
A reduction in penile length can occur following radical prostatectomy. This change is related to tissue changes, a decrease in penile blood flow, and the retraction of penile tissues after prostate removal. While not every man experiences this, it is a known physical change from the surgery.
Pathways to Restoring Sexual Function
Penile rehabilitation is a strategy aimed at preserving erectile function by promoting blood flow and oxygenation to the penile tissues after treatment. The concept operates on a “use it or lose it” principle, suggesting that regular stimulation and blood flow can help prevent tissue damage and fibrosis that might occur if erections are absent for an extended period. Early intervention, often starting soon after surgery, helps maintain the health of the erectile tissues and potentially speeds nerve recovery.
Oral medications, specifically PDE5 inhibitors like sildenafil (Viagra) and tadalafil (Cialis), are often the first-line treatment for erectile dysfunction. These medications work by increasing blood flow to the penis, facilitating an erection when sexual stimulation occurs. However, their effectiveness can be limited if the cavernous nerves have sustained significant damage, as they rely on some nerve function to initiate the erectile process. They may be prescribed in lower daily doses as part of penile rehabilitation to improve blood flow.
When oral medications are not sufficient, other medical interventions are available. Vacuum erection devices (VEDs) create a vacuum around the penis, drawing blood into the erectile chambers to produce an erection, which is then maintained with a constriction ring. Penile injections involve directly administering medications like alprostadil into the side of the penis, which causes smooth muscles to relax and blood to flow in, resulting in an erection. Intraurethral suppositories, such as MUSE, deliver alprostadil in a small pellet inserted into the urethra to induce an erection by increasing blood flow.
For men who do not achieve satisfactory results with other treatments, penile implants offer a permanent and effective surgical solution. An implant involves surgically placing inflatable or malleable rods into the penis, allowing men to achieve an erection on demand. This option is often considered after less invasive methods are ineffective. Penile implants generally have high satisfaction rates.
Navigating Emotional and Relationship Dynamics
Open communication with a partner is essential for navigating sexual changes after prostate cancer treatment. Discussing fears, physical changes, and evolving desires helps both individuals feel understood and supported. Honest dialogue fosters intimacy and allows partners to explore new ways to maintain their connection.
Performance anxiety can be a challenge, as the pressure to achieve an erection leads to increased stress and difficulty. Focusing on pleasurable touch and intimacy without the immediate goal of penetrative intercourse can help alleviate this pressure. Shifting the emphasis away from performance allows for more relaxed and enjoyable interactions.
Redefining intimacy means broadening the scope of sexual expression beyond traditional intercourse. This can include exploring different forms of touch, foreplay, and mutual pleasure that do not solely rely on penile erection. Couples can discover new ways to connect physically and emotionally, maintaining a satisfying sexual relationship that adapts to new circumstances.
Addressing body image and confidence is important. Physical changes from treatment can impact a man’s self-perception and confidence in intimate situations. Acknowledging these feelings and practicing self-acceptance can help individuals regain a sense of self-worth and comfort in their bodies, supporting emotional well-being and sexual recovery.