Maintaining Your Sex Life After Prostate Cancer

Many men with prostate cancer face challenges to their sexual function once they’ve completed treatment.

“The degree of sexual dysfunction depends on the type of treatment, and the man’s overall health and level of sexual function before treatment,” says Nannan Thirumavalavan, MD, chief of Male Reproductive and Sexual Health at University Hospitals Urology Institute. Fortunately, these side effects are often manageable, and most men are able to return to a healthy sex life after prostate cancer treatment.

How Does Prostate Cancer Treatment Affect Sexual Function?

Depending on the type of treatment, side effects from prostate cancer may include:

• Erectile dysfunction (ED): the inability to get or sustain an erection.
• Low sex drive (libido).
• Loss of penis length.
• Dry orgasm: an orgasm without ejaculating because no semen is produced or the semen travels backwards into the bladder.
• Low sperm count.

Some prostate cancer treatments damage the nerves and blood vessels that help produce an erection. Other treatments reduce the levels of hormones needed to achieve and maintain an erection.

Surgery

Surgical removal of the prostate, a procedure known as a radical prostatectomy, is one of the most common treatment options for prostate cancer. Most men who have this surgery will experience ED temporarily following surgery.

Radiation Therapy

About half of men who undergo radiation therapy will develop ED. While ED caused by surgery is typically immediate, ED caused by radiation therapy occurs gradually during the course of treatment and worsens with time.

Hormone Therapy

Androgen deprivation therapy (ADT) reduces or blocks the production of male sex hormones to shrink or slow the growth of the cancer. Common side effects include reduced sex drive, ED, difficulty reaching orgasm and reduced semen in ejaculation.

Chemotherapy

Chemotherapy drugs can reduce sex drive in some patients and cause difficulty achieving an erection.

Don’t Wait to Get Help

“Following prostate cancer treatment, the sooner you’re able to restore blood flow to the penis with regular erections, the better chance you’ll have of returning to a healthy, enjoyable sex life,” says Dr. Thirumavalavan.

He advises patients to prioritize seeing a doctor who can help them manage sexual side effects following prostate cancer treatment, particularly ED.

What to Do About Erectile Dysfunction

Post-treatment care for ED after prostate cancer treatment may include:

• Medication: Taking an ED medication such as Viagra (sildenafil) and Cialis (tadalafil) is usually the first step. These medications increase blood flow to the penis. If you were already taking ED medication at a low daily dose prior to your prostate surgery, your doctor will likely increase your dose immediately after your surgery.
• Penile injections: If ED pills aren’t effective, penile injections increase blood flow to the penis and are much stronger and take effect faster. If a test injection is successful, your doctor will teach you how to administer the injections at home.
• Vacuum erectile device: A vacuum erectile device (VED) can help men with ED get and maintain erections. A VED may be helpful if medication is not enough.
• Penile implants: A penile implant is a device that is surgically inserted into the penis to manually achieve an erection. A more permanent solution, your doctor may discuss penile implants with you if the other less invasive ED treatment methods aren’t effective.

Other Common Issues

Although initially bothersome to some men, dry orgasm caused by the surgical removal of the prostate is harmless. Even when ejaculating very little or no semen at all, a man can still feel the sensation of pleasure that occurs with orgasm, and most men adjust to it over time.

Another common side effect is a small leakage of urine during ejaculation. “While not dangerous to the man or his partner,” says Dr. Thirumavalavan, “this side effect is often managed effectively by practicing pelvic floor exercises.”

Having Realistic Expectations

For many men, the stresses of a prostate cancer diagnosis and treatment-induced side effects can cause anxiety, anger and even shame, which can then lead to reduced libido. Almost all men who have a prostatectomy or radiation treatment for prostate cancer will experience some ED for at least the first few months following treatment. That’s why it’s important to set realistic expectations for recovery.

“Because of the overlapping physical and emotional aspects of managing this disease, we find that many prostate cancer patients looking to get back to having enjoyable sex can benefit from a combination of medical treatment and psychosexual counseling,” says Dr. Thirumavalavan.

“However, with the highly effective treatment options available, nearly all men can have and enjoy sex after prostate cancer,” says Dr. Thirumavalavan.

Related Links

The expert urologists at UH Urology Institute have advanced training and expertise in a wide range of urology services and procedures. The Institute’s Male Reproductive & Sexual Health Division offers leading-edge treatments to help restore fertility and sexual health in men.