Sexual Problems are often left to deal with last, when you have been diagnosed with Prostate Cancer. It is however sexual dysfunction that is strongly associated with treatment satisfaction post prostate cancer treatment. Sexual dysfunction is also a major predictor of both bother and depression in prostate cancer patients, even after the sexual dysfunction has been resolved.

Men are faced with the daunting and debilitating task of trying to search for answers on how to “fix” their sexual dysfunction, often failing so many times that they simply give up trying.

You have handled the unexpected diagnosis of prostate cancer, decided on the best course of action and had your treatment completed. You may have won the battle, but the unknown war is far from over. Life after prostate cancer has never been on the agenda.

What happens after prostate cancer treatment?

Prostate Cancer Treatment involves prostate removal surgery (prostatectomy) or prostate radiation therapy (normally called brachytherapy).  These are the two most common approaches to treat localized prostate cancer.

Both these approaches may effectively cure prostate cancer. But, both these approaches have side effects.

These common side effects include urinary incontinence and sexual dysfunction. While most men will recover from urinary continence, many men may not recover from sexual dysfunction. One study on prostatectomy patients suggested that as many as 70% of patients will not regain their sexual function after a prostatectomy.

Sexual dysfunction and incontinence occur immediately after a prostatectomy. Similar side effects are also associated with prostate radiation therapy (Brachytherapy) but these side effects only start occurring after 2 years, peaking in their severity at 5 years after the treatment. Watch this video on what someone having a prostatectomy should know.

What kind of sexual problems can I expect after prostate cancer treatment?

 

The most common form of sexual dysfunction after prostate cancer treatment, is erectile dysfunction (ED).  It is safe to say that it is very unlikely that your sex life will ever be exactly the same again.  You will no longer ejaculate, your sensation of your orgasm might change, you might have decreased sensation of your penis, your penis might become smaller, you might urinate when you have an orgasm and you might experience pain with erections or orgasms.

Many men also suffer from a low libido after prostate cancer treatment. One of the reasons might be testosterone deficiency, which can not be treated like in men who do not have prostate cancer. (In some cases in men who have been cancer free for some years, their urologists might reconsider this.)

Luckily, most men can resume a satisfying sex life after their prostate cancer treatment. The younger ones with excellent sexual function before surgery and those who can have nerve sparing surgery are the ones that are least likely to sit with long-term sexual dysfunction.  

Prostate cancer treatment and urinary incontinence:

When faced with urinary incontinence and sexual dysfunction most men will start addressing their urinary incontinence immediately after their prostate cancer treatment. Incontinence interferes most with the social and economic activities people are involved with. Urinary incontinence is also easier addressed and less complicated to treat than sexual dysfunction. This video explains more on Urinary incontinence after prostate cancer treatment.

How do we minimize the sexual problems after  prostate cancer treatment?

Minimizing sexual problems after prostate cancer is the topic of a lot ongoing research in the field of sexual medicine. Some key interventions to manage sexual dysfunction after prostate cancer treatment include pelvic physiotherapy that may include pelvic floor rehabilitation, penile rehabilitation and the use of a vacuum erectile device. This video explains more on pelvic floor exercises.

See more on how a physiotherapist can help with a prostatectomy

Other important treatment interventions include pharmaco-therapy (taking medication like PDE5 inhibitor of which Viagra was the first one on the market, but there are now  also various other safe treatment options available) and psychotherapy to name a few.

The My Sexual Health team has a nationwide footprint of experts that would be able to help manage sexual dysfunction in patients who have had treatment for prostate cancer.

 

Written by Pierre Röscher

Physiotherapist and Researcher

https://twitter.com/PhysioPierre