A Guide to Prostate Cancer and Intimacy

April 16, 2013
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Returning to sex after prostate cancer can be difficult. Following surgery and radiation treatments, many men experience declines in their sexual function, including impotency and lowered libido. Depending on factors such as age, erectile function before treatment, the type of treatment chosen and the extent of the cancer, the odds of returning to a “normal” sex life are 10 percent to upwards of 70 percent. However, this doesn’t mean your sex life is gone — it’s just different.

By reading this guide you’re taking the first step toward regaining a healthy and satisfying intimate life with your partner. First we’ll talk about why prostate cancer treatment so often leads to sexual dysfunction, then we’ll look at what you can do to improve your recovery. Next you’ll read tips for communication with your partner, and then get a list of questions to ask your doctor.

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Why does prostate cancer treatment often result in sexual dysfunction?

The prostate is surrounded by sensitive nerves that both play a role in a man’s sexual arousal and help stimulate the penis to become erect. During prostate surgery, it’s very difficult for surgeons to separate the prostate from the surrounding nerves without damaging those nerves. The good news is that it is often possible for these nerves to heal, but the bad news is that this tends to happen very slowly — it’s common for it to take a year, or in some cases even up to four years, before men see a return of their erection. Other things you should know:

  1. Before prostate surgery, choose your surgeon and procedure wisely. Not all surgeons are created equal, and different surgeons may have differing levels of skill, or be skilled only in a particular procedure. The Davinci robot, for example, allows for the possibility of very little damage to surrounding tissue when operating on the prostate, but the surgeon must be extremely skilled in the tool — otherwise, you might end up worse off than with a less precise tool. The SMART technique has a good success rate when it comes to retaining potency. Do your research and decide what procedure and surgeon are right for you.
  2. Following prostate surgery, men will no longer be able to ejaculate. Without the prostate and seminal vesicles, seminal fluid has no pathway to leave the body. Luckily, it is possible to still have satisfying dry orgasms, although this change may take some getting used to on the part of both partners.
  3. If instead of surgery you’ve had hormone therapy, you may physically be capable of erection but have little or no interest in sex. This is a common side effect of the hormones being introduced into your body, and you should not blame yourself and make it clear to your partner that he or she is not to blame either.
  4. Psychological factors also come into play after treatment for prostate cancer. These come in a few different forms:
    • Loss of libido can be devastating to a man, which often serves to reinforce the sexual dysfunction he’s experiencing.
    • A common side effect of hormone therapy are bodily changes that some men find embarrassing or emasculating.
    • Following surgery, leaking urine during sex is common. For many men, the fear of leaking urine or being unable to get or maintain an erection creates embarrassment around the idea of sex, leading to avoidance.

As disheartening as they may be at times, all of these effects are normal. Remember that with time and treatment, it is often possible to recover and/or redefine a satisfying intimate life with your partner.

What are my options for recovery?

There are a few things you can do to drastically improve your sex life following treatment for prostate cancer. Some of these suggestions may be very different from how you’ve had sex in the past, but trying to keep an open mind regarding what sex is and isn’t can go a long way toward helping you and your partner to rediscover each other sexually. For some couples, being open to new options paves the way for a mutually satisfying sex life that never would have been possible before cancer.

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  1. Penile rehabilitation. Penile rehabilitation is a treatment for erectile dysfunction that involves stimulating the penis intermittently during the recovery period. Treatment should begin as soon as possible following removal of the catheter post-surgery. There are several types of treatment that fall under the umbrella term of “penile rehabilitation”:
    • PDE-5 inhibitors: Oral medications such as Viagra, Cialis or Levitra are often used successfully to stimulate the penis following prostate surgery. About 90 percent of patients will experience erections following treatment with these sorts of pills, so this is usually the first stop for patients with erectile dysfunction.
    • Penile injection therapies: This type of therapy is exactly what it sounds like — the penis is injected with medication to create an erection, which lasts roughly 30 minutes to an hour. The injection tends to sting a little, and it’s important for patients to give their doctors feedback about the dosage, as too much of this medication may cause priapism, or painful erections lasting longer than four hours.
    • Vacuum erection devices: A vacuum erection device (VED) fills the penis with blood by creating a vacuum. Once an erection is achieved, it’s maintained by then placing a rubber ring at the base of the penis. A benefit of VEDs is that a man or his partner can control exactly when he gets an erection, and using the VED can be incorporated into sex play. However, for some men this device feels less “natural” than other ways of getting an erection post-surgery, and some experience discomfort caused by the ring.
  2. Meet with a sex therapist or counselor. It’s natural for you and your partner to have a lot of confused feelings about sex following prostate surgery. Many patients become depressed or anxious, and many feel ashamed or frustrated by their difficulty achieving erection. Meeting with a sex therapist or a counselor during this period can be very beneficial to helping you and your partner communicate better, encouraging you to work through your feelings about how your sex life has changed, and finding new ways to connect sexually.
  3. Use toys and masturbation in sex play with your partner. If you and your partner have never used sex toys or masturbated together before, it can feel awkward at first to incorporate these behaviors into your sex play. However, the benefits for both partners will likely soon outweigh your discomfort, if you have any. There are a few ways you can use sex toys and masturbation with your partner:
    • For men recovering from prostate surgery, the use of vibrators and cock rings may be beneficial in creating and maintaining erections.
    • If you’re unable to achieve an erection strong enough for penetrative sex, using these toys on your partner may allow you to retain control over satisfying your partner.
    • Masturbating, both alone and with your partner, is a great way to reteach your body to respond to sexual touch, and to relearn what you respond to. By modeling to your partner what you like, you can learn together how to satisfy you — and you can demonstrate that an erection is NOT necessary to achieve orgasm.
  4. Adjust your expectations. It’s normal for men to experience sexual problems after treatment for prostate cancer. When you first return to being sexual with your partner, you should both go into the experience without any expectations of each other. You may not be able to pick back up where you left off, but you can forge new territory together, as a couple.

The goal is to make the recovery process one of exploration and discovery, as though you and your partner are getting to know each other for the first time. Sex will likely be different after prostate cancer than it was before, and it may at times be frustrating for one or both partners. However, by adopting an open-minded attitude and limiting expectations, you may find that you reach a new level of intimacy in your relationship.

Communication is key.

Talking about sex isn’t always easy, even with the person you love. But like it or not, prostate cancer practically forces you to talk to your partner about sex. And as difficult as that may be for couples who are not accustomed to discussing sex, this may actually be the silver lining to the painful, life-changing experience that is prostate cancer.

Here are some tips for opening up a discussion:

  • Don’t wait. The longer you wait after treatment for prostate cancer, the more difficult opening up a discussion of your intimate life will be. And certainly don’t wait until you’re in the midst of a sexual situation — discuss your concerns or ideas in advance so that you both know what to expect.
  • Be honest, even when it’s difficult. Some men shut down when faced with impotency or fears surrounding their sexual performance. But this is the time when your partner needs to hear from you most. By diving into a discussion rather than keeping your partner in the dark, you reinforce to her or him that your relationship is important — and you open up the possibility of finding solutions together.
  • Listen compassionately. Treatment for prostate cancer and the resulting complications can be just as difficult for your partner as they are for you. Allow your partner to share his or her feelings, and listen without judgment. Try to really understand where your partner is coming from.
  • Don’t assume you understand each other. Be clear and precise when you talk about sex. If you’re worried about leaking urine during sex, for instance, don’t try to get by on “I’m worried something bad might happen” and assume your partner knows what you mean. Be specific so that you’re both really able to understand what the other is thinking and feeling.

When you start to talk to your partner about your intimate life, an amazing thing happens: You both become more satisfied, more willing to experiment with things you’ve always wanted to try, and in the end you may even become happier with each other.

Questions to ask your doctor

This article is meant to give you an overview of what to expect from sex following treatment for prostate cancer, but you should always check with your doctor before rekindling your sex life with your partner. Circumstances vary from individual to individual and from treatment to treatment, so your doctor will be able to talk with you about your specific situation. Here are some questions you might want to ask:

  • Has there been nerve damage to the penis that may interfere with my ability to get an erection?
  • How soon after treatment can I attempt to have sex?
  • Given my age and the type of treatment, what are the odds that I will be able to get and maintain an erection after treatment?
  • If I won’t be able to have erections right away, how long should it take before I’m able?
  • Will I need penile rehabilitation? What method do you think will work best for me?
  • Have there been any new advances that may improve my odds of having a healthy sex life after prostate cancer treatment?

It’s true: Sex may not be the same as it used to be. But by taking baby steps, it’s possible to create a new normal with your partner that may even be more open, honest and intimate than the sex you used to have. You can never go back to the days before cancer, but move into the future without fear — and with your partner by your side.

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