Sex Life After Prostate Cancer Treatment

Richard Beven-Thomas Urologists at USMDPCC
By: Dr. Richard Bevan-Thomas

You just received the news from your doctor, “You have prostate cancer.” A ton of questions flood your mind. What now? How will this affect me? How will this impact my sex life? You may have received information about robotic surgery, cryotherapy, radiation treatment or High Intensity Focused Ultrasound (HIFU). After treatment, your physician assures you that things are progressing normally, but you still worry. It has been several months since your surgery, and yet you are not able to achieve a full erection. Don’t give up hope. While nerve-sparing radical prostatectomy has significantly improved the likelihood that you will regain erectile function, recovery time can vary. Some men may recover their ability very rapidly; others may take a couple of years.

What affects my erectile function after treatment?

Regaining sexual and erectile function after treatment usually depends on several important factors:

1. Age of diagnosis.
2. Sexual and erectile function prior to prostate cancer.
3. The stage of cancer.
4. The type of treatment required to cure the cancer.

What can be done to rehabilitate my erectile function?

Oral Medications

Oral medications such as Cialis, Viagra or Levitra are recommended to improve blood flow and stimulate the nerves. Studies show that consistent, regular use of these oral medications can help men regain sexual and erectile function sooner.

Vacuum Device

A vacuum device also may be prescribed as part of the rehabilitation process. The vacuum device fits over the penis and draws blood into the penis, causing the vessels in the penis to fill with blood, just as they would during a normal erection. Once an erection is achieved, usually two minutes after beginning, the user slips off a tension ring from the bottom of the vacuum and places it around the base of his penis to keep the blood from exiting. The resulting erection can be sustained for about 30 minutes. Routinely, for men undergoing erectile rehabilitation, men are recommended to keep the penis full for a minute and then release the vacuum for a minute and repeat this 5 times. This helps drive blood into the penis, stretching the penis and minimizing any scarring which could occur while the nerves are recovering.

The benefits of using a vacuum device are the lack of serious side affects and the ability to achieve erection whenever you desire. The disadvantages involve the pause in intimacy it brings during operation, and the occurrence of penile feeling that is sometimes described as “not normal.” Regardless, the vacuum device remains a good option for post-prostate treated men needing erectile rehabilitation.

Injection Therapy

Injection therapy involves self-injection with medication that dilates the blood vessels and improves blood flow to the penis. Papaverine, Phentolamine, and Prostaglandin E-1, also known as “trimix,” or Caverject (Alprostadil), are the medications used and can lead to an erection within minutes. While the thought of injecting your penis might cause you terror, most men who are shown how to properly inject themselves are surprised to learn that the pain, if any, is very minimal. The erection lasts from 30 minutes to 2 hours. Injections should be limited to several times per week to minimize risks of scars or penile damage. The most serious complication of penile injections is priapism, a painful condition where the erection persists for longer than 4 hours and does not go away.

Implants

For men who continue to have long-term problems with sexual function after the above treatments have been tried, implants can offer hope for the recovery of their sexual lives. There are two types of penile implants.

  • The non-inflatable implant. This semi-rigid implant is placed in the penile shaft, leaving the penis in a permanent state of stiffness. In intimate moments the implants allow the penis to be simply bent upward for an erection, and pushed down when not in use. This implant is the simplest surgical process and less expensive of than the inflatable implant. Some men have commented that it has an abnormal feel and appearance. Post implant surgery recovery times are a bit longer with this procedure than with the inflatable implant. It remains an option for men facing erectile dysfunction following post-prostate surgery when previous rehabilitation efforts have failed.
  • The inflatable implant. The 3 piece penile implant has become the gold standard surgery for men interested in penile surgery to regain erectile function. This device allows the penis to be flaccid or pumped to an erect state. Compact hollow tubes are implanted within the penis. A pump is implanted in the scrotum, and when squeezed it releases fluid from a small container located in the lower part of the abdomen. This fluid is transferred from the container to the inflatable cylinders, which then expand the penis to erection. To stop the erection, a valve at the top of the pump is squeezed, and the fluid returns to the abdominal reservoir, causing penile flaccidity. This is the most common penile implant surgery done in the United States and has a patient satisfaction rate above 90%.

Talk to Us

There is hope. We know that many men are uncomfortable about talking openly concerning sexual function. Rest assured that your USMD Prostate Cancer Center doctors are aware of this and are prepared to guide you in this discussion and answer any questions you might have regarding your sex life before and after your prostate cancer treatment.

Dr. Bevan-Thomas, M.D.
Medical Director of USMD Prostate Cancer Center

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