Prostate Cancer

Managing erectile dysfunction

Erectile dysfunction (ED), or impotence, is one of the most common side effects of prostate cancer treatment. This inability to get or maintain an erection may be caused by several factors:

  • Nerve or blood vessel damage in the penis during treatment
  • Reduced level of testosterone in the blood resulting from hormone therapy
  • Erection problems before treatment
  • Age (impotence may become more of an issue as men get older)

It is important to keep an open mind because every situation is unique. Regaining erectile function is possible, but it typically takes 18 to 36 months for full recovery after surgery. After radiation, erections are not affected immediately, but may begin to fail over time, worsening year by year. The patient’s age and erectile function prior to treatment are also factors in recovery of function, and a higher percentage of men age 60 and under will recover or retain erections more readily than older men.

Your ability to father children may be affected as well, so if you plan to have children, you may want to consider storing your sperm in a sperm bank before treatment (see ‘Infertility issues’ box).

Be sure to learn about prostate cancer treatments and their potential side effects related to ED before making treatment decisions. Ask your doctor if a nerve-sparing approach is appropriate for you. With this surgical option, the tiny bundles of nerves on either side of the prostate that control erections are left intact.

Ways to manage ED

Some men regain their ability to have erections naturally, whereas others need medical help to correct the issue. Your sexuality doesn’t have to be completely dependent on the ability to have an erection, but your doctor can suggest a number of ways to improve your ability to have one:

  • Oral medications such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) may help you achieve and maintain an erection. Oral medications must be used with care if you take nitrates or alpha-blockers for high blood pressure, heart disease or urinary control.
  • Penile injections are an option if oral medications are ineffective or if you cannot tolerate them. Drugs such as alprostadil (Caverject, Edex or Muse), or a combination of other drugs, may be self-injected into the erectile tissues of the penis to increase blood flow, resulting in an erection that lasts about 30 minutes. The needle used is thin, similar to that used to inject insulin for diabetes, and causes little to no discomfort.
  • A vacuum constriction device is a small pump that is placed over the penis to increase blood flow and encourage an erection.
  • A penile prosthesis or implant put in place with a surgical procedure may help to restore firmness when no other treatments work. Several different types of these implants are available, so speak to your doctor about making the appropriate choice for you.

Emotional effects of ED

The physical side effects of prostate cancer treatment often lead to emotional side effects. Many men (and women) associate masculinity with sexual performance and, if that sexual performance is impaired, shame, frustration and depression can complicate the problem. Talk with your doctor at the first sign of sexual dysfunction before your mental health begins to suffer. If you feel distressed, visit with a counselor. Whether you go by yourself or with your partner, talking with an expert will help you process your feelings and learn ways to keep moving in a positive direction.

How you achieved sexual satisfaction in the past may not be how you’ll achieve it now. Even though sex after prostate cancer treatment may be different, it can be extremely satisfying. View the future as a new beginning with different and exciting experiences ahead. And don’t forget — what drew you and your partner together in the past is still present. The emotional attachment, the love and the physical attraction haven’t disappeared. You’re simply entering a new phase of your sexual life together.

Here are a few tips to get started:

  • Reset your expectations. To avoid disappointment, don’t expect to regain the same level of performance immediately. It takes time to heal, and it takes effort and patience to make sure the solutions you choose are right for you.
  • Rethink intimacy. Men do not need an erection to achieve orgasm. With the right stimulation, such as touching or stroking, an orgasm can be achieved without erection. Bringing your partner pleasure can be just as satisfying. For some people, holding hands or simply holding their partner is intimate. Intimacy can transcend sexual activity. Talk with your partner about alternative ways to be intimate.
  • Redefine communication. Even if you and your sexual partner enjoy good communication in your relationship, talking about ED and how to work through it together can be challenging. Keeping an open mind and communicating your feelings go hand in hand as you explore ways to enjoy a satisfying sexual relationship. Counseling is often a productive forum for exploring feelings and talking about them in a safe environment.

Infertility issues

If fathering biological children is important to you, it is vital to understand how prostate treatment can affect fertility. Surgery, radiation therapy and most drugs that fight prostate cancer may cause temporary or permanent infertility in men. After treatment, your testicles may not make sperm cells, or sperm may not be released as part of the ejaculate. Some treatments, such as chemotherapy, may cause birth defects, so it is extremely important to take proper birth control precautions during and after your treatment.

You might consider storing your semen at a sperm bank before treatment begins. After you complete treatment, if necessary, you can talk with your doctor about pursuing artificial insemination to begin or add to your family. Discuss your treatment options and the potential side effects with your doctor before making any treatment decisions.

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