What Will I Learn By Reading This
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect . Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
- What erectile dysfunction is
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate relationship.
What Is A Dry Orgasm
A dry orgasm is what happens when a man reaches a sexual climax but does not ejaculate, so no fluid emerges from the penis. It is also sometimes known as orgasmic anejaculation and some men get worried by this if they think it is due to a prostate problem.
Although dry orgasms can indeed be caused by some treatments for prostatic disease, this only occurs in middle-aged and older men as a phenomenon called retrograde ejaculation.
Infection Or Inflammation Of The Male Reproductive Tract
Blockage of the epididymis or ejaculatory duct can be caused by infection or inflammation. Infection of the epididymis is known as epididymitis.
A possible cause of these infections is an untreated sexually transmitted infection. Note that the blockage can still be present even after an infection has been treated. This is because scar tissue may be formed during the active inflammation stage of infection. The antibiotics will get rid of the infection but won’t fix the scar.
If you have a history of sexually transmitted infection, tell your doctor, even if it was in the past.
Non-sexually transmitted infections can also lead to inflammation, scar tissue, and blockage. For example, childhood mumps can cause viral orchitis, which is inflammation of one or both testicles. This infection in childhood can lead to permanent scarring, which later in life may mean infertility due to azoospermia.
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Why Fertility Problems Might Develop
When a couple makes a baby, this is called conception or reproduction. When a baby is conceived naturally, a lot of things must take place for it to happen. Any change in how an organ works or a change in a hormone that’s needed for sperm development can block conception. In other words, there can be a body system malfunction that can change a man’s fertility and affect his ability to father a child. Certain health problems, including cancer, can affect these things. Here are some things that can happen in a man:
A tumor or other problem might block or press on an organ and cause it to not work properly.
Hormones that are needed to help with conception can be disrupted.
Testicles may not make healthy sperm or might make fewer or no sperm at all.
- The process of sperm ejaculation can be disrupted.
In many cases, cancer surgery or treatment can be more likely than cancer itself to interfere with some parts of the reproductive process and affect your ability to have children. Different types of surgeries and treatments can have different effects. The risk of infertility varies, depending on:
- The patients age and stage of development for example, before or after puberty, in young adulthood, in older adulthood, etc.
- The type and extent of surgery
- The type of treatment given
- The dose of treatment
How May Erectile Dysfunction Affect My Sex Life
Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.
If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a problem shared is a problem halved. Not everyone wants a sexual relationship. Dont try to guess or assume what your partner wants. Have an open and honest discussion with your partner.
This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.
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How To Treat Impotence
If youre having trouble getting an erection, see your doctor or urologist. Although talking about impotence may be difficult, its important to get treated. Letting the problem persist untreated can put a strain on your relationship as well as prevent you from having children.
First, your doctor will perform a physical exam. Then your doctor may order lab tests to look for diseases such as diabetes mellitus, heart disease, or hormonal problems that could be causing your erection issues.
Based on your exam and laboratory results, your doctor will recommend a treatment plan.
Sometimes, making a few changes to your lifestyle is all it takes, including things like:
- exercising regularly
- cutting back on alcohol
All of these lifestyle changes can help treat your condition.
If those methods dont work, your doctor might prescribe a medication that increases blood flow to the penis to produce an erection. These include:
All of these medications carry risks, especially if youve had heart failure, have other heart disease, take nitrate drugs for heart disease, or have low blood pressure. Talk to your doctor to see if this type of medication is the best option for you.
Another medication used to treat erectile dysfunction is alprostadil , which is Prostaglandin E1 therapy. This medication is either self-injected or inserted as a suppository into the penis. It produces an erection that lasts for up to an hour.
What Are The Chances Of A Man Who Is On Testosterone And Still Wants Children
You should consult a male reproductive specialist if you are taking testosterone and still want children in the future. If you still wish to have your biological children, then testosterone treatment is not for you.
It would be much better to treat the particular low testosterone symptom that you are experiencing, than opt for the testosterone replacement therapy. For instance, a disorder in the pituitary gland can adversely affect testosterone levels in the body.
Still, you can choose being treated with a pituitary hormone HCG as it increases your testosterone level without interfering with sperm production. When you are done having kids of your own, then you can decide to treat low testosterone directly.
But also, if you still want to go ahead with the treatment regardless of the effect it may have lowered sperm count and hormone alterations then it may be best to consider freezing of the sperm for later use.
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Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
The Three Parts Of Male Orgasm
Kacker starts by pointing out a common misconception that erections are necessary for male orgasm. They arent. Men can have experience orgasm without an erection. The converse is also true, of course: men can have an erection without having an orgasm.
When discussing orgasm and radical prostatectomy, its useful to think of the male orgasm as having three separate parts, says Dr. Kacker.
First, secretions from the testicles, the prostate, and the seminal vesiclessmall, slender glands near the prostateflow into the urethra, the tube-like structure that carries semen through the penis and out the body. The emission of those fluids creates a feeling of fullness and a sensation of inevitability.
Second, theres ejaculation, which is accompanied by contractions of the pelvic floor muscles, the group of muscles used to hold in intestinal gas and urine.
And third is the mental componentall of the processing the brain does of incoming sensory signals from penis and pelvis that contribute to the mental experience of build up and release.
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Going Home With A Catheter
You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.
On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.
It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.
Talking About Orgasm Problems Is Important
Men and their partners have become much more open about talking erectile dysfunction, in general and as a consequence of prostate cancer treatment, notes Dr. Kacker.
Whatever you think about all those ads for Viagra and Cialis, they have made it easier to talk about ED and helped remove some of the stigma around the condition.
We should be having the same frank, open discussions about orgasm, says Dr. Kacker. Orgasms can bring a couple together and allow them to maintain sexual intimacy in the difficult period around diagnosis and treatment of prostate cancer.
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Sperm Donor With Iui Or Ivf
Another possible fertility treatment option for men with azoospermia is to use a sperm donor. A sperm donor may be chosen because getting sperm isnt an option , or this can be a first-line choice after diagnosis because other treatment options are too expensive.
Some men choose to go with a sperm donor because they dont want to risk passing along male infertility to their child .
With a sperm donor, either IUI or IVF will be used. This depends on the female partners fertility.
Hormone Adjustments Can Help With Orgasm
Sometimes hormone levels contribute to orgasmic problem. Many men with low testosterone have problems with orgasm, but treating prostate cancer patients with testosterone is still very controversial. Other hormones can also play a role. For example, a low thyroid hormone level or a high prolactin level can make it more difficult to reach orgasm. Even if you have a normal hormone levels, there are a few hormonal medications that may be able to help.
Another hormone that plays a role in orgasm is oxytocin. The level of oxytocin increases in both men and women during sexual arousal. Taking an under-the-tongue formulation of oxytocin five to 10 minutes before sexual activity can help some men achieve orgasm. Its safe and no side effects have been reported, says Dr. Kacker. You need a prescription for oxytocin, and its available only through special compounding pharmacies, not through retail pharmacies.
Cabergoline is another medication that can help with orgasm problems. It blocks the release of prolactin, a hormone that appears to play an important role in the refractory period after orgasm when men cant have another orgasm for a while.
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Dealing With Erectile Dysfunction: For You And Your Partner
The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
How Is Azoospermia Treated
Treatment of azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. Treatment approaches include:
- If a blockage is the cause of your azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or never developed tubes.
- If low hormone production is the main cause, you may be given hormone treatments. Hormones include follicle-stimulating hormone , human chorionic gonadotropin , clomiphene, anastrazole and letrozole.
- If a varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.
- Sperm can be retrieved directly from the testicle with an extensive biopsy in some men
If living sperm are present, they can be retrieved from the testes, epididymis or vas deferens for assisted pregnancy procedures such as in vitro fertilization or intracytoplasmic sperm injection . If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic analysis of your sperm before assisted fertilization procedures are considered.
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Surgery Effect On Ejaculation
Surgery can affect ejaculation in different ways. For example, if surgery removes the prostate and seminal vesicles, a man can no longer make semen. Surgery might also damage the nerves that come from the spine and control emission . Note that these are not the same nerve bundles that pass next to the prostate and control erections . The surgeries that cause ejaculation problems are discussed in more detail here.
Is It Possible To Get Someone Pregnant After Prostate Removal
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Previous Trauma And/or Surgical Causes
Previous trauma to the male reproductive tract can cause damage, scar tissue, and blockage to the vas deferens, epididymis, or ejaculatory duct.
Sometimes, surgery in the general areabut not specifically onthe male reproductive tract can lead to unintentional scarring or injury. For example, surgery to treat an inguinal hernia can lead to injury to the testes or vas deferens.
A previous vasectomya form of permanent birth control where the vas deferens are cut or blocked intentionallyis a possible cause of azoospermia. While this is the goal of vasectomy surgery, some men decide in the future to have the vasectomy reversed.
How Else Can You Treat Low Testosterone
Some other medicines and injections can raise testosterone levels, such as citrate, letrozole, and even pituitary hormone injections.
When using these medications, hormone levels and semen analyses should be carefully monitored as they can often lead to a hormonal imbalance and, in frequent cases, decrease sperm count.
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Who Can And Cannot Use Finasteride
Finasteride can be taken by men aged 18 years or over.
It’s generally not recommended for women or children.
Finasteride is not suitable for some people. To make sure this medicine is safe for you, tell a doctor if you:
- have had an allergic reaction to finasteride or any other medicines in the past
- have severe bladder problems
- have liver problems
- are trying for a baby or have a pregnant partner this medicine passes into semen and can affect an unborn baby
How Is Azoospermia Diagnosed
Azoospermia is diagnosed when, on two separate occasions, your sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope.
As part of the diagnosis, your healthcare provider will take your medical history, including asking you about the following:
- Fertility success or failure in the past .
- Childhood illnesses.
- Injuries or surgeries in the pelvic area .
- Urinary or reproductive tract infections.
- Exposure to radiation or chemotherapy.
- Your current and past medications.
- Any abuse of alcohol, marijuana or other drugs.
- Recent fevers or exposure to heat, including frequent saunas or steam baths .
- Family history of birth defects, learning disabilities, reproductive failure or cystic fibrosis.
Your healthcare provider will also conduct a physical examination, and will check:
- Your entire body in terms of signs of/lack of maturation of your body and reproductive organs.
- Your penis and scrotum, checking for the presence of your vas deferens, tenderness or swelling of your epididymis, size of the testicles, the presence or absence of a varicocele, and any blockage of the ejaculatory duct as evidenced by enlarged seminal vesicles.
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