Can A Man Have A Normal Sex Life After Prostate Surgery
The question is loaded what is a normal sex life anyway? Most men will experience a slowing down or drop off in their sexual activity as they get older.
That said, it is still a source of pleasure and intimacy amongst older couples, and for those for whom it is an important part of their relationship, they are keen to understand what sex after surgery will look and feel like.
The majority of men with a diagnose of localized prostate cancer will undergo a conservative approach known as active surveillance, but some of them will require surgery at some point.
The surgeons will excise the growth, or in some cases remove the entire prostate. There are also less invasive surgeries, such as the TURPs and other non-surgical therapies such as radiation therapy.
With careful intervention, most men will be able to resume a healthy sex life after the initial recovery period.
If you have had a radical prostatectomy without a nerve-sparing technique, theres a high chance you will experience a significant reduction in your sexual sensation and libido
Even then, the likelihood is that pleasure will be diminished, and men will only experience dry orgasms, as they will no longer ejaculate merely experiencing the mental side of orgasm. This is not common, and when it happens, it is temporary.
Erectile Dysfunction Following Radical Prostatectomy
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins’ noted Sexual Behaviors Consultation Unit.
Reasons To Have Prostate Surgery
One of the most common reasons for having prostate surgery, or a prostatectomy, is to treat prostate cancer.
According to the American Cancer Society, prostate cancer is the second most common form of cancer in American men, right behind skin cancer. Nearly 174,000 new cases are reported in the United States every year. If the cancer has not yet spread outside of the prostate gland, then surgery will be a great treatment option. Another reason to have prostate surgery is to treat an enlarged prostate.
As the prostate grows, it may block the flow of urine which can create bladder, urinary tract, and kidney related problems. Removing a part of the prostate can help to solve or prevent these issues.
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Low Intensity Shock Wave Therapy
This therapy is based on the core principle of inducing local microtrauma so that the body will respond by stimulating the growth of tiny blood vessels in the penis. These shock waves can cause upregulation of vascular growth factors and nitric oxide creation, as well as enhance the function of the smooth muscle cells of the penis.
The Takeaway: There Are Many Options At Restoring Sexual Function During The Recovery Of Prostate Surgery The Most Common Will Be The Use Of Oral Medications That Help Relax Penis Muscles And Increase Blood Flow But In The Event That These Are Ineffective Or Not An Option There Are Other Choices Available
For the most part, restoring sexual function is most easily achieved with the help of prescription medication such as Viagra®, Levitra, or Cialis®. In more extreme cases, there may be further surgery required, penile injections, or prosthetics. Ultimately, it will all come down to the specific person and their circumstances, risk factors for erectile dysfunction, lifestyle, and results of the prostate surgery itself.
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Changes In Penis Size
Some men notice that their penis is shorter after surgery . Some men notice other changes such as a curve in their penis or a narrower area. We don’t know for certain why these changes happen, but it could be because of low oxygen levels in the penis, caused by not having erections. Other treatments such as hormone therapy with radiotherapy may also cause changes to the size of your penis.
Encouraging blood flow to the penis after surgery may help prevent this. In particular, using a vacuum pump, either on its own or with PDE5 inhibitor tablets could help maintain your penis size and improve erections.
Keeping your penis active after surgery
Although you may not be ready or recovered enough for sex, you can still start treatment for erection problems in the weeks immediately after surgery. It could be taking a low-dose PDE5 tablet once a day or using a vacuum pump, or sometimes both together. The treatment along with masturbation encourages blood flow to the penis. This can help keep your penis healthy. You may hear this called penile rehabilitation. Think of it in the same way as having physiotherapy if you had injured your arm or leg. Starting treatment soon after surgery may help improve your chance of getting and keeping an erection. But it may not work for every man.
Your Emotions And Sex
Your prostate cancer and its treatment wonÃ¢â¬â¢t just affect your body. TheyÃ¢â¬â¢ll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of havingÃ sex. The more you worry, the worse the struggle. If youÃ¢â¬â¢re in a relationship, your partner will be going through many of the same feelings.
One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don’t assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate. Ã
Talking with a mental health professional — either one-on-one or with your partner — can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.
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Sex And The Prostate: Overcoming Erectile Dysfunction When You Have Prostate Disease
If you are concerned about erectile function, its important to understand what erectile dysfunction really is. Failing to have an erection one night after youve had several drinks or even for a week or more during a time of intense emotional stress is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesnt get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, its time to talk to your doctor.
Erectile dysfunction can have many causes, including some forms of prostate disease and medications and surgery for prostate cancer. Fortunately, in many cases, this problem can often be effectively addressed. Some men find relief by taking medications to treat erectile dysfunction. If these arent effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.
Cut Back Or Change Antidepressants
Another thing to think about is any other medications youre taking, notes Dr. Kacker. Many men are, unknowingly, taking medications that suppress orgasm. By far the number one offender is the SSRI class of antidepressants, which include fluoxetine and Paxil . By reducing the dose of these drugs or eliminating them entirely, or switching to a non-SSRI like bupropion , many men see an improvement in their ability to orgasm.
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How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
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What Is Erection Restoration
UCLA HealthThe Mens Clinic offers a penile rehabilitation program for men after prostate cancer therapy. You do not have to have your cancer care through UCLA Health to see the specialists at The Mens Clinic. The idea of penile rehabilitation is to optimize blood flow to the erectile tissue as it is recovering from surgery or radiation therapy.
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Surgery To Remove The Prostate
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
You are still able to have an orgasm, but it will be a dry orgasm. Some men say that a dry orgasm without semen feels normal. But other men find that their orgasm is less intense and pleasurable. The loss of a visible ejaculation can be significant for some men and their partners. Some men say that it feels different but they have managed to find ways to adjust to this.
If you are used to having anal sex and you are the receiving partner, surgery to remove the prostate gland can change this experience. Some men can find the penis rubbing against the prostate gland pleasurable. So if the prostate gland is no longer there, anal sex might feel different. You could look at different ways of enjoying sex and being intimate. Counselling and sex therapy might help.
What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
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Can You Still Have An Erection If Your Prostate Is Removed
When you have a radical prostatectomy , you have surgery to remove your prostate gland. These nerves, blood vessels, and muscles may be weakened when you have surgery for your prostate cancer. For a period of time after surgery , many men are not able to get an erection . This time is different for each man.
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Doctors may also make a number of assumptions about patients, including about their family support system, their sexual orientation and their sexual interests.
Your doctor might tell you youll have an erection strong enough for intercourse, but anal penetration requires 33 percent more rigidity, Rosser said. Hes heard men say their doctors neutered them. Others have said theyd rather be dead. In all, 15 percent of all men whove had a radical prostatectomy exhibit some kind of treatment regret. For gay men, so long ignored by medicine, Rosser believes those rates are much higher.
with a postmenopausal wife who doesnt want sex anyway might just accept having a low libido, he explained. But if your partner is another man, and his drive isnt diminished, it can be a real problem.
Rosser said the silence and shame surrounding the topic allows ugly myths to flourish like that gay sex somehow caused their cancer. Guys can feel guilty, Rosser said. Or, their partners may think on some level, they can catch it.
He had some of those thoughts himself: Im a cyclist did being in the saddle too much cause it? Did enjoying receptive anal sex?
Without good data, researchers cant get to the truth, Rosser stressed.
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The Basics: How An Erection Occurs
At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.
Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis .
Figure 1: Anatomy of the penis
The penis is made up of three cylindrical bodies, the corpus spongiosum which contains the urethra and includes the glans of the penisand two corpora cavernosa , that extend from within the body out to the end of the penis to support erection. Blood enters the corpora cavernosa through the central arteries.
Other Ways Sex May Change After Prostate Surgery
1. Dry orgasm
Removal of the prostate gland and seminal vesicles means youll no longer ejaculate, this is called anejaculation. This might change how your orgasm feels after surgery and youll no longer be fertile.
2. Reduced penis length
A possible side effect of surgery is reduced length of your penis, while erect and/or flaccid, which may be due to scar tissue or poor functioning of the nerves and blood supply.
3. Loss of libido
If youre having androgen deprivation therapy as part of your treatment, it might reduce your sex drive due to the decrease in testosterone. This can also affect your ability to get and maintain an erection. A prostate cancer diagnosis can cause stress, poor sleep, anxiety and depression, and these factors can also impact your sex drive.
4. Leaking urine at orgasm
Some men can also experience climacturia, which is when you leak urine at orgasm.
5. Changes to anal sex
If youre experiencing any of these issues and they bother you, its important to talk to your doctors and other specialists for help.
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How Does Prostate Surgery Affect You Sexually
If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.
While the prostate isnt directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.
The prostate is next to a dense group of nerves and the seminal vesicles .
There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.
For men who have had an open prostatectomy, they will find that they can no longer ejaculate. This is known as a dry orgasm and can still be pleasurable.
Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.
However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.
Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.
According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.
For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.