Causes Of Sexual Problems
While many men experience sexual issues following prostate cancer treatment, these issues are not often due to prostate cancer itself.
Most prostate cancer symptoms involve problems with expelling urine due to enlargement of the prostate gland. This enlargement begins to inhibit the urethra carrying urine out of the body. Urinary symptoms should not affect a persons sex life, however.
More active treatments for cancer, such as surgery, radiation therapy, or hormone therapy, may lead to sexual dysfunction.
Nerves that run close to the prostate gland control erections. Surgery that completely removes the prostate gland carries a risk of erectile dysfunction for this reason.
This type of surgery is usually only suitable for men with aggressive prostate cancer that is likely to grow or spread. Younger men with prostate cancer might also choose it, however.
In these surgical cases, a nerve-sparing prostatectomy aims to avoid damage to the erection-controlling nerves. Nevertheless, nerve-sparing operations are not always possible.
While reducing the risk of erectile dysfunction, this type of treatment may not deal with the cancer fully and may leave behind some cancerous tissue.
Surgery carries the greatest risk, but other treatment methods for prostate cancer can also affect sexual activity.
Treatment options with a risk of erectile dysfunction include:
Brachytherapy has a lower risk of erectile dysfunction than other types of radiation therapy.
What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
Those muscles are the core of how your body and therefore keeps erections strong.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
We would also recommend them as part of a daily routine, for men who are experiencing general sexual problems or incontinence. Your general health is an essential indicator of how likely you are to experience ED.
For more information on the pelvic floor exercises, click here.
Chemotherapy Drugs For Prostate Cancer
The drugs listed above are only a sample of what is available and is used to illustrate a truth. Because of the range and variety of drugs used in both these treatments the impact on sexual function can range from sever to insignificant.
Hormone replacement therapy for prostate cancer, for example, can often impact sex drive rather that create erectile dysfunction. It is important to work with your physician to explore all available treatment options. How to keep a healthy erection?
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Theme : Importance Of Education/comprehensive Information
The men in our study spoke about the importance of education and comprehensive information before and throughout the process of prostate cancer treatment. Many men who were dissatisfied with their care were upset when they were given misinformation or they felt the information about sexual dysfunction after prostate cancer treatment was not accurate. Although the men who were most unhappy about sexual dysfunction after prostate cancer did not feel well-prepared in terms of their understanding of the impact of prostate cancer treatment on sexual function, the men who had come to terms with their sexual dysfunction felt they had been well-prepared for the sexual side effects of treatment. Men recommended that information be repeated before, during, and after treatment due to challenges in terms of readiness to learn immediately after the cancer diagnosis. They also talked about the challenges of dealing with a stigmatized topic such as sexual dysfunction. The participants said the following:
Man 16: I was fully informed by everybody. All the doctors that were involved fully informed me that these were things that I was up against if they removed my prostate So definitely you definitely must keep everybody informed about whats going onIts really-thats extremely important
What Are The Current Expectations With Regard To Outcomes After Radical Prostatectomy
Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes. Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 inhibitors within 2 years.
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This Study Analyzed Both Patient
Radical prostatectomy is the most commonly selected treatment for localized prostate cancer, but population-based studies estimate that 78% to 87% of patients have erectile dysfunction following radical prostatectomy, an outcome associated with patient distress, dissatisfaction, and decision regret.1-5 So, what role does the surgeons technique and skill play in whether patients recover sexual function after radical prostatectomy? Quite a significant one, according to a new prospective cohort study. Agochukwu-Mmonu and colleagues found a wide variation among surgeons in the sexual outcomes reported by their patients, and these differences persisted even after controlling for patient characteristics.6
Take Note
- “The value here is that with robotic techniques being the predominant approach used today for this surgery, there is an opportunity to video record the procedures and use the ones with the best and most consistent outcomes as a teaching model for proper technique to improve sexual function outcomes for men after radical prostatectomy.” –Laurence A. Levine, MD, Rush University Medical Center, Chicago
An independent expert not involved in the study, Laurence A. Levine, MD, called it an interesting and potentially important study, noting that recovery of sexual function after prostatectomy has not been previously been studied in this way.
Surgeon and patient factors impact post-op sexual function outcomes
An opportunity for improvement
References
Why Does It Take So Long To Recover Erections After The Very Best Surgery
A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.
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Prostate Cancer Survivorship Program Helps Men Maintain Sexual Health
After cancer treatment ends, patients expect life to return to normal. But what they often find is that normal means something different than it did before cancer. That can be particularly true for men who undergo surgery for prostate cancer.
Erectile dysfunction is one of the long-term side effects of surgery to treat prostate cancer. But there are many ways to help men return to an active sex life. To help address concerns like this that men face during their recoveries, the University of Michigan Rogel Cancer Center in collaboration with the Department of Urology has established a Prostate Cancer Survivorship Clinic.
We talked with Daniela Wittmann, a social worker and certified sex therapist with the clinic, about how couples can work toward restoring their sexual health.
Q: How likely is it that men who undergo surgery for prostate cancer will experience erectile dysfunction?
A: Many factors are involved, so recovery depends very much on the individual. Broadly speaking, the degree to which erectile dysfunction will be a problem depends on whether the nerves that surround the prostate were spared. Before a man undergoes surgery, his doctor will talk to him about the stage of the cancer, what type of surgery will be performed and how many nerves may be involved. After surgery, the doctor will tell the patient how many nerves were spared. A mans age and how strong his erections were before surgery may also play a role.
Q: What is penile rehabilitation?
Types Of Prostate Cancer Treatments
For men who have undergone prostate cancer surgery, for example, many surgeons recommend avoiding sexual activity for at least several weeks in order to allow for proper healing. Radiation therapy, hormone therapy, and chemotherapy do not necessarily preclude men from returning fairly rapidly to their prior level of sexual activity.
However, there can be side effects as a result of these treatments that make sex difficult or impossible. These possible side effects include fatigue and erectile dysfunction. So even if you’ve been given the go-ahead by your healthcare provider, you may find it necessary to redefine what sex means for you and your partner and to explore new or alternative sources of pleasure.
If you have been treated with implanted radioactive seeds , your healthcare provider will likely give you a certain time frame wherein sexual activity should be avoided due to the presence of radioactivity within your prostate. Most men can have sex one to two weeks after their seed implant. Men should wear a condom for the first two months after their seed implant. This break in sexual activity is also meant to allow for proper healing following the implantation procedure.
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Recovering From Prostate Surgery
The patient can usually leave the hospital within a day or two, but the incision site will likely feel sore for a few days after. The patient will most likely not be able to drive for at least a week, but should be able to return to normal activities within a few weeks.
During the recovery, the patient may experience several side effects including:
- Urinary tract infection
- Temporary loss of bladder control
- Ejaculatory dysfunction
- Erectile dysfunction
After the surgery, its possible to experience erectile dysfunction for a few weeks, a year, or even longer in some cases. This is because the surgery might potentially injure one of the nerves, muscles, or blood vessels that are involved with getting and maintaining erections. There are other factors that could influence the severity of the erectile dysfunction during recovery as well and so it can be difficult to predict how any specific person may recover from the surgery.
If there are any injuries to nerve tissues sustained during a radical prostatectomy then the recovery process will take longer. Additionally, if the patient is already experiencing erectile dysfunction before the surgery, then it wont be resolved afterward. There have been many improvements in prostate surgery techniques that have resulted in much better outcomes for the men undergoing them.
However, there are other additional factors that could negatively impact the patients sexual health, such as:
- Sedentary lifestyle
Cost Of Enlarged Prostate Treatment Without Insurance
At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.
At New York Urology Specialists, we offer a flat-fee all-cost-included Rezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.
At New York Urology Specialists, we offer a flat-fee all-cost-included Urolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.
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Questions To Ask Your Doctor Or Nurse
- How could my prostate cancer treatment affect my sex life?
- Which treatments for erection problems would be best for me? Can I get them on the NHS?
- Is there anything I can do to prepare myself before I start my prostate cancer treatment?
- What happens if the treatment doesn’t work? Are there others I could try?
- What other support is available to me?
- Can my partner also get support?
What Treatment Options For Sexual Dysfunction Are Safe After Prostate Surgery
All of the treatment options come with risks, even the all-natural ones. You need to be careful about sourcing supplements, being confident in the supply.
Many US-based manufacturers were caught by the FDA selling natural Tongkat Ali which actually contained prescription ED drugs! Likewise, overtraining can lead to injury or soreness. However, theres no doubt that the natural approach is safer than the alternative.
Only purchase Tongkat Ali supplements from a reputable company that provides 3rd party lab tests to prove that it is an unadulterated and safe supplement.
If you are looking for a safe and natural testosterone boosting supplement that contains Tongkat Ali, we recommend our Testo-Booster supplement.
The side effects from the most commonly used ED pharmaceuticals include minor ones, such as headache, flushing, runny nose and pains in the stomach or back.
In some cases, dizziness and a sudden drop in your blood pressure can take place. Thats why men with heart conditions have to be evaluated by a physician before they take it, and may have to rely on a lower dose.
Around 1 out of every fifty men who take those drugs will also experience painful or persistent erections.
In addition, the implant itself may degrade, and is a constant risk of infection, even after the surgery has healed. Around a third of implants need to be replaced within 10 years.
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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
Prostate Surgery And Erectile Dysfunction
The short answer is yes prostate surgery is very likely to cause erectile dysfunction.
A prostatectomy, even though modern surgeries are nerve-sparing is likely to cause months of issues to a mans sex life.
Less invasive procedures that avoid the bundle of nerves and seminal vesicles next to the prostate will still likely cause ED, even if its a shorter-term issue.
Other surgeries are less likely to cause lasting damage, but the fact is that sexual dysfunction is a complicated issue. Men have to grapple with the mental side of it as well.
A cancer diagnosis can weigh heavily on a mans mind, which can impact both his sex drive as well as his ability to maintain an erection.
Theres also the fact that as we age, men experience a natural reduction in sex drive and are likely to be less able to get and maintain an erection.
The likelihood is that any surgery would just exacerbate the underlying issue.
Around 1 out of every 4 men over the age of sixty will experience some form of erectile dysfunction. Thats also the most likely group to undergo surgery, which is why the two are often linked, but not necessarily the sole cause.
If you have some pre-existing medical condition that impacts your floor muscles, sexual function or urine/ urinary function than you might find that the side effects of the surgery are more severe.
You should talk with your Urologist about any pre-existing medical conditions and how they might affect the treatment.
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Palliative Or Supportive Care
If your cancer is at an advanced stage and cant be cured, your medical team should discuss how the cancer will progress and which treatments are available to ease the symptoms.
You can be referred to a palliative care team, who can provide support and practical help, including pain relief.
Page last reviewed: 01 July 2021 Next review due: 01 July 2024
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Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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Your Emotions And Sex
Your prostate cancer and its treatment wonââ¬â¢t just affect your body. Theyââ¬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 havingà sex. The more you worry, the worse the struggle. If youââ¬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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