Dealing with Sexual Changes After Prostate Cancer Treatment

As with most treatments, prostate cancer treatment comes with a range of side effects depending on the treatment type. Dealing with these side effects can be challenging as they may disrupt many aspects of your daily life and sometimes interfere with future plans. Feelings of frustration, anger or embarrassment as a result of some of these side effects are normal. You are not alone if you feel this way.

Cancer treatment, particularly for the prostate, can bring about various side effects that may affect the sexual aspects of your life.

Erectile dysfunction, the persistent inability to achieve and maintain a penile erection, is the most common side effect of prostate cancer treatment. It is most commonly a result of prostate surgery or radiation therapy as the delicate nerves and blood vessels are exposed to damage and radiation. Other treatments such as hormone therapy, may also decrease your libido (sex drive) due to the decrease in testosterone levels.

These sexual changes may not only be a cause for concern on a personal level, but they may also cause friction or stress in a relationship. Fortunately, there are methods to deal with these sexual changes. Those with erectile dysfunction or decreased sex drive following prostate cancer treatment might find solutions in the following:

• Oral medications

There are oral medications available that relax the muscles in the penis, allowing rapid blood flow to the penis, allowing an erection to form. These medications take about an hour to take into effect and are only temporary, lasting approximately 4 to 36 hours. Men who have undergone nerve-sparing prostatectomy tend to have better results taking these medications as compared to men who have undergone radical prostatectomy.

It is important to note that this may not be a solution for those who take certain heart medications (e.g. nitrates, commonly used to treat angina). It is best to consult a doctor before taking any new medication.

• Mechanical devices

There are devices that can mechanically cause or assist with maintaining an erection. Vacuum erection devices create a vacuum to force blood into the penis, causing an erection. A rubber ring can then be used to maintain the erection.

Similar to vacuum erection devices, penile pumps use suction to draw blood into the penis, resulting in an erection. However, instead of using a constriction ring to maintain the erection, some pumps come with a tension band that can be placed at the base of the penis after achieving an erection.

• Penile prostheses

The use of penile prostheses is another option for those who want to maintain their sexual life with their partners. Penile prostheses help to simulate an erection.

A common penile prosthetic is a penis sleeve, which is a penis-shaped device that is slipped over the penis (and sometimes testicles). While these do not create an actual erection, it may still help in maintaining a sexual relationship with your partner. However, it is crucial to have open communication with your partner on how comfortable they are with such devices. This may not be the solution if either one of you is uncomfortable with it.

• Implants

A more permanent solution may require surgery. A penile implant may be surgically inserted to provide a longer-lasting solution. There are a few types of implants available ranging from a single flexible rod that is inserted along the length of the penis to a system of flexible plastic cylinders, a pump, and a reservoir of fluid to mimic the natural erection of a penis. If you are considering an implant, it is best to discuss with your doctor the options available to you.

• Intermittent hormone therapy

If you are experiencing sexual changes as a side effect of hormone therapy, you may want to consider discussing with your doctor whether intermittent hormone therapy is an option. This means that you take breaks between periods of treatment, or you only start hormone therapy again when your prostate-specific antigen (PSA) levels rise. This may help improve your sexual drive, though it is not guaranteed. Also, there is a risk that intermittent hormone therapy may not be able to control the cancer for as long. Speak to your doctor to check the suitability of intermittent hormone therapy as an alternative.

Learn more: Sex after Prostate Cancer

Sexual changes can often affect your relationship with your partner. Communication is key to maintaining a healthy relationship with your partner after prostate cancer treatment. Be open with them about your feelings, concerns, and changes in sexual function. Find and discuss alternative forms of intimacy that can strengthen your emotional connection. Consider speaking to a counselor or a therapist, either individually or as a couple, to address the emotional and psychological aspects of sexual changes. It is crucial to involve your partner in discussions and decisions, as they are likely to be affected by these changes as well. Additionally, patience and understanding are key as both of you navigate through the emotional aspects of these challenges. Do not hesitate to reach out for professional support if needed, whether it is from your healthcare team, a counselor, or a support group.

It is important to note that the extent of sexual changes can vary from person to person. Educating yourself about sexual health and exploring alternative forms of intimacy and pleasure can be empowering and enriching. This might involve learning about different sexual activities or techniques. Additionally, advancements in treatment techniques and supportive care can help to mitigate some of these changes. Do communicate openly with your healthcare team about any side effects you may be experiencing, as there are often strategies and medications available to manage these changes.