Prostate cancer causes changes in sexual function in general and particularly with respect to erectile function. It is important to keep in mind that the younger you are, the better your chances of regaining the ability to have erections after prostate cancer treatment. Be aware that if you have a sexual dysfunction before treatment, it will usually be aggravated by the treatment. However, it can be fixed or improved after surgery. The information below covers a variety of treatments that may cause sexual dysfunction.
Whether you are single or have a partner, changes in the way you see yourself, your family role, and your patterns of sexual intimacy often occur during and after prostate cancer treatment. Side effects of prostate cancer treatment associated with sexual function may include infertility, decreased libido, or erectile dysfunction. It is essential to remain open and honest and to get timely medical assistance and counseling to deal with these changes.
Infertility is the inability to procreate. It can cause a problem for men who choose to treat their cancer with surgery or radiation therapy. The surgery used to treat prostate cancer causes infertility because the source of sperm (i.e. the prostate and seminal vesicles) is removed; the man can still have orgasms, but will not ejaculate. Infertility is also common after radiotherapy because the seminal fluid produced does not transport sperm properly. If you want to have children after your prostate cancer treatment, you should consider freezing your sperm.
Loss of libido
A decrease in sexual desire is a common mental and physical side effect of prostate cancer treatment, particularly with hormone therapy. Men with prostate cancer should not take testosterone because this hormone only fuels the growth of cancer cells. It can be helpful to talk to your partner or see a counselor or sex therapist.
Erectile dysfunction is the inability to get or maintain an erection sufficient for sexual intercourse. Even when the surgeon preserves the erectile nerves during the radical prostatectomy, different degrees of erectile dysfunction are a common result. Most men who undergo surgery regain their ability to have an erection over time. However, some men may never regain the ability to have a natural erection. Men undergoing radiation therapy also experience erectile difficulties that usually fade with time.
Mechanisms of erection
The penis consists of two corpus cavernosa and a corpus spongiosum. The corpus cavernosum consists of two chambers that contain many blood vessels. The corpus spongiosum is a spongy chamber that contains the urethra, the tube that drains urine from the bladder. When the man is sexually excited, the blood vessels in both chambers of the penis relax, open, and fill with blood. This mechanism triggers a firm and rigid erection. Erectile dysfunction must persist for at least three months before being considered a medical problem.
The impact of erectile dysfunction
Erectile dysfunction can have devastating effects on men struggling with this problem. It causes anxiety and psychological problems. From a young age, men today are exposed to the idea that masculinity is synonymous for an erect penis. That penis performance defines sexuality. This is why it is not surprising to find that the male identity is destabilized when the penis cannot perform.
What the man has taken for granted for so long is no longer feasible. Feelings of shame and mediocrity, loss of self‑esteem, and lack of confidence are negative emotions that only make their situation more unbearable. This is shy it is important for men to have a satisfying orgasm even in the absence of an erection. A weak erection does not mean the end of sexuality.
Anger caused by erectile dysfunction can be directed against oneself or against their partner. If he fears failure, the man can avoid all sexual activity. This reaction may be detrimental to their relationship as a couple—his partner may believe that she has become less attractive, that she no longer excites him, or that she is getting old. Wives sometimes question their husbands—is he having an affair? This situation can lead to feelings of rejection.
Talking openly about erectile dysfunction can help alleviate the tension. By living through an experience like this, many men find out just how strong their relationships are and discover that apart from the sex, there are other ways to live a fulfilling life as a couple.
NEVER LOSE HOPE! In most cases, erection problems can be treated. In the meantime, if you need help to get through this difficult period, do not hesitate to talk to your healthcare team, doctors, nurses, or healthcare professionals.
What I need to know
Consequences of erectile dysfunction treatments
Radical prostatectomy: Damage to the nerves responsible for erectile function during surgery
- Erectile dysfunction presents immediately after surgery.
- Between 40 and 70 percent risk of erectile dysfunction depending on the age of the patient.
- Can last for 12 to 24 months before complete nerve recovery and the ability to have an erection is restored.
- In some cases, impotence is permanent.
- Note: The percentage of side effects may vary depending on the type of surgery and tumour.
Radiation therapy: Damage to the arteries causes decreased blood flow to the penis and to the nerves responsible for erectile dysfunction
- Between 20 and 50 % risk of erectile dysfunction depending on the type of radiation therapy.
- Erectile dysfunction can occur up to one to three years after treatment, sometimes even after five years.
Brachytherapy: Damage to the arteries causes decreased blood flow to the penis and to the nerves responsible for erectile dysfunction
- About 25% (sometimes higher) risk of erectile dysfunction.
- The percentage of side effects varies depending on the type of brachytherapy used.
Hormone therapy: Causes a decrease in libido or sex drive, as well as erectile dysfunction.
- During treatment, no sexual appetite in most patients. After treatment, possible restoration of libido, but not in all cases.
Some men get the impression that radical prostatectomy or external radiation therapy has caused their penis to shrink. This may not actually be the case. This impression may be due to the fact that, if you do not have an erection for awhile the penis can retract from the lack of blood flow.
In order to prevent the lack of blood flow and oxygen from causing fibrosis (hardening) of the penile tissues, men are encouraged to have an erection as soon as possible after the operation or during and after radiotherapy treatments. This increases the changes of regaining the ability to have a natural erection.
Certain recent studies suggest that taking medication such as Cialis, Livitra, or Viagra regularly after surgery can speed up erectile recovery and reduce the risk of penis shrinkage.
It is advisable not to remain sexually inactive. Penile rehabilitation (making sure your penis can have a satisfactory erection) is extremely important following surgery. It is best to discuss this with your urologist before your surgery.
What you also need to know
Consequences such as erectile dysfunction, retrograde ejaculation, dry orgasms, and the decrease or loss of libido go beyond the physical and impact our own body image. The impact of these consequences can appear in a number of ways.
- Changes in body weight and muscle mass caused by hormone therapy
- Breast enlargement
- Testicular loss or atrophy
- Loss of bladder control
Some are temporary, others last for a long time, and some are permanent. Regaining your ability to have an erection is not enough, masculinity itself needs to be redefined and rebuilt.
- Loss of self‑esteem
- Performance – obligation
- Perception of sexuality
- Unrealistic expectations – high demands
- Impact on marital life / sexuality
- Financial impact: oral treatments, injections, pumps, etc.
Sex therapy with a sexologist includes sexual education and support.
Sex therapy can give results on various levels
- Regaining a virile body image
- Giving your partner pleasure despite ED
- Improving intimacy
- Redefining sexuality, despite a decreased libido
- Fighting against anxiety and depression
Management and treatment
Managing Erectile Dysfunction (ED)
If you have ED as the result of prostate cancer treatment, it can be yet another source of frustration in your life. But there are a few ways you can help gain control over your situation:
Don’t give up
Don’t assume you have a permanent problem and nothing can be done. Depending on your treatment you may recover your erectile function, but it can take a long time. In the meantime, try to control your anxiety around sexual encounters and activity, which can make ED worse.
Involve your partner
Honest and open communication can help make sure they know that this isn’t a sign of diminished interest in them, and can help you explore other ways to satisfy one another. Treatment is often more successful when a man involves his partner.
Manage your mood
Stress, anxiety and depression can seriously impact intimacy and erectile function. Be open with your healthcare team about all the issues surrounding your treatment and recovery.
Sex therapy support
A sexologist can help the patient and couples overcome and resolve their physical problems or learn to live with them. For example, sex therapists can help the patient integrate medical treatment with their sex life when the man is no longer able to have an erection naturally. The sexologist can also help them explore other facets of their sexuality and other way to express their affection.
Sexuality can take on different forms and remain just as fulfilling for both partners. When there is no sex drive because of hormone therapy, the sex therapist helps both the patient and couples deal with the situation in order to avoid suffering, discouragement, and guilt. You will have access to concrete strategies for resolving potential conflicts with your loved ones and those who care about you.
Treatment of ED
There are several treatments for erectile dysfunction. Talk to your urologist.
Cialis, Levitra, Viagra (PDE5)
- Sexual intercourse success rate of 40–60%
- Minimally invasive treatment (easy to take)
- Maintenance of spontaneity
- May not work
- Cannot be taken with medication containing nitrate
- Does not work if erectile nerves have been removed
- Success rate of up to 85%
- Works even if erectile nerves have been removed or damaged
- Useful if the man cannot take PDE5 inhibitors
- Discomfort in the penis
- May not work
- Risk of inappropriately prolonged erection
- Scar tissue in 10–15% that causes the penis to curve
- Fainting (rare)
- Success rate of 57%
- No needle
- Works even if erectile nerves have been removed or damaged
- Useful if man cannot take PDE5 inhibitors
- Penile discomfort
- May not work
Vacuum constriction device
- Success rate of 85–92%
- Does not require medication or surgery
- May cause bruising
- Cannot be worn for more than 30 minutes
- Cannot be used with anticoagulants
- The penis can be cool to the touch, which may not feel natural
Penile prosthesis (or implant)
- Reported satisfaction rate of 85%
- Spot surgery
- Avoids the risk of a curved penis caused by penile injections
- More relaxed preliminaries that don’t change the feeling of the skin
- Infection in about 2% of cases that require the removal of the prosthesis
- 15% of implants fail and surgery is required to repair/remove the prosthesis; this can be embarrassing with a new partner.
- 15% of men who opted for this type of surgery have never tried it with a partner.
For more information, you can view, download, or print the document (PDF) on the treatment of erectile dysfunction. Here are some additional links for more information on injections, penile pumps, and the MUSE applicator.
Before trying any of the treatments listed above, you should definitely talk to your urologist about which therapy option best suits your needs. The information given is general informational purposes only. It is not a replacement for medical advice. Your health may prevent you from accessing the treatments we have described; some may even put your life in danger. As always, we ask you to discuss it openly with your urologist.
Alone or with a partner
Intimacy as a couple
After treatment, especially with radical prostatectomies, many men reported having feelings of happiness, sadness, and fear as well as mood swings.
They also stressed the need to continue having intimate relations with their partner despite their inability to have full sexual intercourse. Touching, kissing, holding hands, walking together, talking to each other, or simply being together can be immensely satisfying and help you recover.
Orgasms will return in due time. We suggest discussing your thoughts and concerns openly with both your partner and urologist.
Do not hesitate to talk to a sex therapist who can help you overcome and resolve physical problems or come to terms with your new reality. The sexologist can also help them explore other facets of their sexuality and other way to express their affection. Sexuality can take on different forms and remain just as fulfilling for both partners
Maintaining a fulfilling sex life
Points to keep in mind when you are ready to have sex again
- It is advisable to wait 4 weeks before having sex for the first time after surgery. You do not need to wait after radiation therapy.
- Sexual intercourse will not cause recurrence.
- Be prepared for to laugh at the unexpected. Sex should not be a “serious affair” or a “marathon”. Allow yourself to stop and rest if you are tired.
- Sexual intercourse should not cause discomfort or pain. If this happens, talk to one of our doctors or nurses. Fear of pain can lead to sexual problems.
- Performance anxiety can occur if you are too focused on your erection.
- Skin is the biggest sexual organ and the brain is the most important. By using them, the sexual possibilities are limitless.
- Being diagnosed with cancer should not dictate what a man can or cannot do. Use your imagination and humour to explore new ways to maintain intimacy.
You should know that very few couples separate because of prostate cancer. In fact, this ordeal can actually bring you closer together since cancer forces you to communicate, break taboos, and use your imagination.
If you are single
Several men who have had prostate cancer can tell you that their life has never been the same.
Our priorities, values, and lifestyle change and we no longer see life in the same way. But you should know that you do not need to give up on love just because you have prostate cancer. On the contrary, it could become the most important thing in your life. Here are some guidelines to keep in mind when looking for your next partner.
Love is an open door
Even if you don’t believe in it anymore, tell yourself that love is always open to you, even after prostate cancer treatments. The only person that can stop you from meeting the love of your life is yourself. Keep your mind open and stay alert, you could meet that special someone.
Sex is not everything
Fears stay the same
Whether or not you have undergone prostate cancer treatment, you should know that the fears remain the same regardless of age. Things that can stop you from finding love include: fear of living alone, rejection, isolation and prejudice, opening up, not living up to expectations, being disappointed, or heartbreak
You should know that by letting these fears take over, you can miss out on something amazing. This is why it is important to overcome your anxiety and despair and take that risk. If in doubt, tell yourself that everyone has these feelings.
Apart from sexuality, there are other factors to consider when choosing your partner. If you chose your former partner(s) based only on this element, you may have been somewhat disappointed. To increase your chances of success, here are other factors that can help you in choosing a partner.
- Personality: do you really like the way she behaves, acts, and thinks?
- Personal and social values: ideally, these should be compatible with your own.
- Projects and life goals: does he or she want the same things you do in life?
- Common interests: You are more likely to be happily in love if you choose a partner that has the same interests as you, like cooking and traveling.
- Availability: The person you desire must be available and ready to start a new relationship. She may have the best personality in the world and the same values as yourself; but if she is not physically or emotionally available, your relationship will go nowhere.
Now that you know more about the keys to being happily in love, you are ready to start your search for a new partner.