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How to cope with ED following prostate cancer?

Is sex after prostate cancer a possibility?

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As if a cancer diagnosis isn’t distressing enough only to find out that after you have come through all the treatment you can no longer make love with your partner.

Sexual dysfunction is defined as the inability to achieve or maintain an erection long enough to have satisfactory sexual intercourse. Usually, when a man becomes sexually aroused, a number of things will happen:

  • The brain sends a message to the penis directing the blood vessels in the penis to dilate and allow more blood to flow through them
  • As the blood flow increases, the penis becomes engorged with blood, the penis enlarges and becomes stiff; this is an erection

In order for this to be achieved, there are several symptoms of the body involved including the nervous system, the endocrine system, the vascular system and muscles. If the treatment for prostate cancer interferes with any of these systems, it may result in difficulty achieving or maintaining an erection.

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Treatments for prostate cancer

There are several treatments that may be considered in the treatment of prostate cancer and they include:

Radical prostatectomy

The prostate gland is situated below the bladder and in front of the rectum. It is the size of an almond and forms a doughnut shape around the urethra, the tube through which urine leaves the bladder. Where it is situated means that it is in the vicinity of key nerves, muscle and blood vessels which are instrumental to achieving an erection.

During a radical prostatectomy, the prostate gland is surgically removed and it is possible for nerves, blood vessels and muscle to be compromised in some way which in turn may result in erectile dysfunction. For a period of time after surgery, many men will find that they are unable to achieve an erection but the length of time will be different for every man. It may be less than a month or more than a month;it may not even be possible for a year or more post surgery.

It is with highlighting at this point that once your prostate gland is removed, there will be no seminal fluid that is produced in the prostate gland and gives semen its fluidity. This means that when a man has sex post radical prostate surgery, he can orgasm but cannot ejaculate.

Radiation therapy

The risk when radiation therapy is used on the prostate is that nerves situated near the prostate that are involved in producing an erection can be damaged. If there is any nerve damage, the result will vary from case to case from having less frequent erections to having permanent erectile dysfunction.

Hormone therapy

The advantage of hormone therapy is that it does not damage the nerves, blood vessels or muscles which surround the prostate gland. What hormone therapy does however is to lower the levels of testosterone in the body and testosterone is responsible for libido or sex drive. This means that the patient is likely to be much less interested in sex as well as having some degree of erectile dysfunction. The effects of hormones will vary from man to man with some still having strong desire but having problems with erections or reaching orgasm. The plus side of hormone therapy is that after treatment stops, provided the man’s sexual function was healthy prior to treatment, erectile function should improve.

Post prostate cancer treatment

If prostate cancer treatment has left you with erectile dysfunction, there are treatments that will be able to help you with the problem. However, there are other factors which may have an influence on your particular case of erectile dysfunction and they include:

  • Whether or not you had been able to have normal erections before treatment
  • Whether you suffer from other conditions such as high blood pressure (hypertension) or diabetes. Your doctor will need to address other medical issues separately and treat accordingly
  • Medication which you may take for the treatment of hypertension, heart disease, seizures, cancer or depression
  • Lifestyle choices like being a smoker or being a heavy drinker
  • Your age
  • The type of treatment given for prostate cancer

Seeking advice from your healthcare team is the first step in finding help for the problem. They are in the best position to advise on the most suitable treatment for you. Going to your doctor first is important because any medication you are taking or other condition you may have can interact with some ED treatments.

Types of ED treatments

Medication

There is a variety of ED medication available and whilst they all work in slightly different ways, they are designed to improve erectile dysfunction by facilitating increased blood flow to the penis. The most popular group of ED drugs are known as phosphodiesterase type 5 inhibitors (PDE 5). They act by blocking the enzyme activity which is responsible for erectile dysfunction. This type of drug may not be suitable for use by a person with heart disease and for this reason must be taken under the supervision of a health care professional. If you are treating heart disease using nitrates, PDE 5 inhibitors can cause dangerously low blood pressure and should not be taken under any circumstances.

Types of PDE 5 inhibitors

  • Avanafil (Stendra) - this is taken 15 minutes prior to having sex and should only be taken once daily. Common side effects include headache, flushing, stuffy nose, back pain and sore throat.
  • Sildenafil (Viagra) - taken as an oral tablet, this should also be used once per day. It should be taken 30 minutes prior to intercourse and its common side effects include headache, flushing, stuffed or runny nose, back pain, upset stomach, muscle aches and changes in vision such as blurring or changes in colour perception.
  • Tadalafil (Cialis) - this oral medication will increase blood flow throughout the body and should be taken one per day only about thirty minutes prior to having sex; effects may last as long as 26 hours. Common side effects are headache, flushing, runny or blocked nose, backache, upset stomach and pain in the limbs.
  • Vardenafil (Levitra) - this medication is taken 60 minutes prior to sexual intercourse and should be taken no more than once per day. Side effects are headache, flushing, stuffed or runny nose, back pain, upset stomach and dizziness.

Other medications used to treat ED that are not PDE 5 inhibitors 

  • Alprostadil (Caverject, Edex, MUSE, Vitaros) - there are three different ways of administering this drug, firstly as an injectable solution which is injected directly into the penis 5 - 20 minutes prior to sex and can be used up to three times a week with a 24 hour minimum lapse between injections. The medication also comes as a suppository which is put in place 5 - 10 minutes prior to sex with maximum use twice in a 24 hour period. Finally, alprostadil topical creams are applied to the tip of the penis using a dropper 5 - 30 minutes prior to sex. Dosage for this is a maximum of once per day and no more than three doses per week.
  • Testosterone - this may be given as hormone replacement therapy. Testosterone is the main sex hormone present in the male body and levels will drop naturally as we age. This reduced testosterone can lead to a number of issues including erectile dysfunction, fatigue, reduced libido, reduced sperm count and weight gain. Testosterone can be used in conjunction with PDE5 inhibitors to treat ED in patients with reduced testosterone levels.

Counselling therapies

Stress and anxiety are two of the many emotions that men may feel as a result of being told that they have prostate cancer. Other feelings will include fear, helplessness, loneliness, even relationship problems and all these things can lead to a post traumatic stress situation. The best approach to combat emotional problems after the dust settles is counselling and your GP will be able to direct you to the most appropriate type. 

Mechanical devices for erectile dysfunction

Medication to treat erectile dysfunction does not suit everyone as it can be accompanied by some very unpleasant side effects for some people. If medication does not suit you then there may be a mechanical device that will:

  • Vacuum pumps - these devices are a tube that is placed over the penis. A pump is then used to create a vacuum in the tube by removing the air from the tube and sealing the device with a retaining band to prevent the sir from re-entering. Creating a vacuum encourages the blood to flow into the penis and so creating an erection. The tube is then removed, intercourse occurs and finally, the retaining band is removed to allow the erection to subside. Whilst a vacuum device is not a cure for ED it can enable a man to have an erection and so have a more normal sex life.
  • Erectile dysfunction rings - these rings are placed around the base of the penis to allow an erection to be maintained. It is most useful in cases where a man cannot maintain an erection or achieve a full erection.

Surgery for erectile dysfunction

Several surgical procedures may also help with erectile dysfunction:

  • Penile prosthesis - the prosthetic device is implanted into the penis and this an ‘erection like’ state. There are two types of implants, the first is a malleable implant which creates the appearance of a permanent erection.
  • The second type is an inflatable implant. The device consists of a reservoir, a pump unit and two inflatable cylinders. When an erection is needed, the area of the scrotum where the pump is located can be pressed and this allows the chambers to be filled with fluid from the reservoir; this creates an erection.

Microsurgical penile revascularisation

This procedure involves microsurgery to repair and divert blood vessels following injury to the pelvis. Removal of the prostate gland may constitute such an injury and so this procedure may be a useful option if blood vessels have been damaged during surgery.

This procedure is not suitable for older men who have developed atherosclerosis (hardening of the arteries) and so may have limited use in that it is most successful in men under 40 years.

Alternative remedies to treat erectile dysfunction

There are many claims on the internet for products and supplements that will cure ED. There is very little evidence to suggest that any of the remedies work and so it would be advisable to save your money!

Conclusion

To be told that you are suffering from cancer is traumatic in itself but to find that, after successful treatment, that you are not able to pick up life where you left off cannot be easy.

Erectile dysfunction however can be treated and the problem that was once hidden behind closed doors is much better understood. As a result, medications and other treatments have come on in leaps and bounds and there is now life after ED!

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