Erectile Dysfunction and Prostate Cancer
by Jeffrey Albaugh, PhD, APRN, CUCNS
Regardless of treatment choice – surgical removal of the prostate, radiation treatment, or hormone ablation – the most common adverse effect of prostate cancer treatment is sexual dysfunction, particularly erectile dysfunction. Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse. In addition, men who have undergone prostatectomy do not ejaculate during climax, and some men have reported a shortening of the penis after surgery.
Many factors are involved in determining the likelihood of recovering erectile function after treatment for prostate cancer. In general, erections will not be as firm after treatment with surgery, radiation, or hormone ablation as they were before treatment. Return of erectile function can take up to two years after completing treatment. Penile rehabilitation after prostate cancer treatment involves encouraging regular increased blood flow to the penis to promote the health of the blood vessels and surrounding tissue.
Most men can climax (even though they do not ejaculate) after prostatectomy, even without an erection. And sexual relations may continue to be enjoyable. Men and women both can climax from other types of stimulation. There is no reason a couple can’t continue to be intimate, even with the absence of an erection.
This common side effect of prostate cancer treatment can often be treated. Know your options so you can find the one that works for you.
If penetrative sex is the goal, several categories of treatments for erectile dysfunction are available. Each treatment option has advantages and disadvantages that need to be explored before beginning any treatment.
The vacuum constriction device is a highly effective, non-invasive treatment option that not only can provide an erection sufficient for sex but also may provide penile rehabilitation in terms of return of spontaneous erections and re-establishing penile length after prostatectomy. The keys to success with a vacuum constriction device are adequate instruction and plenty of practice.
Oral medications are the most popular treatment for erectile dysfunction because of their ease of use and discreetness; however, the failure rate with these medications is high in people taking them after prostate surgery. They may be more effective in men who were treated with radiation therapy. However, regular use of oral agents also has been used to encourage blood flow to the penis, promoting penile rehabilitation after prostate surgery.
There is no reason a couple can’t continue to be intimate, even with the absence of an erection.
The intra-urethral suppository (Muse®) is inserted immediately after urination and provides a treatment option that is simple to use. Emerging research shows that regular use of Muse may improve erectile function after prostatectomy. However, Muse cannot be used by everyone and should be initially tried in the clinical setting under supervision. One disadvantage of this type of treatment is that it does not work in some men. In addition, side effects may include burning pain, aching in the penis, and, less commonly, a decrease in blood pressure, dizziness, lightheadedness, and fainting.
Penile injections provide an effective treatment option for erectile dysfunction. Side effects may include pain, bleeding and bruising, and, less commonly, an erection that will not resolve (which is considered a medical emergency requiring immediate medical attention), and scar tissue in the penis. The success of injections is dependent on one-on-one clinical instruction and dosing. Penile injections not only can produce an erection sufficient for sexual relations after prostatectomy but may also improve spontaneous return of naturally occurring erections when used three times a week.
The penile implant is a treatment option that is highly effective. Implants can be of the simple, malleable type, or they can be inflatable. The malleable implant is always rigid, while the inflatable implant can be inflated with fluid to make it more rigid for sex and then deflated after sex. Disadvantages to the implant are that it will permanently change the tissue of the penis and that it is a surgical procedure associated with some side effects. The most common side effect after surgery is pain, which typically resolves over time.
Many men can continue to have a fulfilling sexual life after prostate cancer treatment. For this to happen, however, communication with your partner is essential. It may also be helpful to work with a sex therapist. For optimal recovery of sexual function, it is important to begin promoting blood flow to the penis soon after treatment. You should work closely with your healthcare provider to choose the treatment option that feels most comfortable for you (and your partner).
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Dr. Jeffrey Albaugh is an advanced practice urology clinical nurse specialist at the Northwestern Memorial Hospital, Center for Integrative Medicine and Wellness, and the Jesse Brown VA Medical Center Sexual Health Clinic in Chicago, IL. He specializes in treating men with prostate cancer, as well as individuals and couples with sexual dysfunction.
This article was published in Coping® with Cancer magazine, January/February 2010.
Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.