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Working Through Sexual Dysfunction after Prostate Cancer

by Leslie R. Schover, PhD

“Working through” is a good description of a man’s journey with sex after prostate cancer treatment. With patience, a willing partner, and openness to experiment, almost every man can have pleasurable sex. For most men or couples, it takes a few months after surgery, radiation therapy, or hormone therapy to find their new sexual normal.

Accurate “Sexpectations”
I have heard too many men express disappointment about sex after prostate cancer treatment. At least a third of men consider sexual function when choosing a treatment for prostate cancer. As they search for the best option, they are quoted rates from medical articles on recovery of erections. Unfortunately, such articles are often based on unusually young and healthy groups of men who start out with firm, reliable erections. They are treated by the most expert surgeons or with the latest radiation techniques. Even then, reports “fudge” in defining a sexual success. A man is called “potent” if he has ever managed to penetrate a partner sexually since cancer treatment. Success rates would be far lower if only men who usually have firm erections were counted. Men who use pills or injections to get better erections are also included in the “success column.” Yet many of these men are dissatisfied with sex. Even worse, men given unrealistic expectations often feel like a failure if they end up with poor erections.

When it comes to sex after prostate cancer treatment, there is no free lunch. All current treatments leave most men with erectile dysfunction (ED). At least a third of men with prostate cancer already have ED because of aging and risk factors like smoking, being overweight, heavy drinking, heart disease, high blood pressure, and diabetes. For these men, cancer treatment is certainly not going to improve sex.

When it comes to sex after prostate cancer treatment,
there is no free lunch.

For many years, new prostate cancer treatments have promised to avoid ED, including:

• nerve-sparing radical prostatectomy;
• robotic radical prostatectomy;
• brachytherapy (radiation to the prostate with implanted seeds);
• radiation therapy planned by sophisticated computers;
• radiation with proton or photon beams;
• drugs that block testosterone from cancer cells; and
• hormone therapy given until a man’s PSA (prostate-specific antigen) zeroes out and discontinued until PSA rises again.

After each of these treatments became widely used, researchers admitted that most men ended up with ED. The only sex-sparing “treatment” for prostate cancer is active surveillance – waiting to treat the cancer until tests suggest it is becoming dangerous to health.

Taking Action to Rescue Your Sex Life
It does no good to dwell on disappointments. If a man and his partner want to have a more active and enjoyable sex life after prostate cancer, they have many options.

It is important to get regular blood flow into the penis after surgery or radiation therapy to prevent damage to tissue in the penis. Some men take a daily pill to enhance erections (PDE5-inhibitors like Viagra®, Cialis®, or Levitra®). Others inject medication into the penis to produce an erection or use a vacuum erection pump without the constriction band that maintains the erection for intercourse. If you have ED, see a specialist. PDE5-inhibitor pills only work for mild ED after prostate cancer treatment, but penile injections, vacuum pumps, and surgery to implant a penile prosthesis (inflatable erection pump) can restore erections.

Urologists can treat other sexual problems common after treatment such as leaking urine at climax or pain with erection or climax.

Having a partner who enjoys sex is very important. A mental health professional trained in sex therapy can help partners improve sexual communication and change their lovemaking to make the most of an ED treatment. Even men on hormonal therapy may enjoy lovemaking if they get extra mental and physical stimulation.

Advice on sex after prostate cancer can be found in self-help books or websites. Support groups or peer counseling programs offer suggestions from men who have been through the process.

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