Treatment of prostate cancer including surgery, radiotherapy, or hormonal therapy is certainly effective in combating the disease, but can also cause undesirable side effects on sexuality. The sexual disorders inherent to the different treatments for prostate cancer are quite common and can result in erectile dysfunction, ejaculation, and libido disorders with an overall decline in the quality of sexual life of patients and a strong impact on a psychological level. The occurrence of sexual disorders depends on different factors (such as the patient’s age and the quality of their sexual life) and the treatments received. It is important not to hesitate to ask for help from your doctors to find out the different therapeutic solutions available.
Prostate cancer and sexuality the impact of different types of treatments
Each type of prostate cancer treatment can have adverse effects on sexuality. These effects are detailed to the patient before starting treatment and the benefits/risks of each are assessed on a case-by-case basis.
What are the problems after prostate surgery?
Prostate surgery is one of the standard treatments for prostate cancer. It can lead to sexual problems and in particular erectile dysfunction, the degree of which varies depending on the man. Furthermore, patients who have undergone a radical prostatectomy will no longer be able to ejaculate externally. The orgasm is preserved, but “dry”. Sexual pleasure remains and improves over the months following the operation.
The time to recover sexual function can take anywhere from several weeks to two years.
It occurs either spontaneously, or (most often) after the administration of treatments that the medical team proposes to modulate during the monitoring protocol according to the progress made in the recovery of erections. Treatment is not necessarily lifelong, but should be implemented as quickly as possible after surgery to reduce the risk of erectile tissue fibrosis which can hamper the effectiveness and outcome of sexual recovery.
On the other hand, it will be impossible to conceive a child after prostate surgery. If this removes the sperm, conception is impossible and sperm conservation can be offered to young patients who wish to conceive at a later date. This only affects a small portion of prostate cancer patients, as the disease usually occurs in older men.
Erection after prostate cancer the consequences of focal treatment
The focal treatment of prostate cancer consists of treating only the part of the organ that is diseased, but keeping the rest of the prostate intact as well as the neighboring structures and in particular the erectile nerves.
This treatment, which does not yet have the same level of validity as radical surgery, can be offered to certain patients who have a disease diagnosed at an early stage and which only affects part of the prostate.
The consequences of this treatment on sexual life are minimal. Focal treatment most often makes it possible to maintain erections without treatment and to regain sexuality very shortly after the end of treatment.
This involves interstitial laser treatment, microwave ablation, or high-intensity focused ultrasound treatment (HIFU or Focal one)
Sex life after radiotherapy for prostate cancer
Prostatic irradiation concerns not only the prostate itself but also the vascular-nervous bands of the erection, which can lead to erectile dysfunction after this type of treatment. This results in tissue fibrosis and vascularization which complicates erection.
At the end of radiotherapy, erectile function is often little affected but gradually decreases over the two years following irradiation. It is estimated that about half of treated men maintain erections (totally or partially) for several years after radiotherapy. For other men, the urological surgeon can offer therapeutic care to treat this disorder.
Ejaculation can also be impacted by prostate radiotherapy. The so-called “dry” orgasm is, however, possible.
Hormone therapy and loss of libido
This treatment, often proposed in the presence of advanced prostate cancer, can have an impact on the quality of sexual life of patients and lead to a loss of libido. These effects are temporary or permanent depending on the duration of treatment. However, solutions exist to remedy this.
Sex life after prostate cancer: what solutions?
Several management options are available for patients treated for prostate cancer who present with sexual dysfunction.
Medical treatment of erection after prostate cancer
Prescribing medication is one of the possible solutions to improve the frequency and quality of erections. It is rather reserved for moderate erectile disorders and helps stimulate the blood supply to the penis to oxygenate the cavernous tissue. This type of treatment allows you to obtain erections that can last more than an hour. If the erections obtained are not satisfactory, other solutions are offered.
Intracavernous injection to facilitate erection after prostate cancer
It is carried out at the base of the penis using a very fine needle. Intracavernous injection improves blood supply to the penis by dilating the blood vessels to achieve an erection similar to a natural erection.
Patient education is carried out by one of the specialists to avoid the risk of incidents and allow men to administer this treatment effectively and without pain.
Erection after prostate cancer: the vacuum pump
This is a vacuum erector in the form of a hollow plastic cylinder with an open end for inserting the penis. The other end of the device is connected to a pump to create an influx of blood into the corpora cavernosa and cause an erection. To maintain it, an elastic ring is placed at the base of the penis with a compression effect.
This solution certainly requires preparation, but it is more than 90% effective and avoids the need for medical treatments. It causes no side effects and is very well tolerated.
Improving erection after prostate cancer with a penile implant
The implant is surgically inserted into the penis. There are several types of penile implants. Most often, they are characterized by two inflatable cylinders that the surgeon inserts into the corpora cavernosa. These cylinders are connected to a reservoir filled with liquid which is implanted in front of the bladder.
A pump inserted in the bursae, next to the testicles, connects everything. It is the patient himself who activates the mechanism to cause or stop the erection.
This solution is rather reserved in the event of permanent alteration of erectile function or if other treatments have not shown effectiveness.