After you have surgery and radiation treatment for prostate cancer, the biggest certainty is that your sex life will be different. Not gone, just different.
After treatment for prostate cancer, the biggest certainty is that your sex life will be different. Not gone, but different.
“After surgery and radiation treatments, many men quickly discover that sex will never be normal again. Sensations change,” Tara Parker-Pope writes in The New York Times. “Many men can no longer achieve erections without pumps or pills.”
That was the conclusion of a study that offered “straight talk”
based on the cases of 1,000 men at various treatment centers. The upshot is that surgery and radiation take a greater toll than most men are led to believe.
Among men in the study who reported good sex lives before cancer, fewer than half had normal erections two years after treatment.
“The new data should allow men and their doctors to determine a more realistic view of a man’s chances for sexual recovery after treatment,” Parker-Pope wrote. “Depending on age, erectile function, the extent of cancer and the type of treatment, a man’s chances of returning to a somewhat normal sex life can range from less than 10 percent to 70 percent or more.”
There’s the theory that some men will forgo treatment for prostate cancer if they are told the naked truth, but study lead author Martin G. Sanda, MD, director of the prostate care center at Beth Israel Deaconess Medical Center in Boston, says men should be enabled to make their own decisions with the most information available.
“I probably lose some patients because someone else is promising them the moon, but more often than not, I find that couples appreciate the transparency and honesty,” Sanda said. “You don’t want the man to forgo effective treatment for cancer because of a fear of sexual side effects. The discussion needs to be linked with talking about what’s available to help keep them sexually active.”
What to expect after prostate surgery
Prostate cancer impacts men’s lives at three levels: body, mind and relationships. At the physical level, men are at risk of erectile dysfunction, loss of libido, and infertility.
Learning you have cancer and about prostate surgery side effects tends to cause anxiety or depression, and altered feelings about sex. Prostate cancer may also affect your relationship.
Managing any sexual problems will depend on your partner and your sexual relationship in the past. It’s difficult, but there are ways to manage the challenges that arise from prostate surgery side effects.
Erectile dysfunction medicines, implants, or vacuum devices can help. But the psychological and emotional burdens of prostate surgery weigh just as heavily on a patient, and you’re encouraged to share your thoughts and feelings. A psychologist can help, as well as support groups in which you can share your experiences.
Support sponsored by the Prostate Cancer Foundation includes financial resources, help finding a doctor or treatment center, and help finding a support group and prostate cancer blogs.
Sex after prostate cancer surgery
According to one prostate expert, sexual problems after treatment can be minimized if the cancer is caught early and the surgery is done by an experienced doctor using “nerve-sparing techniques,” such as prostatectomy and brachytherapy.
For the vast majority, their sex lives will return after surgery, usually beginning within three to six months with continued improvement for two or three years, according to William J Catalona, MD, a researcher and prostate cancer surgeon who ran some of the first widespread prostate cancer screening tests in the U.S.
“There are certain things that are never going to be the same,” counters Sharon Bober, director of the sexual health program at Dana-Farber Cancer Institute in Boston. But she adds that sexual problems are rarely just physical; that it’s possible to “re-engineer your sex life so that it’s really satisfying. But it might look really different.”
March 30, 2020
Christopher Nystuen, MD, MBA