Dealing With Sexual Dysfunction After Prostate Cancer

Prostate cancer attacks the walnut-sized gland that produces some of the fluids contained in men's semen, the liquid that transports sperm. Survival rates for men who get prostate cancer are high, but treatment can create challenges for individuals seeking to resume a normal sex life.

A common problem

Globally, prostate cancer is the second most common form of cancer and the fifth-leading cause of cancer-related death among men. It is a common health threat that becomes increasingly dangerous with age: In the United States, approximately 14 percent of men over age 40 are diagnosed with prostate cancer. Today, 6 in 10 cases of prostate cancer occur in men over age 65.

Early diagnosis and increasingly effective treatments greatly improve an individual's chances of survival. While roughly 1 in 41 men will die of prostate cancer, it is estimated that more than 3 million men who have been diagnosed with prostate cancer are still alive today. Medical science has come a long way in treating and curing prostate cancer, but some men pay a heavy price for a new lease on life.

A new reality

Some forms of treatment make it difficult for a man to resume normal sexual relations, particularly after surgery. For example, a man who undergoes a prostatectomy, in which the entire prostate and seminal vesicles are removed, may experience dry orgasms because his body's means of producing seminal fluid has been excised. Other treatments, such as radiotherapy, hormone therapy and brachytherapy, can also impact erections and ejaculation; hormone therapy lowers a man's testosterone level and, therefore, reduces his libido.

The nerves that control erections run alongside the prostate and are often affected during surgery. Nerve-sparing techniques can be used to preserve the nerves, if possible, but even when precautions are taken, it is common to have postoperative issues with erections.

A man who has undergone surgery or some form of therapeutic treatment may find himself dealing with low sperm counts, dry orgasms or even a reduction in penis size. Adjusting to strange new sensations during sex can be disruptive and psychologically troubling. After all, most men's expectation is that sex will produce intense physical pleasure. A prostate cancer survivor struggling with such a drastic, and unexpected, change in his sex life may face feelings of inadequacy and guilt, or fall into depression and be unable to perform.

Getting back to normal

Men who are used to a healthy sex life may find post-treatment processes to be psychologically dispiriting, but the physical side effects can usually be managed. Penile injection therapy can help patients who sustain nerve and blood vessel damage during surgery achieve erections. In more challenging cases, implantation of a penile prosthesis can make a significant difference.

Sexual intimacy is about more than intercourse and orgasm, however. Getting back to normal can be a time-consuming and frustrating process for men who are not comfortable talking openly about sexual dysfunction. Fortunately, counseling, behavioral therapy and other supportive care therapies can help men dealing with the aftereffects of prostate cancer restore self-confidence, and begin a healing and productive dialogue with a loved one.

Behavioral health therapy can help prostate cancer survivors recover lost libido and sexual confidence by showing them how to explore their emotions and learn to cope with impaired sexual capabilities. Couples therapy is also effective in helping prostate cancer survivors and their partners adapt to physical changes that may result from treatment.

Quality of life

A 2001 study of men who experienced sexual dysfunction due to prostate cancer revealed that their dysfunction impacted a number of areas:

• The quality of their sexual intimacy
• Their normal daily interactions with women
• Their sexual fantasizing
• Their perceptions of their masculinity

The study's authors concluded that physicians and therapists should take special care not to overlook "psychosocial issues" when treating prostate cancer survivors suffering from sexual problems. Quality of life, always an important factor among cancer survivors, is of particular concern among prostate cancer survivors who anticipate the restoration of their sexual health.