How to Improve Sexual Performance after Prostate Cancer

According to ACS (American Cancer Society), approximately 220,800 cases of prostate cancer were diagnosed and reported in the year 2015 (1). The mortality rate due to prostate malignancy was 8% i.e. 27,540 (lower than the deaths caused by breast cancer in 2015). It is estimated that approximately 1 of every 7 males are at risk of developing prostate cancer during lifetime. Needless to say that malignancy of prostate gland is associated with a significant risk of morbidity and long term complications in the sex life of affected males.

What are some factors that may influence sexual performance in males affected by Prostate cancer?

A number of factors can influence sexual performance in males (independent of prostate malignancy). For example, some specific factors that may influence sexual performance in the setting of prostate cancer are; advancing age, coexisting and chronic medical conditions (such as diabetes, hypertension or atherosclerosis) and surgeries of inguinal region.

The chances of developing erectile dysfunction after the treatment of prostate cancer depends on the location of the tumor and its aggressiveness.

• Age: The risk of developing erectile dysfunction increases with progressing age. Similarly the risk of success of treatment decreases with increasing age.
• Treatment type: The treatment mode which a person opt, plays a vital role in developing erectile dysfunction. For example, there is a greater risk of ED with radical prostatectomy (a surgical procedure) as compared to radiation technique. According to a new research study, investigators analyzed the effects and long term complications of prostate cancer treatment in 1187 men.  As part of the analysis, 901 candidates underwent surgical removal of tumor and 286 received radiation therapy for malignant lesion. The analysis revealed that only 21 percent men were able to achieve normal penile erection after surgical intervention; whereas 36 percent after radiation therapy.

Some men who developed ED after prostate cancer surgery were able to regain their erectile function after a certain period of time; but in vast majority of patients, ED was permanent,

Nerve sparing surgery

Most men develop erectile dysfunction after surgical treatment because the nerves which surrounds the prostate gland are severed/ destroyed during radical prostatectomy procedure. However, a new technique ‘nerve sparing prostatectomy’ can be utilized which is associated with a very low risk of ED after surgery. Studies revealed that approximately 60-80% of men were able to experience functional erections after the surgical intervention. However, it should be kept in mind that every men/ tumor is not a candidate for nerve sparing surgery (due to location, size and stage of tumor at the time of surgery).

How can you Improve Sexual Performance after Prostate Cancer?

1. Use of erection drugs

Use of erectile dysfunction drugs are usually effective only if a nerve sparing surgery is performed. This happens because erection is the result of massive pooling of blood in the penile sinuses as a result of tactile stimulation via nervous action. In case of nerve dysfunction, most traditional ED treatments are ineffective.

According to research study conducted by Italian researchers it was concluded that only 15 percent men were able to regain their erections with use of pharmacological agents after conventional surgical procedure; while 50 percent men were able to achieve normal erection with drugs after nerve sparing surgery.

2. Males don’t need erection for pleasurable orgasm

There are different nerves which control the erection and orgasm. So even if the nerves of the prostate gland are affected, the orgasm remains active. However it does become difficult to handle a flaccid penis with orgasm but stimulation provided with mouth or hand helps is achieving and maintaining the erection.

3. Drug/ Dose modification:

It is noteworthy that mild to moderate sexual dysfunction is almost inevitable with prostate malignancy and treatment process, but in most cases, affected individuals can still enjoy their sexual life with lifestyle modification and over-the-counter interventions.  It is important to speak to your doctor regarding plausible treatment options; for example certain drugs (such as antidepressants like selective serotonin reuptake inhibitors) can also negatively affect orgasm and sexual performance. Additionally, in some cases, impaired orgasm or poor sexual performance is due to low testosterone levels (4). Consequently, hormone replacement therapy is often helpful in such cases.

4. Assistive Devices:

Some popular and effective assistive devices that are known to improve sexual functions in males after prostate surgery are:

• Penile Implants: Penile implants are useful in addressing sexual dysfunction in males after inguinal procedures. You can opt for a mechanical devices or an implant.
• Penile vacuum pumps or rings: these agents are useful in males who have difficulty in maintaining erection during the entire period of intercourse. Use of rings help in prolonging the period of erection.
• MUSE: This is a small medicine (about the size of a rice grain) that is directly placed on the urethra to promote pooling of blood in the penile sinuses.
• Penile Injections: Penile injections are usually self-administered by the patient to achieve and maintain normal penile erection through the process of intercourse.

References

1. Stanford, J. L., Feng, Z., Hamilton, A. S., Gilliland, F. D., Stephenson, R. A., Eley, J. W., ... & Potosky, A. L. (2000). Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. Jama, 283(3), 354-360.

2. Litwin, M. S., Flanders, S. C., Pasta, D. J., Stoddard, M. L., Lubeck, D. P., & Henning, J. M. (1999). Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE. Urology, 54(3), 503-508.

3. Wang, C., Swerdloff, R. S., Iranmanesh, A., Dobs, A., Snyder, P. J., Cunningham, G., ... & Berman the Testosterone Gel Study Group, N. (2000). Transdermal Testosterone Gel Improves Sexual Function, Mood, Muscle Strength, and Body Composition Parameters in Hypogonadal Men 1. The Journal of Clinical Endocrinology & Metabolism, 85(8), 2839-2853.