Prostate Cancer and Loss of Normal Sexual Function

"While different treatments [surgery, radiation, hormonal therapy] have somewhat different effects, all cause erectile dysfunction, loss of or diminution of ejaculation."

"Men on hormonal therapy lose their sex drive because of the loss of testosterone, and have diminished erectile function, diminished ejaculation and possible loss of orgasm. Surgery can damage nerves that are responsible for erections, and erectile dysfunction [EI] occurs immediately after surgery."

"Even when surgeons attempt to save those nerves, they take a long time to recover [two-plus years] and it's likely they will not recover fully. With the loss of the prostate men can still orgasm, but they lose the ability to ejaculate."

Daniela Wittmann, associate professor of urology, University of Michigan, certified sex therapist

"I tried pumps and masturbation, pelvic floor exercises and Viagra, all of which helped to a certain extent, but . . . I was becoming increasingly frustrated and agitated."

"I missed the spontaneity of sex. I started to feel very unsure of myself, with my confidence seeping away and worse, I felt very, very angry."

"I think we all need to learn to talk about our sexual health just as easily as we do about our dental health."

Elvin Box, aggressive prostate cancer, surgical patient Essex, Britain

Image by: Movember

 

New guidelines have recently been published in The Journal of Sexual Medicine reflecting a need to recognize sexual dysfunction resulting from prostate cancer surgery and prescribed hormones, relating to the impact on men following prostate cancer treatment of loss of sexual function, as a side-effect. Based on 25 years of research, the guidelines combine perspectives from international clinicians and researchers, including the personal journeys back to health of prostate cancer survivors.

Sexual dysfunction is recognized as the most-reported quality-of-life outcome, the greatest unmet need in  prostate cancer care. Health-care professionals are encouraged in the new guidelines to provide tailored care in view of enhancing the sexual health of every patient. Clinicians, patients and their partners should be involved in decision-making. The problem is widespread; one in eight men are diagnosed with prostate cancer in the U.K. in their lifetime; globally in 2020 1.4 million men were diagnosed.

Survivors of prostate cancer in Britain see between 25 and 80 percent experiencing some form of erectile dysfunction. What is at issue is not the cancer affecting sexual performance,but its treatments. Despite which, conventionally patients do not receive specialist advice or support. Life After Prostate Cancer Diagnosis published in the U.K. revealed that few men with prostate cancer were offered assistance with ensuing sexual problems. 

Patients face a choice between radiotherapy followed by testosterone-lowering hormone treatment, or a radical prostatectomy (surgical removal of the prostate). The guidelines take into account the needs and experiences of men from different ethnic backgrounds, or men who are LGBTQ+. Treatment at stages 1 and 2 has a near 100 percent survival rate in comparison with about 50 percent at stage 4 cancer; the difference between catching the cancer in its early stage as opposed to later.

Frequent urination, particularly at night is among the most common symptoms of prostate cancer. Difficulty starting urination or holding back urine, or a weak or interrupted flow are other symptoms. Among some men difficulty in holding an erection, painful ejaculation or blood seen in urine or semen can be identified. Frequent pain or stiffness in the lower back, hips or  upper thighs can signal that prostate cancer has spread. Men over 50 should take a PSA test.

No matter the cancer, treatments often cause side effects that affect patients’ quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patient’s sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment

"It is not necessary for men to lose their sex lives just because their erections are not working well. There is plenty more of their sexuality to draw on. And for some men, erections will not be very affected or will return fairly well over time. There are also practical tools -- vacuum devices, injections, pills, penile implants -- and sex therapy and support groups, which can help too."

Daniela Wittmann, University of Michigan

"For too long, sexual health research in prostate cancer has focused on white, heterosexual men."

"The guidelines are an important step in acknowledging these limitations and ensuring that equity, diversity and inclusion sit at the centre of high-quality care."

Karen Robb, physiotherapist, program implementation director, Cancer Movember U.K.