How a Radical Prostatectomy Will Affect Your Sex Life.
One of the biggest concerns for men with prostate cancer is their treatment options. Men who undergo “active surveillance” worry that they are not doing enough to treat their cancer. Men who choose radiation, chemotherapy and surgery are concerned with how these treatments will affect their health.
Perhaps one of the scariest courses of treatment is the option for radical prostatectomy, or a surgical procedure in which a doctor removes the man’s prostate and the surrounding tissue.
As with any invasive surgical procedure, radical prostatectomies come with a myriad of concerns and questions. However, one of the biggest concerns with this form of treatment is how it will affect a man’s sex life.
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Side Effects of Radical Prostatectomies
The side effects of prostate surgery are numerous and can include incontinence, blood clots or loss, infection, anesthesia side effects, damage to the urethra or the rectum, or erectile problems.
The penis is an organ comprised of erection chambers – corpora cavernosa – and corporal sinusoids, or erectile tissues. The corpora cavernosa are primarily muscles, which are triggered first by the brain. Once chemicals are released in the brain, they travel through the spinal cord and nerves and into the penis. These nerves then release nitric oxide, which relax the muscles in the penis and cause blood to rush into the erection chambers.
The nerves in this process are crucial. When these nerves are damaged – as they are in surgery – erectile dysfunction is going to occur. Inflammation can also affect these nerves, which often happens after surgical trauma.
According to the American Cancer Society, radical prostatectomy surgery can also affect fertility. The surgery can also damage the nerves that control the seminal vesicles, making it difficult for some men to ejaculate. This does not mean achieving an orgasm will be impossible, it simply means that ejaculation may not be a byproduct.
It is important to know that everyone recovers from surgeries at their own pace, and not all men experience these side effects. With a skilled surgeon, these side effects will typically last no longer than several months to a year following the procedure.
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Can I Have a Normal Sex Life After Prostate Surgery?
If you read “erectile problems” on the list of side effects and immediately balked, don’t worry. Most men are able to return to healthy sex lives following surgery.
This does not mean that you will emerge from the surgery free of erectile issues or will be able to resume your sex life right away.
According to the Prostate Cancer Foundation, 40-50% of men are able to return to normal sexual function one year after undergoing nerve-sparing radical prostatectomies. After two years, 30-60% of men who have had prostate surgery are able to return to their pre-treatment function.
So, yes. You will be able to have a sex life following surgery, but it may take time. Recovery depends on many factors, including the type of surgery, the surgeon performing the operation, the stage of the cancer and your age. Age is a determining factor in sexual function, as erectile issues commonly increase with age. The good news is that these problems can be fixed.
Treating Erectile Problems
Erectile dysfunction as the result of a prostatectomy no longer has to interfere with a man’s sex life. There are plenty of options that can treat erectile issues.
Popular medicines like Cialis and Viagra can help by stimulating blood flow to the penis. MUSE, a small medicated pellet that is inserted into the penis via a plastic tube, also stimulates blood flow. MUSE contains alprostadil which contains vasodilatory properties. This means that it widens the blood vessels and allows for an increased blood flow. The side effects of MUSE are burning and aching in the groin and can also include dizziness, fainting, or swelling of the leg veins.
Caverject is another option for treating erectile dysfunction. It is a single-dose injection, containing alprostadil, and works similarly to MUSE by relaxing certain muscles in the penis and widening the blood vessels. Side effects of caverject include bleeding or swelling at the injection site and difficulty urinating.
Erectile dysfunction can also be treated through a surgically-implanted penile implant. During this surgery, a narrow tube is inserted along the length of the penis and a small, fluid-filled structure resembling a balloon is attached to the abdominal wall. When an erection is desired, a release button is pressed and the fluid is released into the tube, resulting in an erection. This procedure is done under general anesthesia and, presuming the parts function correctly, is 100% effective.
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Emotional and Psychological Side Effects of Prostate Surgery
Not all post-surgery erectile problems are physical, however. Robotic Oncology reports that the worries about these side effects can also interfere with erections. Cancer takes an emotional and mental toll; some men may feel “less” after surgery because they are unable to function as they did before their diagnosis. Terms like “normal” and “pre-treatment” in relation to sexual activity don’t help, because recovery and pre-treatment sexual function differ for each person.
According to the New York Times, doctor’s definitions of “normal functioning” are misleading. Most surgeons report that their patients are able to obtain erections “adequate for intercourse” following surgery. This definition does not cover the myriad of unique circumstances surrounding a patient’s cancer treatment.
According to the director of robotic prostatectomy at New York Presbyterian Medical Center, Dr. Ash Tewari, a patient who sexuallt functions well before surgery – without the use of drugs – has roughly “an 85 percent chance of regaining an erection firm enough for intercourse” following the surgery. However, reaching that point will take time and the use of erection-enhancing drugs.
Remember that recovery from cancer-related surgery is not just physical. You should talk to your partner about what to expect from the surgery and your recovery time. Speaking to a professional and asking your doctor to clearly define what “normal” sexual function means in relation to you, personally, can also help ease anxieties.