Sex after Cancer, Things you Need to Know

It is a common misconception that prostate cancer treatment is often associated with transient or permanent sexual dysfunction. The myth is true to some extent, but it is very important to understand that treatment modalities are not always responsible for sexual dysfunction. For example, according to a latest study reported in the peer reviewed Journal of Sexual Medicine (1), investigators suggested that erectile dysfunction was reported in approximately 52% prostate cancer patients prior to the initiation of therapeutic intervention. According to another study reported in the Urology (2) journal, investigators identified that the prevalence of erectile dysfunction is 25-41% in males younger than 75 years of age (as evidenced by Sexual Health Inventory for Men (SHIM) score of less than 17). SHIM is a popular screening criteria that is used in clinical practice to identify ED.

In short, sexual dysfunction has a multifactorial etiology; with more than one factor contributing to the pathogenesis of erectile dysfunction (ED). Therefore, it is usually difficult to pinpoint if the cause of ED is strictly prostate cancer malignancy.

Treatment method employed for prostate cancer

Some of the common methods available for treating prostate cancer include,

• Radical prostatectomy, in which the prostate glands are removed from the body by surgical intervention.
• External beam, in radiation from an external source is used to destroy the cancer
• Seed implantation, a radioactive pellet is inserted.

Although all the described methods are equally effective, but the success rates varies one from another,

• Radical prostatectomy: 81%
• External beam: 81%
• Seed implantation: 83%
• Combine therapy: 77%

Generally, the surgery is associated with poor prognosis in terms of sexual health. More patients report sex

ual dysfunction after invasive prostatectomy than those who undergo radiation therapy.

Things you need to Know about Prostate Cancer and Sexual Dysfunction

1. Does Prostate cancer treatment affect my sexual performance?

As discussed previously, sexual dysfunction is a likely possibility after prostate cancer treatment for a number of reasons; for example:

• Damage to vital nerves that are responsible for sexual stimulation.
• Poor self-esteem, low energy levels or weakness.
• Inability to achieve as frequent erections.
• Changes in sex drive/ libido as a result of negative changes in the body image.

2. How early can I resume my sexual activity after prostate surgery?

The answer to this question is highly variable and depends on the nature of treatment employed and overall physical health. In most cases, you can resume your activity as early as a few weeks.

3. Will I be able to achieve erection without artificial help?

Depending upon the nature of treatment and staging of cancer at the time of diagnosis, most people can achieve erection after treatment. Additionally, you can always utilize artificial means such as drugs and prosthesis to achieve erection.

4. Will I be able to achieve orgasm without erection?

Orgasms are usually unaffected after prostate cancer surgery. Most men are able to achieve orgasms without penile erection by utilizing various types of physical/ sexual stimulation.

5. Is there anything I can do to improve the quality of my sexual life?

Certain lifestyle changes can help in improving the quality of sex life; such as:

• Quit smoking, as it may pose more deleterious effects on the libido of affected males.
• Perform Kegel exercises (or other pelvic floor strengthening activities) for bowel and bladder support.
• Work with a psychotherapist or counselor to discuss your concerns. It is believed that stress, anxiety and emotional pressure can further worsen the residual sexual functions.
• Consume a healthy diet and maintain a physically dynamic lifestyle. Make sure to avoid excessive alcohol consumption that is known to worsen sexual vigor and libido.

It is recommended to opt for periodic assessment of general physical health in order to detect medical issues well in advance. With early detection, prompt diagnosis and reliable treatment, the risk of developing serious sexual dysfunction is rather rare.

References

1. Ong, W. L., McLachlan, H., & Millar, J. L. (2015). Prevalence of Baseline Erectile Dysfunction (ED) in an Australian Cohort of Men with Localized Prostate Cancer. The journal of sexual medicine, 12(5), 1267-1274.

2. Bianco, F. J., McHone, B. R., Wagner, K., King, A., Burgess, J., Patierno, S., & Jarrett, T. W. (2009). Prevalence of erectile dysfunction in men screened for prostate cancer. Urology, 74(1), 89-93.

3. Hébert, J. R., Hurley, T. G., Harmon, B. E., Heiney, S., Hebert, C. J., & Steck, S. E. (2012). A diet, physical activity, and stress reduction intervention in men with rising prostate-specific antigen after treatment for prostate cancer. Cancer epidemiology, 36(2), e128-e136.