Sexual Life After Prostate Cancer

The side effects of prostate cancer treatments, including surgery and radiation, can seriously affect a couple’s sex life. But a new study finds that counseling helped married men and women determine out what sorts of treatments for erectile dysfunction worked for them and how to incorporate those methods during sex. In doing so, they returned some luster to their love lives.
Experts enrolled more than 200 men who’d been treated for prostate malignancy and their wives into one of three groups: 1 received three face-to-face counseling sessions; the other was offered Internet-based counseling, and the third was put on a waitlist. At a six-month follow-up (about three months after counseling), men who received either the face-to-face or web-based counseling reported an improvement in sexual function and satisfaction with sex. When the man reported his sexual function improved, his wife’s reports of sexual function and satisfaction did as well.
Those in the wait-listed group experienced no improvements, suggesting that “time alone does not heal the issues,” said study author Leslie Schover, a professor of behavioral science and a clinical psychologist at the University or college of Texas M.D. Anderson Malignancy Center in Houston. Despite nerve-sparing surgery, prostate malignancy treatment still causes significant erectile disorder, experts say. Other problems may include difficulty reaching orgasm; a decreased intensity of orgasm; pain and leaking urine at orgasm.

Many men who have prostate cancer are older, and their erectile function may have already been compromised due to cancer itself or other underlying vascular or nerve disease, explained Dr. Bruce Gilbert, director of reproductive and sexual medicine at North Shore-Long Island Jewish Health System’s Smith Institute for Urology. “Before nerve-sparing prostatectomy [surgical removal of the prostate], 100 percent of men would have erectile disorder afterward,” Gilbert said. “That has come down quite a bit. But you are dealing with a populace of men who are generally not 30 or 40 years aged. They’re older and may already have an underlying problem with erectile disorder.”

Most men have some level of erection difficulties after prostate malignancy medical procedures, experts said.

In addition to dealing with that, “the counseling program focused on the woman’s right to pleasure in sex and on fixing problems like postmenopausal vaginal dryness or loss of desire related to poor sexual communication, during treatment, you can use various intimate lubricants such as in order to live a full sex life,” Schover said.

“We educated both partners about available treatments to restore erections and experienced them complete a ‘decision aid’ to physique out what treatment to try, based on mutual opinions,” she said. “If that treatment did not work well for them, we motivated them to try another choice.”

After prostate cancer, many men try pills for erectile dysfunction, experts said. But those may not be enough. Other options include penile injections, vacuum pumps and or penile implants, but Schover said she suspects many men throw in the towel when they avoid get the results they need and avoid pursue the other alternatives.
Men and women were given questionnaires that asked about a wide variety of steps of sexual function and sexual satisfaction, including their erectile function (for men), ability to achieve orgasm and their level of desire.

“Every subscale improved except desire, which we weren’t surprised by because very few had low desire, to begin with, so there wasn’t that much to go on that,” Schover said.

Mens ability to achieve “near-normal” erections also improved after counseling. Before counseling, about 12 percent to 15 percent of men reported few erection troubles. That increased to between 36 percent and 44 percent for those who underwent counseling.

At one 12 months, men who reported that they found a successful erectile disorder treatment had scores on the sexual function and satisfaction level that were about the same as healthy men.

One limitation of the study is that about 34 percent of couples enrolled in the counseling dropped out for unknown reasons, said Dr. Bruce Gilbert, director of reproductive and sexual medicine at the Smith Institute for Urology at North Shoreline LIJ Health System.

Still, he added, “a study like this is very important and highlights that presently there is a lot that happens if you engage couples or the patient in some type of counseling,” Gilbert said.

Couples and physicians should also never forget that while prostate malignancy is frightening, so is the worry that even if it’s cured, “they may not be the same after a process than before,” Gilbert said. “That’s an actual fear for men.”

Ideally, patients should start “penile rehabilitation” even prior to having the treatment, which has been shown to improve outcomes.

Urologists should be able to suggest methods of improving erectile function, experts noted. They suggested that if you’re not getting all the help you need from your urologist, inquire for a referral to a urologist that is an expert in sexual medicine, or a mental health professional that treats issues related to malignancy treatment, often found at large teaching hospitals in major cities.

Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital in New York City, said “the idea of providing Internet-based counseling to couples going through sexual disorder after prostate surgery is usually excellent.”

“This study proves that patients and their partners respond to instructive sex therapy. Since insurance protection for psychotherapy is usually sparse, it is usually encouraging to know that web-based help is usually available to these couples,” Kavaler said.