Dear Dr. G,
I send you this email with a very heavy heart as I recently discovered I have prostate cancer, which was detected when I visited the doctors for my medical check up recently after several months of night-time urination.
The doctors performed PSA blood tests and a rectal examination, which was followed by a biopsy confirming high-grade prostate cancer.
Thankfully, all the scans also indicated that it was detected early and as such the hope for recovery is high.
However, having discussed treatment options with my urologist, I am sorry to say I have a bad feeling that the cure will spell the end of my sex life.
Don’t get me wrong, I am in my mid fifties and not crazy about sex but intimacy has always been a strong part of my relationship with my wife.
Obviously, my wife says she doesn’t mind a sexless life as long as we are aggressive in getting rid of the cancer.
However, I am hoping to put Dr. G on the spot to explore the possibility of “normal” sex life after prostate cancer.
I was told I am likely to face erectile dysfunction after the operation. Worse still, I discovered I no longer can ejaculate after the op and my libido may even be affected.
The doctors also discussed the options of radiotherapy and hormonal therapy, I am under the impression the side effects are even worse than the surgery.
I also read somewhere that the risk of penile shortening is also high in some individuals and this is a shock to me as I thought 21st Century medical advancements could overcome all these issues.
As such, I would like to put Dr. G on the spot to explain more about a sex life for men after radical prostate surgery.
Is it all doom and gloom?
Radical Surgery of Prostate.
The prostate gland is a walnut-sized male reproductive organ, located between the base of the bladder neck and the opening of the penile urethra. The sole function of the prostate is to release secretion, vital for the nourishment assisting forward movement of sperm. The muscular structure of the prostate is also necessary for the outward propulsion of ejaculation.
The general aging process of the prostate will result in the constrictions of the urinary flow, however the cellular changes of the prostate may also result in cancer in the gland.
According to the Centre for Disease Control and Prevention (CDC), prostate cancer has become the most common cancer in men in the United States and many developed nations. Additionally, the prevalence of prostate cancer is also rising in Asian countries primary due to advances in cancer detection, an increasingly sedentary lifestyle and a longer life expectancy for men.
Out of all the different types, the most common prostate cancer is adenocarcinoma and although conservative treatment may be possible for slow growing cancers in older men, radical treatment is the only option for cure in younger individuals with aggressive cancer.
Having said that, prostate cancer treatment has evolved tremendously over the last two decades but even then, all the treatments for men - ranging from robotic radical surgery to cryotherapy and brachytherapy - will all impact sexual life in some way.
The impact will depend on the extent of the cancer and the type of intervention, but it will include erectile dysfunction, decreased libido, dry orgasm and the shortening of the penis. This is because the functional existence of the prostate is to produce semen. Therefore the complete removal by surgical means will eliminate a man's ability to ejaculate. The anatomical location of the gland is also closely adhered to a key nerve and the blood supply necessary for an erection. Therefore, radiotherapy or operative interventions can adversely affect the neurovascular bundles and render individuals impotent. Studies have also revealed that the contraction after the operation may shorten the length of the penis. For men requiring adjuvant hormonal treatment, the suppression of the testosterone to enhance the efficacy of treatment can also dampen the libido of sexually active men.
Although these may sound like doom and gloom, the advancement in robotic and pharmaceutical technology have ensured an excellent preservation of a man's sex life after cancer intervention as several strategies to help men to regain a normal level of performance between the sheets have been extensively evaluated. These include regular erection-enhancing medications before and after the interventions, vacuum pumps to draw blood into the penile tissues regularly, shock-wave therapy and state-of-the-art penile implants.
All of these therapies can allow penile rehabilitation before and after the operation, and can in turn help men to regain an erection, sexual confidence and enjoy sex life again.
The American poet and civil right activist Maya Angelou once said that “bitterness is cancer- it eats upon the host. It doesn’t do anything to the object of pleasure!”
The increase in prevalence of prostate cancer, especially in young and sexually active men has undoubtedly struck fear in men facing the doom of the cancer and the gloom of losing the ability to perform between the sheets. Open communication with partners and healthcare providers is often the key to understanding the likelihood of sexual dysfunction after cancer treatment and making the necessary adjustment to sex and relationship.
When unfortunate young men facing the challenges of prostate cancer put Dr. G on the spot for his advice on sex life after the treatment, his response is that "prostate cancer can be bitter. It eats upon the pride and joy of the host. The elimination of the cancer is priority and a positive mental attitude will be the sweetness to the object of pleasure!” For more information about a sex life after prostate cancer, please visit www.onlymencan.com
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at firstname.lastname@example.org
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