Sexual Function

The prostate is a sex gland. Diseases affecting it and its treatment inevitably impact on a man’s sex life. Prior to any treatment, your consultant should advise you of the impact of the disease and of each treatment type, so that you can make an informed choice. All radical treatments will affect sexual function and the ability to achieve a firm erection, which is controlled by the nerves and vessels that are intimately associated with the prostate and structures near the penis. Any treatment that damages the prostate will also result in loss or severe impairment of ejaculatory function and hence fertility.

Fertility

If fertility is important to you, you should discuss creating a sperm bank with your consultant. After any of the most common prostate cancer treatments – surgery, radiation therapy, or Hormone treatment – you will become infertile. During surgery to remove the prostate, the seminal vesicles and part of the vas deferens are also removed, which disrupts the connection to the testes. Orgasm may still occur, but ejaculation will be dry and natural conception will not be possible. Radiation therapy similarly destroys the prostate and seminal vesicles; chemotherapy and Hormone treatment are both harmful to sperm production.

Erectile dysfunction

It is thought that around half of men over 40 may have a degree of erectile dysfunction (ED). ED can limit your intimacy, affect your self-esteem and impact your relationship with your partner. As the nerves that control erections cover the surface of the prostate, any trauma to the area can result in a change in nerve function. Most treatments will affect erectile function to a greater or lesser degree.

Surgery often has a significant initial impact but, where the surgery is nerve-sparing, this normally improves over time. Penile size however (both flaccid and erect) is often reduced post treatment particularly after surgery. Radiotherapy treatments may initially have less of an impact on erections compared to surgery, but this can decrease over time rather than improve. Brachytherapy is similar to or slightly better than external beam radiotherapy in this respect. Results from HIFU have been fairly encouraging, especially where the treatment has been focussed specifically on the tumour area, called Focal HIFU. Few patients achieve erections after cryotherapy.

Men that have other diseases or disorders that impair their ability to maintain an erection, such as diabetes or vascular problems, will have a more difficult time returning to pre-treatment function. It should be noted that, with some treatments, orgasm is normally achievable in spite of these problems. After treatment, it is important to get the system back into working order as quickly as possible. ‘Use it or lose it’ is the motto. Penile rehabilitation/physiotherapy using a vacuum pump is often recommended.

Treatments for Erectile Dysfunction

There are a variety of treatments for erectile dysfunction, these include:

Viagra, Cialis, Levitra pills – all of which are available on normal prescription through your GP and are also available across the counter in chemists. They work by enhancing the effects of chemicals that increase blood flow into the penis. They rely on there still being some degree of activity in the nerves concerned with sexual function. There are different strengths and side effects can be experienced.

Alprostadil (MUSE) – available as a small pellet that is inserted into the urethra at the tip of the penis. It works because alprostadil acts directly on the penile blood vessels to increase blood flow and then potentially produce an erection. It may be successful where nerve function is completely lost. Around 40% to 60% success rate has been reported. There are different strengths and side effects can be experienced.

Alprostadil (Caverject) – uses the same drug as MUSE but is delivered by injection into the penis. Around 60% to 85% success rate is reported. There are different strengths and side effects can be experienced.

Alprostadil (Cream) – this is fairly new to the market. Applied to the tip of the penis, it works again to stimulate blood flow.

Vacuum Pump – by creating a vacuum, it forces blood into the penis, the subsequent erection is maintained by rolling a rubber ring onto the base of the penis so that the blood does not escape. Around 80% to 90% success rate reported.

Penile Implant – a surgically inserted penile implant that can be almost 100% successful. It uses a small pump in the scrotum, which when pressed, releases fluid from a small balloon into a plastic tube inserted in the penis, which pulls it up into an erection. The procedure is now available on the NHS.

It’s important to know there are treatment options beyond medication that are safe and effective. Each treatment option has varying degrees of success and reliability, with some maybe more effective or satisfying than others. Most treatments can be at some cost to spontaneity. A penile implant is a unique permanent solution, because it allows you to have intimacy wherever, whenever and for as long as you want, with no medication side effects. Consult your doctor to see which option could be right for you. Discussion with your partner is essential.

Psychological and Sexual Counselling

Problems can be mental as well as physical. Many hospitals now have staff with expertise in this area, and you should not be frightened to ask. If you wish it, you and your partner are entitled to sexual counselling. Remember that treatments for sexual problems caused by prostate cancer are available free under the NHS.

Hormonal treatments particularly can cause lack of interest in sex and this can become a barrier to discussion. In such circumstances your partner may be in for a particularly distressing time, as the cause of the problem, if not discussed, may not be apparent.