The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect (unwanted changes that may occur in your body during or after prostate cancer treatment). Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate (very private or close) relationship.
Erectile dysfunction (sometimes called impotence) is when a man’s penis cannot get hard enough for him to have sex. This can be difficult for the man whether or not he has a sex partner.
To help you understand why prostate cancer treatment may cause you to have erectile dysfunction, it is good for you to learn how your body may be changed by your treatment. Usually when a man is sexually aroused (excited):
The prostate is a gland that is about the size of a walnut. It sits around the urethra like a donut. The urethra is the tube that carries urine and semen to the outside of your body. Located near the prostate gland are the nerves, blood vessels and muscles needed to have an erection and to control your bladder. When you have a radical prostatectomy, you have surgery to remove your prostate gland. These nerves, blood vessels, and muscles may be weakened when you have surgery for your prostate cancer.
For a period of time after surgery, many men are not able to get an erection. This time is different for each man. It can be less than a month or longer than a month. However, you may find that you cannot have an erection even a year or more after surgery. Your ability to have an erection after your surgery will depend on whether your prostate cancer was close to the nerves that control your erections, whether you had erections before surgery, and your age. If you were having problems having erections before surgery, these problems will not be better after surgery. If you are able to have an erection after surgery, there will be no semen (the fluid that comes out when you have sex) ejaculated when you have an orgasm. The prostate gland makes this fluid. When your prostate gland is removed, there will be no more semen. This surprises some men if they are not expecting it, but this is normal after your prostate gland is removed. This also means that you will not be able to father a child after surgery.
Radiation therapy may damage the nerves near your prostate gland that help you have erections. Over time, you may notice that you are not having as many erections as you used to. Some men start having erectile dysfunction six months or more after their radiation therapy. If this happens, the erectile dysfunction usually does not improve.
If you are able to have an erection after radiation therapy, you may notice that the amount of semen (the fluid that comes out of your penis at climax of sex) when you have an orgasm will become less. Some men have dry orgasms (orgasm without the release of semen). You will find that as time goes on, the amount of semen will become less. You probably will not have enough sperm to father a child. You may also have some pain for a few weeks when you ejaculate. This usually goes away after several weeks.
Hormone therapy does not damage the nerves, blood vessels, or muscles around the prostate gland. Hormone therapy lowers the amount of testosterone in your body. Testosterone is a hormone that makes you interested in sex. With hormone treatment, you may find that you are not interested in sex. You may also have erectile dysfunction. Some men on hormone therapy say that their sexual desire is still strong, but they have problems getting an erection. Or they may have problems reaching orgasm. The side effects of hormones are different from man to man. Some men are able to feel desire and have erections and orgasms. Your ability to have an erection and your interest in sex may get better several months after your hormone treatment ends.
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial (man made) methods like medicines or medical devices (an object which is useful to treat a medical condition). If you were having problems having erections before treatment, this will not get better after treatment.
Yes. An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm.
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.
If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a “problem shared is a problem halved.” Not everyone wants a sexual relationship. Don’t try to guess or assume what your partner wants. Have an open and honest discussion with your partner.
This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.
When you’re ready to start having sex again, talk to your doctor or healthcare team. Other people you can talk to about your relationship include a counselor, your minister, a health professional, or other men in prostate cancer support groups. Your partner can be a valuable support if you’re feeling a little nervous about doing all the talking. Take them with you when you see your doctor. Please talk to your doctor or healthcare team about how you are doing with intimacy.
Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.
Some changes you may want to consider are:
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a man’s self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance (your body image). All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
If you have a partner, it is important that you involve them in any decisions you make about treatment for erectile dysfunction. The loss of sex in a relationship, changes in the way a couple have sex, or starting sex again after prostate cancer treatment can all affect a relationship. Your partner can go with you to your doctor appointments to learn more about your prostate cancer treatment and how to manage your side effects. Relationship therapy may also be available to you.
One of the effects of prostate cancer treatment is erectile dysfunction or impotence. This means that your partner may not be able to have erections that are hard enough for him to have sex with you or that he may not be interested in sex because of the medicine he is taking to treat his prostate cancer. This affects not only the man, but you, too, as his intimate partner. If you are the partner of a man with erectile dysfunction, it can be difficult to cope with changes in your sexual relationship. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in him staying away from intimate (very private or close) situations where he may feel under pressure to make love. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. This may not have anything to do with his feelings for you, but is a result of his cancer treatment. Erectile dysfunction can be difficult for both of you. You may want to reassure your partner that:
It may help if you explain to your partner how important nonsexual touching and intimacy such as kissing and cuddling is to you.
However, it is important to understand that sex may be very important to both of you. This may be an opportunity for you to experiment sexually with each other and work on ways to remain intimate, even when an erection is not possible. There are many different ways to be sexual. Take this time to explore, together, the things you can do with each other that are sexually exciting. Explore a variety of options to maintain sexual and emotional intimacy and satisfaction. If you are used to your partner being the sexual initiator, this may be the time for a little role-reversal. It is OK for you to tell your partner that even though he has erectile dysfunction, you want to stay in touch physically and intimately. Talk to your partner about ways to do this. Instead of trying to “fix your sex life” take this as a time to “play.” Again, please don’t hesitate to talk to your partner’s doctor or healthcare team, if you are having difficulties with your partner’s erectile dysfunction.
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If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
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