In this article, we look at how people can manage the potential effects of prostate cancer treatment on their sex lives. We also discuss the links between prostate cancer and sexual activity.
Managing prostate cancer and sex
Prostate cancer can have a profound effect on a person's sex life. especially after treatment.
Several strategies can help a person regain normal sexual function if prostate cancer treatment leads to problems achieving or maintaining an erection.
Some medications are beneficial in supporting healthy erections. These include:
- oral drugs, such as sildenafil (Viagra), avanafil (Spedra), tadalafil (Cialis), and vardenafil (Levitra)
- topical creams that can be applied to the penis directly, such as alprostadil (Vitaros)
- alprostadil, an option that is available in the form of injections and pellets
Alternatively, people can try some physical or "mechanical" therapies. These include:
- vacuum pumps that a person uses before sex to draw blood into and harden the penis
- implants, which a person may wish to try when other treatments have not achieved satisfactory results
All these therapies mean rehabilitation is possible after treatment for prostate cancer. Rehabilitation can allow a person to regain an erection, and engage in sexual activity and enjoyment again.
A further option is masturbation that can help an individual gain and maintain an erection. Masturbation encourages blood flow to the penis.
Some people may also benefit from psychological support, for example, with a sex therapist. This may help if the effects of cancer and its treatment strain relationships.
Couples therapy may support people in making adjustments to sex and other aspects of their relationships as they accommodate physical changes.
To navigate couples therapy, people can visit AASECT to find a certified sex therapist near them.
Understanding the likelihood of sexual dysfunction after prostate cancer treatment may help an individual cope with changes they experience. Learning about the experiences of others in similar situations can also be useful.
Some men have talked on video about their experiences of sexual dysfunction due to prostate cancer. Some of these recordings are available through the not-for-profit website healthtalk.org.
Can masturbation cut prostate cancer risk?
In this area of interest, a study that took information from 32,000 men looked at whether regular ejaculation helps to prevent prostate cancer.
The researchers published their work in the journal European Urology and reported that more frequent ejaculation might lead to a lower risk of prostate cancer.
Among men aged 20–29 years old who had 21 or more ejaculations a month, there were 2.39 fewer in every 1,000 who developed prostate cancer when the researchers compared them to those ejaculating 4–7 times a month.
Among men who were aged 40–49 years old, there were 3.89 fewer people per 1,000 who developed prostate cancer.
The reasons for these results are unclear, but one theory refers to prostate stagnation. This means that less frequent ejaculation allows prostate secretions to build up, possibly contributing to cancer.
An earlier study threw light on other potential aspects of prostate cancer, indicating that frequent sexual activity in younger life increased the risk of prostate cancer. However, the study also indicated that this activity seemed to give protection against the disease when people were older.
Causes of sexual problems
Radiation therapy treatment can lead to sexual dysfunction.
While many men experience sexual issues following prostate cancer treatment, these issues are not often due to prostate cancer itself.
Most prostate cancer symptoms involve problems with expelling urine due to enlargement of the prostate gland. This enlargement begins to inhibit the urethra carrying urine out of the body. Urinary symptoms should not affect a person's sex life, however.
More active treatments for cancer, such as surgery, radiation therapy, or hormone therapy, may lead to sexual dysfunction.
Nerves that run close to the prostate gland control erections. Surgery that completely removes the prostate gland carries a risk of erectile dysfunction for this reason.
This type of surgery is usually only suitable for men with aggressive prostate cancer that is likely to grow or spread. Younger men with prostate cancer might also choose it, however.
In these surgical cases, a nerve-sparing prostatectomy aims to avoid damage to the erection-controlling nerves. Nevertheless, nerve-sparing operations are not always possible.
While reducing the risk of erectile dysfunction, this type of treatment may not deal with the cancer fully and may leave behind some cancerous tissue.
Surgery carries the greatest risk, but other treatment methods for prostate cancer can also affect sexual activity.
Treatment options with a risk of erectile dysfunction include:
- cryotherapy, using probes to freeze prostate cancer cells
- radiation therapy
- brachytherapy, where surgeons plant radioactive seeds in the prostate gland
- hormone therapy
Hormonal therapy can lead to problems with erections. This treatment, which includes removing the testicles and using antiandrogen drugs, can also reduce interest in sex and cause fertility problems.
Brachytherapy has a lower risk of erectile dysfunction than other types of radiation therapy.
As this article described earlier, only rarely do men with prostate cancer have problems getting an erection because of the disease itself.
Prostrate cancer can cause psychological problems, however. Men may feel low or anxious about their diagnosis or treatment, and this can reduce interest in sex.
Some men may opt to manage a very slow-growing prostate cancer with "watchful waiting" or "active surveillance." If so, these treatment paths may not cause problems with sex.
Effects on orgasm and ejaculation
A number of factors involved with prostate cancer may change how a man feels about sex. Understanding the risks may help people deal with these consequences.
Removing a prostate gland entirely for cancer treatment means that ejaculation will no longer be possible. Instead, the man may have a "dry orgasm."
Some surgical treatments may lead to a disorder called retrograde ejaculation. With this condition, the semen does not leave the body during orgasm. Instead, it goes into the bladder and leaves through urination.
Other prostate cancer treatments may result in smaller ejaculations. Hormone therapy may also reduce the intensity of orgasm sensations.
The prostate gland and prostate cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The gland's surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
What is prostate cancer?
Prostate cancer occurs when cells in the gland divide uncontrollably. This leads to a lump, or tumor, that draws nutrients and blood away from other vital functions in the area.
Acinar adenocarcinomas, or slow-growing tumors, are the most common type of prostate cancer
Thousands of men die in the U.S. every year from prostate cancer, but the CDC highlights that most men who have prostate cancer are over 65 years of age and usually die from a different cause.
Prostate cancer cannot pass from one person to another and is not a sexually transmitted disease.
Symptoms do not often occur with prostate cancer. When symptoms do start, they can include:
- weak or unsteady urine flow
- urine leakage
- a feeling of not emptying the urine bladder completely
- having to strain to produce urine
- blood in the urine
Prostate cancer and treatments for the cancer might impact on a man's ability to achieve and maintain an erection, as well as causing reduced sexual desire.
Various different surgeries for cancer can disrupt the ejaculation process.
Certain medications and physical treatments, such as Viagra and related pills and creams, are available to treat erectile dysfunction. These include vacuum pumps and implants.
Masturbation might also help promote healthy blood flow to the genitals, which can support erectile function. Couples therapy may also help address the psychological aspects of cancer treatment that can strain a relationship.