Cancer of the prostate gland and its treatment can leave men having difficulties with sex. Problems range from being unable to get an erection to losing sexual desire.
This article may help to improve sex life by explaining the role of the prostate and how it can be affected by cancer treatment.
The information should be helpful in setting out expectations for sex life, both for the patient and their sex partner.
Healthcare professionals working in this field are aware of the issues involved, and they can offer professional help.
Contents of this article:
Prostate gland and prostate cancer
The prostate gland is a sex organ found in men. This male reproductive organ sits around the urethra, the outlet tube for urine, just below the bladder. The gland's surface is normally smooth and regular. The prostate is about the size of a walnut.
The prostate gland is part of the male reproductive system.
The prostate gland releases a clear fluid into the urethra. It represents up to a third of the semen during ejaculation. One of the functions 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 happens when cells of the gland divide uncontrollably. This leads to a lump, a tumor.
Thousands of men die in the U.S. every year from prostate cancer, but the CDC point out that most men who have prostate cancer are over 65 years of age, and they usually die from something else instead.
The Cleveland Clinic say up to 80 percent of men over 80 years of age would show signs of prostate cancer revealed by tests after death.
Symptoms of prostate cancer
Symptoms do not often occur with prostate cancer. When they do, they may include:
- Weak or unsteady urine flow
- Urine leakage
- A feeling of not emptying the urine bladder properly
- Having to strain to produce urine
- Blood in the urine.
Slow-growing tumors known as acinar adenocarcinomas are the most common type of prostate cancer.
Prostate cancer cannot be passed from one person to another, and it is not a sexually transmitted disease.
Prostate cancer and sex
Problems with sex are not usually caused by prostate cancer itself.
Most symptoms of prostate cancer stem from urine output problems, because the enlarged gland begins to block the urethra, which carries urine. Urinary symptoms should not affect the sex life.
Some prostate cancer surgery comes with a risk of erectile dysfunction.
Only rarely do men with prostate cancer have problems getting an erection because of the disease itself.
Psychological problems may occur, however. Men may feel low or anxious about their diagnosis or treatment, and this can reduce interest in sex.
Men who opt to manage a very slow-growing prostate cancer with "watchful waiting" or "active surveillance" should not experience problems with sex.
More active treatment, such as surgery, radiation therapy, or hormone therapy, may pose problems.
An erection is controlled by the nerves that run very close to the prostate gland. Surgery that completely removes the prostate gland includes a risk of erectile dysfunction for this reason.
This surgery is usually only for men with aggressive prostate cancer that is likely to grow or spread. Younger men may opt for it. A nerve-sparing prostatectomy aims to avoid damage to the erection-controlling nerves.
Nerve-sparing operations are not always possible, however. While reducing the risk of erectile dysfunction, this type of treatment may not treat the cancer fully. Some cancerous tissue may be left behind.
Other options for prostate cancer can also affect sexual activity, but surgery carries the greatest risk.
Treatment options with a risk of erectile dysfunction include:
- Cryotherapy, using probes to freeze prostate cancer cells
- Radiation therapy
- Brachytherapy, or implanting radioactive seeds in the prostate gland.
Brachytherapy entails a lower risk of erectile dysfunction than other types of radiation therapy.
Hormonal therapy can lead to problems getting an erection. It can also reduce interest in sex and affect fertility. Hormonal treatments include removing the testicles and using antiandrogen drugs.
Effects on orgasm and ejaculation from prostate cancer treatment
A number of factors may make change how a man feels about sex. Understanding the risks may help to deal with them.
Removing a prostate gland completely for cancer treatment means an 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. The semen does not come out during orgasm, but instead goes up into the bladder and comes out when urinating.
Other prostate cancer treatments may result in a smaller amount being ejaculated.
Hormone therapy may reduce the intensity of orgasm sensations.
Managing sex life with prostate cancer
A number of strategies can help a man to regain his normal sexual function, if erectile dysfunction is caused by prostate cancer treatment.
Oral drugs such as Viagra may help a man to regain his normal sexual function.
Drugs that can help a man to get an erection include:
- Oral drugs, such as sildenafil (Viagra), avanafil (Spedra), tadalafil (Cialis), and vardenafil (Levitra)
- Cream to put directly on the penis, such as alprostadil (Vitaros)
- Other drugs, namely alprostadil, in the form of injections and pellets.
Physical or "mechanical" therapies include:
- Vacuum pumps used before sex, to draw blood into the penis and make it hard
- Implants when other treatments have failed.
Rehabilitation is possible, following treatment for prostate cancer. It involves gaining an erection, using the above treatments if necessary, and masturbating. This encourages blood flow to the penis, and it may help men to gain and maintain erections.
Some men may benefit from psychological support, for example with a counselor. This may also help if relationships become strained by the effects of cancer and treatment. Couples therapy may help couples to make adjustments to sex and other aspects of their relationship.
Understanding that sex problems are likely with prostate cancer treatment may help. Learning about the problems of other men in similar situations could also be useful.
Some men have talked on video about their problems with sexual dysfunction due to prostate cancer. Some of these are available through the not-for-profit website healthtalk.org.
Can masturbation cut prostate cancer risk?
A study of 32,000 men, published in the journal European Urology, looked at whether regular ejaculation helps to prevent prostate cancer.
Findings showed that ejaculating more often was linked to a lower risk of prostate cancer.
Among men aged 20 to 29 years who had 21 or more ejaculations a month there were 2.39 fewer cases of prostate cancer in every 1,000 person years compared with those who ejaculated 4 to 7 times a month.
Among men aged 40 to 49 years, there were 3.89 fewer cases for the same comparison
The reasons are unclear, but one theory refers to prostate stagnation, where less frequent ejaculation allows prostate secretions to build up, potentially causing cancer.