cancer de la prostate et sexualité

Impact of Prostate cancer treatments on Sexual life – Frequently Asked Questions

The Prostate cancer treatments can affect patient desire for sex (Libido) to various levels as well as impact his erection & ejaculation.Patient concerns and fears are geared towards impact of treatments on sex life, the different solutions to implement and attitude of each of the partners in order to win back a satisfying sex life. 

Impacts of prostate surgery 

  1. Question: Will I recover normal erections?

Depending on the degree of prostate cancer extension, erectile function will be more or less preserved.

In all cases, the patient must be reassured because treatments do exist, allowing progressive recovery of his erection capacities.

 

  1. Will I recover normal ejaculations?

Post radical prostatectomy, the patient won’t succeed to ejaculate outwards. However, his sexual pleasure can remain with orgasms so-called “dry” while improvements in this field are seen within months following the intervention.

 

  1. After how long time can I resume normal sexual activity?

The recovery of sexual function may occur within a few weeks to two years from the surgery date.

This recovery can take place spontaneously, but usually occurs after treatments prescription (not necessarily definitive, but modulated through a medical monitoring of patient’s progresses in recovering his erections).

These treatments should be instituted early after surgery, to prevent erectile tissues fibrosis that could compromise the quality of sexual rehabilitation final result.

 

  1. Will I recover procreation capacity?

Since surgery cancel ability to ejaculate, it becomes impossible to procreate in a conventional manner. If the couple has a procreation project, which is generally unusual at ages prostate cancer show up, sperm must be stored in a sperm bank prior surgery completion,  so couple’s procreation project will remain viable.

 

Impact of radiotherapy on the prostate

1.Will I recover normal erections?

The neurovascular bundles responsible for erectile function which are anatomically, in intimate relationship with the prostate, receive the same levels of radiation as the prostate gland throughout radiotherapy treatments.

Likewise in surgery, the patient’s age and preoperative quality of sexuality have major impact on chances erectile dysfunction will remain after treatments.

At the end of radiotherapy treatment, the erectile function remains most often undisturbed but gradually decreases over the 2 years post- treatment. Overall, nearly half of patients will keep all or part of their erectile capacity few years after irradiations.

For others, the urologist will offer treatments that will reduce side effects caused by radiotherapy.

Devascularization and tissue fibrosis induced by radiotherapy are the main causes of erectile dysfunction after these treatments.

 

2. Will I recover normal ejaculations?

To treat prostate cancer, irradiation of the gland must be high altering the gland functioning. While prostatic fluid constitutes the major part of semen ejaculated, this one can be significantly reduced or disappear post radiotherapy, but does not prevent occurrence of so-called “dry” orgasms quite satisfactory for patient’s sex life.

 

What solutions to find a satisfactory sexuality?

1.What place for medication?

Medication is recommended for moderate disorders. Medicine can improve erections quality & frequency, as well as cavernous tissues oxygenation, stimulating the blood flow throughout the penis. The induced erections can last for +1 hour.

In case of ineffectiveness or when erections are too “soft” to enable full sexual intercourse, the following solutions should be considered.

 

2.What is an “intra-cavernous” injection? 

Intra-cavernous injections

Intra-cavernous injection consists of injecting a chemical fluid right at the penis base with a very fine needle, the drug injected dilates blood vessels facilitating blood flow throughout the penis. Erections achieved are very similar to natural erections.

To avoid incidents the patient is trained on carrying out this technique by an urologist or andrologist. Intra-cavernous injections remain well accepted by patients thanks to their efficiency.

 

 3. What is a “vacuum pump” or “vacuum constriction device”?

Vacuum constriction devices

The vacuum constriction device (VCD) is an erector vacuum represented by a hollow cylinder of transparent plastic opened at one of its ends wherein the penis is introduced. The other end of the cylinder is connected to a pump.

The vacuum raises blood flow throughout the corpora cavernosa producing an erection. The erection triggered by this system is maintained thanks to an elastic ring placed at the base of the penis.

This solution requires some preparation but its efficiency is above 90% and it avoids drugs usage. Moreover, its tolerance, lack of side effects and quality/price ratio turn it into an excellent solution.

 4. How penile implants work?

penile implantPenile implants are surgically implanted in the penis. Several types of implants are available but the most sophisticated one is represented by two inflatable cylinders placed in the corpora cavernosa, connected to a container filled with liquid placed just before the bladder, while a pump placed next to the scrotum and the testicles is activated by the patient himself to trigger or stop an erection.

It’s important to note that these cylinders act in place of erectile tissues of the corpora cavernosa, therefore this solution should be considered only when the operation of these tissues is permanently altered, in case of other treatments failure.

 

Impacts on the libido of prostate cancer treatments

Libido may be affected by the anxieties naturally felt once illness is known, as well as throughout cancer evolution stages and physical and psychological consequences of its treatments.

The situation must be dramatized in the patient eyes: the couple should engage in dialogue efforts, understanding and complicity between the partners remain a key element that will contribute to recovery process, if necessary involving a sexologist might be considered. 

What should each partner do to recover a satisfactory sexuality?

 

1. What involvement should I implement?

The patient must communicate without taboo with his partner and not be bothered neither by his difficulties to have erections and ejaculations, nor by solutions adopted for this purpose. The patient must implement treatment advised as soon as possible while, above all, he should be motivated to get back a fulfilling sex life.

 

2. What participation my partner should implement?

The partner should help the patient to implement the treatments prescribed by remaining patient, discreet and maintaining her desire. Partner should play a proactive role while still caring about her own sexual happiness without sacrificing herself for her spouse welfare.