Sex After Prostate Cancer

October 29, 2014 at 12:00 am

According to information from Prostate Cancer UK, prostate cancer will affect 1 in 8 men at some point during their lives. It mainly affects men over 50, and the risk of developing the disease increases with age. The average age of men with prostate cancer is 70-74 years. Prostate cancer can occur in younger men, especially if they have a genetic predisposition such as a family member having had the disease. The incidence of prostate cancer in black men is higher, with 1 in 4 men developing the disease.

Being aware of your risk of developing prostate cancer is important. Taking steps to reduce that risk will help you cut the chances of developing the disease or help you to recognise that you may have it. Prostate cancer can be easily treated, especially if it has been detected early, but some of the treatments used can affect sexual function and sexuality. However, there are many ways in which these problems can be alleviated.

The effects of prostate cancer treatments upon sex

There are many ways in which treatments used for prostate cancer can affect your sex life, including:

Your sexuality
Ability to have an erection (erectile function)
Desire to have sex (libido)
Ability to ejaculate and reach orgasm
Your fertility
Body image
Your relationships

The way you feel about having prostate cancer can affect how you view your sexuality. Being fully informed by your doctor about how the side effects of your treatment may affect your sexual function and pleasure is important to ensure that you are prepared. They can discuss ways to combat such side effects and how to cope with them should they occur. They can also refer you to an appropriate health professional who will be able to offer counselling for both you and your partner about how you are feeling.

Erectile dysfunction

Prostate cancer does not cause erectile dysfunction, but some of the treatments can, such as:

Surgery to remove the prostate gland
Radiotherapy
High Intensity Focused Ultrasound (HIFU)
Cryotherapy (freezing cancerous tissue)
Hormone therapy

Surgery

Erectile dysfunction (ED) occurs in all men immediately after surgery, but how severe it is depends upon the type of surgery used, the stage of the cancer and the skill of the surgeon. If a nerve sparing technique is used, the patient may recover their erectile function after one year post operatively. If surgery involves nerves, erectile dysfunction can be permanent.

Often, if a man is able to maintain an erection, he experiences a dry orgasm whereby little or no ejaculate is released. Known as retrograde ejaculation, this is when the sperm travels backwards and enters the bladder instead of being ejected from the urethra. The man feels the experience of an orgasm, but produces little or no semen. It does not pose a threat to health but can cause infertility. However, as many of the men whom experience prostate cancer are over 50, becoming a father may not be a problem. If it is an issue, sperm banking may be recommended.

Radiotherapy

Erectile dysfunction following radiotherapy is more gradual and usually occurs about 6 months after having the treatment. However, it occurs less frequently with the use of more sophisticated treatments, such as radioactive seed implants (brachytherapy), intensity-modulated radiotherapy and 3-D conformal radiotherapy.

High Intensity Focused Ultrasound (HIFU)

Targeting only the area in the prostate gland where the tumour is located, HIFU can enable men to maintain normal erectile function and recover their sexual function quicker than with standard prostate ablation.

Cryotherapy

Erectile dysfunction after cryotherapy depends on the man’s age, his current sexual function and the location and stage of his disease. Many younger men able to have sexual intercourse without using medication prior to treatment are more likely to retain their sexual function after cryotherapy.

Hormone therapy

The use of hormone therapy to treat prostate cancer can cause erectile dysfunction to occur between 4-6 weeks after commencement of treatment, usually resulting in low libido. Boosting your testosterone through dietary changes can help a low libido

Treatments for erectile dysfunction

There are several treatments for ED, including:

tablets
injections
pellets
vacuum pumps
surgical implants
sex therapy

Many of the above treatments work by improving the blood flow to the penis to restore erectile function. Getting and maintaining an erection relies upon your thoughts and feelings, so tackling any worries or relationship issues can increase success when used in conjunction with the treatments mentioned. The efficacy of any one treatment depends on each individual man, the type of treatment he has received to treat the prostate cancer and his sexual needs.

Tablets

Cholinesterase type 5 (PDE5) inhibitors are the group of drugs used to help men get and maintain an erection and include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These drugs only work if you are sexually stimulated, so do not work for men with low libido. Taken at least 30 minutes to 1 hour before sex, they remain active within the body for 4 hours. You may need to take the drugs at least 8 times before deciding how effective it is or changing to an alternative tablet. Some men are unable to take PDE5 tablets if they have a cardiac condition and take medication which contains nitrates.

Injections

As scary as this may sound, many men find it to be a painless and very effective treatment. Injecting the drug alprostadil into the penis, the results are often very quick and you will get an erection within 15 minutes which last between 30-45 minutes.

Pellets

The same drug comes in pellet form and is inserted into the penis through the end and massaged either by the man or his partner to help absorption of the drug. Again, an erection will occur between 5-15 minutes after inserting the drug and will last for 30-60 minutes.

Vacuum pumps

These involve placing the penis into a plastic tube and creating a vacuum using a hand pump or battery operated device. The vacuum increases the size of the penis by increasing the blood flow within the tissue of the penis. You then slip a ring onto the base of the penis to prevent the blood from returning back into the body once you have removed the vacuum device. Some pumps use water which is considered to be more gentle on the tissues of the penis and can avoid over-pumping the penis, which may lead to rupture of blood vessels causing bruising.

The Bathmate Hydromax uses water which is gentler on the tissues of the penis and can prevent overpumping, leading to damage. It is ideal when used regularly as a penis exerciser, to increase blood flow to the penis. You can read the long term review of our Bathmate tester here.

Using a penis pump may suit a man who is unable to take medication.

Surgical implants

This involves inserting an implant into the penis. Semi-rigid rods keep the penis fairly firm all the time, but allow it to be bent down when not being used for sex and an inflatable implant placed in the penis and the pump in the scrotum which is squeezed prior to having sexual intercourse, which fills the implant with saline and creates an erection.

Pelvic Floor exercises

Often seen as something only done by women, pelvic floor exercises can benefit the sexual health of men, making erections stronger, last longer and improving sexual performance. Research by the University of the West of England Bristol (2003) found that pelvic floor exercises may be very effective in treating erectile problems when performed regularly.

Researchers from the Sapienza University of Rome (2014) have demonstrated that pelvic floor exercises can help men control premature ejaculation, making sexual intercourse more pleasurable and satisfactory for them and their partners. According to researchers, Kegel exercises also increases blood flow to the penis so men can sustain erections and orgasm.

Seek advice from a physiotherapist who can teach you how to perform pelvic floor exercises to ensure that you learn how to do them correctly, in order to benefit your sexual health. Your doctor should be able to refer you to a suitable physiotherapist who is trained to treat male sexual health problems.

Sex therapy

Talking with a sex therapist can help a couple to explore how they are feeling about their relationship and find ways in which they can enjoy sex again. A sex therapist will help them to open up an honest conversation about they are both feeling.

Great sex without intercourse

Thinking about the way in which you had sex prior to having prostate cancer and how your sex life was can have a negative effect upon how you have sex now. Try embracing new ways of exploring your sexual relationship with your partner, be honest about how you both feel, expressing your hopes and fears about your future together.

Incorporating sex toys into your sex life is a great way to remain intimate, enjoy pleasure and have fun together. From simple bullet vibrators to clitoral stimulators, to internal sex toys that vibrate or pulsate

Bondage is a great way to discover new sexual sensations from sensory deprived sex to exploring sensual touch

Sex Toys for Men

Penile rehabilitation should start during the weeks and months immediately after surgery, even if you do not feel like it. Regular masturbation will improve the blood flow to the penis and there are many sex toys for men which can help..

Some sex toys designed for female pleasure are great to use as a couple or for solo play such as Fun Factory Volta as the open end is great to stimulate the head of the penis and bullets are ideal for stimulating the head and shaft of the penis and the perineum.

The Pulse III Solo Essential is a uniquely designed male sex toy that uses a piston-type mechanism that causes its PulsePlate to move up and down. This technique is known as Penile Vibratory Stimulation.

The design of the Pulse enables the user to enjoy an orgasm without the need for an erect penis and also allows for hands free stimulation, ideal for those with physical disabilities.

The ergonomically designed Pulse III SOLO by Hot Octopuss firmly holds the penis within its wings, the oscillating plates massaging the frenulum to create mind blowing sexual sensations. When used with lubrication, the Pulse becomes the world’s most innovative male masturbator, while without, it can be used statically for a totally unique, prolonged orgasm.

This amazing male vibrator is rechargeable and has easy to use + and – controls.

The Pulse III Duo is a couples’ vibrator that encourages sexual intimacy between men suffering from ED and their female partner. Like the Solo, the Pulse III Duo uses oscillating plates to stimulate the flaccid or erect penis, but the Duo also has a vibrating underplate to stimulate the clitoris. This is great for couples who are no longer able to enjoy penetrative sex but are looking to maintain their sex life.

Using the or Fun Factory Cobra Libre 2 can produce sexual stimulation even when you are unable to get an erection. Unlike normal masturbators which often require you to have an erect penis prior to use, the innovative design of the Cobra Libre v2 offers powerful stimulation to the head of the penis. The smooth silicone opening is designed to hug the end of the penis, sending powerful vibratory sensations via two motors.

Cobra v2 also has 11 different speeds and stimulation modes, meaning that you’re sure to find the right sexual sensation just for you.

Constriction rings can help you maintain it. Choose from non vibrating rings to those that vibrate, such as Je Joue Mio which are great for solo pleasure but also with a partner too.

Some men find using a powerful bullet vibrator such as the We Vibe Tango offers sexual stimulation which enables them to have an orgasm or just feel pleasurable.

Even if you are unable to have penetrative sex, you can still enjoy sexual intimacy with your partner thorugh sex play with a vibrator or dildo.

Having prostate cancer does not need to be the end of your sex life, so do not suffer in silence – there are many people who can help you restore your sexual function back to normal or change the way in which you gain sexual pleasure. Do not be embarrassed to ask, many health professionals are trained to help you with these problems and it may only take a short chat to help you start to enjoy sex again.

Prostate UK have created leaflets for people who are LGBTQ+and have a dedeicated group on their online forum for Gay, bisexual, MSM (men who have sex with men).

Useful websites

Prostate Cancer UK : www.prostatecanceruk.org
Macmillan : www.macmillan.org.uk
Orchid : www.orchid-cancer.org.uk
Tackle Prostate Cancer : www.tackleprostate.org
College of Relationship and Sexual Therapists : www.cosrt.org.uk
“Pelvic physiotherapists”: https://pelvicphysiotherapy.com/list-of-therapists/

Written By : Samantha Evans

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