Prostate cancer itself might not directly affect sexual health. However, as an aftermath of surgical interventions, radiation and hormonal therapy for its treatment significantly impact sexual health. Addressing sexual health concerns both before and after surgery, experts emphasize on strategies like penile rehabilitation, kegel exercises, counseling and lifestyle modifications to improve intimacy post-prostate cancer treatments.
The impact of prostate cancer treatments on sexual health
The surgery that is done for the removal of the prostate in an individual with prostate cancer is called radical prostatectomy. Dr Shreyas Nagaraj, consultant urologist, uro-oncologist, andrologist and renal transplant surgeon, Cytecare Cancer Hospitals, Bangalore shares that the prostate is removed during this surgery, which can affect the sexual function of the individual.
The surgery can disrupt the delicate network of nerves that are required for sexual function or erection in men. These nerves lie in close vicinity to the prostate and may get damaged or removed along with the prostate as a part of the removal of cancer—leading to complications like urinary incontinence (involuntary leakage of urine) and erectile dysfunction, explains Dr Nagaraj.
Additionally, Dr Anshuman Agarwal, senior consultant, urology & robotic surgery, Indraprastha Apollo Hospital, Delhi, says that after prostate surgery, the blood supply reduces as the nerves to the penis are damaged, making the penile tissues go into an atrophic state.
Explaining the effects of hormonal therapy and radiation (or radiotherapy) for prostate cancer, Dr Agarwal adds that these therapies decreases or blocks testosterone, i.e., the male hormone, leading to a loss of libido, i.e., a low sex drive. Radiation also decreases the desire to have sex and damages the nerves present behind the prostate, which ultimately leads to sexual dysfunction.
Strategies to enhance intimacy post-prostate cancer treatment
Reclaiming a sense of closeness and intimacy post-prostate cancer treatment can be quite challenging. However, experts share ways in which you can address this concern and can potentially live a fulfilling life with your partner.
Counseling
To improve intimacy post-prostate cancer surgery, Dr Nagaraj highlights the need for counseling. He says, “The issues and expectations must be addressed before planning the surgery itself, so that the patient is prepared well.” The word ‘cancer’ itself brings fear in any individual and tends to affect them psychologically.”
As mental health is strongly associated with sexual health, proper counseling plays an extremely key role in letting the individual know what to anticipate and how to address it, he adds.
Alternative surgeries
Dr Raghunath S.K, uro-oncologist and robotic surgeon, director & head of urological oncology and robotic surgery, HCG Cancer Hospital, Bengaluru says, “As the nerves that are required for sexual function run just a millimeter or two behind the prostate, to preserve the nerves during prostate treatments, one can undergo nerve-preserving radical prostatectomy surgery in the early stages.” He adds that if the nerves are preserved completely, the individuals can lead an active sexual life and have a good erection post-surgery as well.
“The preservation of nerves can be best done by robotic surgery compared to laparoscopic surgery or even open surgery.” The doctor elaborates that due to the dexterity of the tremor-free instruments in robotic surgery, they get 10 to 40 times magnification, which assists them in visualizing the neurovascular bundle properly to further help them preserve the nerves.
Exercise
According to a study published in the JCO Global Oncology journal (2023), men with prostate cancer benefited from supervised exercise, both resistance and aerobic, which improved their erectile function and satisfaction during intercourse.
Dr Raghunath opines, “Whether a person has undergone radiation or surgery—exercise can be beneficial in improving sexual function.” If the person is getting erections, exercising will certainly improve overall health and intimacy in the long term, adds the doctor. Post-surgery, the individuals are advised to just walk for three months, followed by workouts in the gym, weight training and brisk walking at the end of those three months when the wound is completely healed, say experts.
However, Dr Raghunath adds, “One should note that if the person’s neurovascular bundle is completely removed, then even exercise may not help him.”
On the other hand, according to Dr Nagaraj, kegel exercises can help strengthen the pelvic floor muscles and improve blood flow, helping with urinary incontinence and premature ejaculation.
Penile rehabilitation
Helping men in regaining or reaching an erection after prostatectomy, penile rehabilitation is a treatment where the individuals are encouraged to use manual stimulation, vacuum erection devices, or low dosages of PDE-5 inhibitors which include medications like sildenafil, tadalafil, etc. to improve blood flow in the penis to enhance sexual function and get a proper erection, says Dr Agarwal.
Lifestyle changes
Lifestyle plays a key role because getting an erection is a mechanism that requires adequate blood flow into the penis. Therefore, factors like being physically fit, not smoking, and adequately controlled diabetes and cholesterol levels, help in better sexual function, added Dr Nagaraj.
Takeaways
- The treatments for prostate cancer like surgery, radiation and hormonal therapy can affect sexual health.
- During the surgery, the nerves that are responsible for erection are in close vicinity to the prostate, which tends to get damaged and removed, leading to erectile dysfunction.
- There are alternative surgeries where the nerves are completely preserved, which helps to maintain sexual health
- Leading a good lifestyle, exercising and counseling before the surgery can help in keeping your intimacy alive.
