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Sex and erection problems after treatment for prostate cancer:

Prostate cancer treatments can affect your sexual health. Some therapies might damage the nerves necessary for getting an erection, while others can influence the hormone levels needed for maintaining an erection.

The testicles

The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.

Image of the testicles (cruk)

Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.

The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.

 Testosterone:

 The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:
  1. A deeper voice
  2. Facial hair growth
  3. Increased muscle mass
  4. The ability to achieve an erection
  5. Male sexual drive (libido)

Where does testicular cancer start:

 The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:
  • Seminoma
  • Non-seminoma
Testicular cancer and the lymph nodes:  Lymph nodes are a part of the lymphatic system that spans the entire body. They, along with lymph vessels, contain a yellow fluid known as lymph. This fluid circulates through the lymphatic system, collecting waste products and draining into veins for waste removal. Cancer can spread to lymph nodes, causing them to enlarge. In testicular cancer, it’s common for the disease to spread to lymph nodes located at the back of the abdomen, known as retroperitoneal lymph nodes. These retroperitoneal lymph nodes are situated behind the intestines and in front of the spine. They lie next to the main blood vessels in the abdomen, the aorta, and the inferior vena cava. Image of the lymph nodes with testicles Who gets it: Younger men are more likely to get testicular cancer. Trans women can also develop testicular cancer if they haven’t had an operation to remove their testicles (orchidectomy). Men in their early 30s are the most likely to get it. It then becomes less common as men get older.

Even if you struggle with erectile dysfunction, you can still have a fulfilling sex life. Several erectile dysfunction treatments are available, although not everyone decides to pursue them. These treatments include:

– Medications like tablets and creams

– Vacuum erection devices

– Penile implants

Sex therapy and counselling can also provide support. Speak to your urologist or specialist nurse if you think these options could be beneficial for you.

By addressing the sexual side effects of prostate cancer treatment, you can improve your overall quality of life.

How prostate cancer surgery affects your sexuality:

Surgery to remove the prostate gland, known as a radical prostatectomy, can impact your sex life in various ways.

Erection Issues Due to Nerve Damage

Radical prostatectomy can damage the nerves used for erections. Nerve-sparing surgery can help lower this risk, but it’s not suitable for everyone. This type of surgery removes cancer without cutting or damaging the nerves. However, if the cancer is close to the nerves, they will need to be removed.

Some men regain the ability to have erections, which can take from 3 months to 3 years. Others may need erectile dysfunction treatments for the rest of their lives.

Ejaculation Issues

After a radical prostatectomy, men no longer ejaculate semen because the prostate gland and seminal vesicles are removed. The testicles continue to produce sperm cells, which are reabsorbed into the body. This is known as retrograde ejaculation. Men can still have orgasms, but they are dry orgasms.

Some men find dry orgasms to feel normal, while others find them less intense and pleasurable. The lack of visible ejaculation can also be significant for some men.

Effects on Same-Sex Relationships

A radical prostatectomy can change the experience of anal sex for men who are the receiving partner. Some men find the penis rubbing against the prostate gland pleasurable. Without the prostate, anal sex might feel different.

How hormone therapy and radiotherapy affect your sexuality:

Hormone therapy reduces testosterone levels, which can make it harder to get and keep an erection. It may also affect the intensity of your orgasms.

Radiotherapy to the prostate can damage the nerves responsible for erections, often leading to erection problems as a delayed side effect. Men may experience these issues 3 to 5 years after completing their treatment.

How high intensity focused ultrasound (HIFU) and cryotherapy affect your sexuality:

HIFU and cryotherapy typically cause fewer erection problems compared to surgery or radiotherapy. However, there’s still a risk of erectile dysfunction with these treatments. Researchers are continuing to study the long-term side effects of HIFU and cryotherapy for prostate cancer.

Treatment for sexual problems:

Various treatments are available to help manage sexual problems. Discuss your options with a doctor or specialist. If they cannot provide specialist advice, request a referral to an Erectile Dysfunction Clinic.

Treatments for sexual issues are often part of a program known as penile rehabilitation, also referred to as erectile dysfunction rehabilitation. The goals of penile rehabilitation are to:

– Maintain blood flow to the penis

– Prevent damage to the muscle and tissue in the penis

– Stimulate erections

A penile rehabilitation program may include:

– Counseling and sex therapy

– Healthy lifestyle choices

– Oral medications

– Vacuum pumps

– Topical creams

– Injections or pellets

– Implantsminutes, which can last for 1 to 2 hours.

Counselling and sex therapy:

Discussing your erection difficulties with your partner can be beneficial. If you’re not in a relationship, talking to a close friend may also provide support.

Counselors and therapists can assist if you have concerns about your sex life and sexuality. You can ask your healthcare professional for a referral to a counselor or therapist through the NHS, though there may be a waiting list.

Consult your healthcare professional to explore available resources in your area. Local hospitals or Erectile Dysfunction Clinics may offer these services.

Healthy living:

Making lifestyle changes can enhance both your overall well-being and sex life. Staying active and maintaining a healthy weight can boost your interest in sex and support better erections. Additionally, quitting smoking and reducing alcohol intake can further improve your erectile function.

Research suggests that pelvic floor exercises may also benefit those with erection issues. The pelvic floor muscles, located between the tailbone and pubic bone, support the bladder and bowel. Strengthening these muscles through targeted exercises can contribute to better sexual health.

Creams:

Your doctor might recommend using alprostadil cream, also known as Vitaros. To use it, apply the cream to the tip of the penis with an applicator. This usually leads to an erection within 5 to 30

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Daignosis

If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,

Treatment options

A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected