Sexual Health

Sexuality is a significant component of men’s health. Since the prostate is located in an area directly related to sexual function, its normal to feel apprehensive of the impact treatment may have on your sex life.

Long-term erectile dysfunction (ED) develops in 10 to 40 percent of men during the two years following external radiation (EBRT). For those receiving brachytherapy, erectile dysfunction can affect 10 to 60 percent of patients. These variations largely depend on the patient’s age. About 50 percent of men suffering from ED as a result of radiation treatment will respond well to treatment with ED drugs.

Most men also suffer some urinary problems during radiation treatment. This usually disappears within a few months. Only about 5 percent suffer severe or permanent symptoms. Temporary rectal problems occur for less than 10 percent of men, but it is normal to find some blood in the bowel after treatment.

The nerves involved in sexual function are often damaged by radical prostatectomy or radiation therapy, causing Erectile Dysfunction (ED), also known as impotence. For men who suffer from erectile dysfunction, there are several solutions:

• There are several erectile dysfunction drugs that promote erections by increasing blood flow to the penis.
• A prostheses or penile implant can restore the ability to have erections.
• A naturally produced substance, Prostaglandin E1, can produce erections. It can be injected almost painlessly into the base of the penis before sex.
• Specially-made vacuum devices can create an erection by placing them around the entire penis before sex.

Penile Implants

There are two different types of penile implants: malleable or inflatable. Listed below are the advantages and disadvantages of both types.

Malleable

Advantages

• Easy for you or your partner to activate
• Good option for men with limited dexterity
• Totally concealed in the body
• Involves a simple surgical procedure

Disadvantages

• Stays firm when not in erect position
• May "show" through clothes

Inflatable

Advantages

• Easy to use
• One-step deflation
• Totally concealed in the body
• Natural flaccidity compared to non-inflatable implants
• Acts and feels more like a natural erection
• Expands girth of the penis
• More firm and full than other implants
• Feels softer and more flaccid when deflated

Transurethral System

Drug therapy that is administered by injection, and can produce a rapid, predictable erection. May be ideal for men who have not responded to oral therapy, or who have experienced adverse reactions or intolerance to oral drugs.

Surgery

Erectile dysfunction can begin immediately following surgery to remove the prostate, regardless of the technique that tries to spare the nerves that control the erection. If a nerve sparing technique can be used, recovery from erectile dysfunction may occur within the first year following the procedure. Recovery of erectile function after non-nerve sparing procedures is unlikely.

Studies show that as many as 60-70 percent of men who have their nerves spared on both sides of the prostate will regain erections. Other studies show that erectile dysfunction drugs have been reported to work in 43 percent of men who have had surgery to remove the prostate.

Radiation

Erectile dysfunction can also occur after radiation therapy but doesn’t begin until about six months following the start of treatment. About 50-60 percent of men regain erections after radiation with the aid of erectile dysfunction drugs.

In Prostate CA, Sexual Decline After Radiation Has Limit by Charles Bankhead | MedPage Today | 01.29.2010

Prostate Volume and Risk for Acute GU Side Effects After IMRT ProstateCancerInfoLink.net | 05.22.2010

An ejaculation Is Likely After Radiation Therapy For Prostate Cancer by Jill Stein | Medscape.com | 06.10.2010

Hormone Therapy

Erectile dysfunction may occur about two to four weeks after the beginning of treatment and is almost always paired with a decreased desire for sex. Studies show that erectile dysfunction drugs do not have much of an impact, if at all, after hormone therapy. However, erectile function returns after hormone therapy is discontinued.

For More Information

• Adult Conditions: Sexual Function and Infertility
  American Foundation for Urologic Diseases, Sexual Function Advisory Council
• Sexuality for Men and Their Partners
  The American Cancer Society, Treatment Topics and Resources
• Erectile Dysfunction
  Cornell University, Urology, Sexual Medicine Program
• Straight Talk About E.D. (PDF)
  

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