Many problems men have after cancer treatment will not last long. As you begin to feel more in control of your body and your life, you will find that your self-confidence returns and your sex life often gets better.
But some cancer treatments can cause a life-long change. It’s hard to know what will happen. One man’s erections may come back after his prostate is removed while another man’s may not.
Getting used to changes in your body
As men age or go through health problems, they may need more time and stroking to get aroused. If you have trouble reaching orgasm during sex, try different kinds of touching. You might buy a hand-held electric vibrator for more intense stimulation. Try having a sexual fantasy or looking at erotic stories or pictures. The more excited you are, the easier it is to reach orgasm.
The best time to talk with your doctor or cancer team about side effects or long-term changes in your sex life is before treatment. That way, you can learn about common problems and how long healing takes. But you can bring up the subject any time during and after treatment, too.
You may need a few months to heal after treatment. If erection problems last longer, talk with your doctor again and try different ways to deal with them. If the problem doesn’t get better, your doctor may ask you questions about your sex life, and get special tests to find the cause. And it may take more than one doctor to get the treatment you need.
Your doctor may want to find out if you are having normal erections while you sleep. This may be done at a sleep lab, where a machine can measure changes in the size of your penis during the night. Other ways to check sleep erections are monitors or gauges you can use at home. If your sleep erections are strong, you may do well with sexual counseling. If your sleep erections are poor or you don’t have them, surgery or medical treatment may be needed.
Some doctors use special tests to measure blood flow in the penis. One test uses sound waves to show the speed and direction of blood flow. It looks for a block in blood flow that could be causing the erection problem. Other kinds of tests check the nerves and reflexes in the genital area. Blood tests may be done to check your hormone balance.
Erectile dysfunction (impotence)
Drugs: The drugs Viagra®, Levitra®, and Cialis® all help a man get and keep an erection by helping more blood to flow to the penis. About half of men with erection problems due to physical changes are helped by these drugs.
Men with nerve damage from prostate cancer treatment may not respond as well to these drugs as those with some other physical causes. But some research suggests that men who use one of these drugs fairly often, starting within 6 months of prostate surgery, may have better erections (as long as the nerves were spared). Some men who don’t get a good enough result with one of these drugs may do better when they use it along with a shot in the penis. (See “Penile injections” below.)
Many drugs are known to cause problems if you take them while you are taking Viagra, Levitra, or Cialis. For instance, nitroglycerin and other drugs used to treat heart disease may cause serious problems or even death when taken with one of these drugs. Be sure your doctor knows about all medicines you take, even those you take rarely. Learn about the side effects before you try the drug.
Surgery to restore blood supply: If the main vessel that brings blood to the penis is blocked and is causing an erection problem, surgery may help. The surgeon can take a piece of a blood vessel from another place in the body and sew it to the tiny blood vessels in the penis.
Penile injections (“shots”): A man can be taught to inject his penis with a drug that causes erections. The drug is put into the side of the penis with a tiny needle a few minutes before starting sex. Sexual excitement and the drug together help to produce a firmer and longer-lasting erection.
Because the shot can have side effects, the first one is usually done in the doctor’s office. A few men may get an erection that will not go down. If this happens, the man needs to go to an emergency room right away for treatment. Some men can get scars in the spongy tissue after many injections, causing the penis to curve. The only way to treat this is by surgery on the penis.
Pellets: A way of getting the same drug used in the shots is to have a man put a tiny pellet in the small hole at the tip of the penis. Although easier than shots, the pellet does not always work as well. It can have the same kind of side effects. It can also cause some burning for the man and his partner. Because the pellet can make some men dizzy, the man may try a test dose in the doctor’s office.
Vacuum devices: Another treatment, called the vacuum constriction device (VCD), is less risky but may disrupt sex more than a shot or pellet does. A man puts a plastic cylinder over his penis and pumps out air to create suction around the penis. The suction draws blood into the penis, filling up the spongy tissue. When the penis is firm, the man takes the pump off and slips a stretchy band onto the base of his penis to help it stay erect. The band can be left on the penis for up to half an hour. It may take some practice to learn the best way to use a vacuum device. Although most vacuum devices are prescribed by doctors, the FDA has approved some to be sold over the counter.
Vacuum devices, injections, and pellets have a success rate between 50% and 70%. When injections or a vacuum device are to be used, sexual counseling can help a couple look at their options and find ways to fit the new treatment into their sex life. (See the section called “Professional help.”)
Penile implants: Surgery to put an implant (prosthesis) in the penis was the first really helpful treatment for medical erection problems. These operations have been done for many years. They still work quite well to treat life-long erection problems. There are different types of implants.
- Semi-rigid rods: For the simplest type, 2 silicone rods are placed into the spongy tissue of the penis. The result is a penis that always stays mostly erect. Most semi-rigid implants are easy to shape. When you bend the penis up or down to hide it during daily activities, it stays bent.
- Inflatable pumps: These are pump systems placed inside a man’s body. When a man is ready for sex, he squeezes a pump in his scrotum to move salt water from a small tank into his penis. After sex, he presses a release valve and the salt water flows back through the tubes to the tank until it’s needed again. There are different types of pumps, some more complex than others.
Things to think about before choosing an implant: Men in poor health may want to try the semi-rigid or less complex inflatable types. The surgery is minor and the risk of future problems is low. A man who has bladder tumors may need an inflatable prosthesis because the semi-rigid rods interfere with a test that looks inside the bladder. A man who is very active may prefer an inflatable type, since it isn’t in the way as much when you move around a lot.
Implants carry some risk of problems, such as infection. Also, the implants with more parts are more prone to failure, which leads to more surgery. And implants can’t help with desire problems or lack of feeling in the penis.
Learn as much as you can and ask your doctor questions about the pros and cons before you decide on an implant. A man who is married or in a long-term relationship should include his partner as he chooses implants.
Hormone replacement therapy: In the rare case that a man has problems with hormone balance, testosterone may help with desire and erections. But hormones are too often used without careful thought. Most men have enough testosterone, even after age 50 or 60. Taking extra hormones will not cure a sexual problem. And the hormones can cause serious side effects.
Herbs and supplements: Many herbs or supplements are sold over the counter as “natural” cures for erection problems. But they have not been proven to help men have erections. And in the past, many supplements have been found to contain things other than what is listed on their labels.
A worse problem is that some of the supplements have been found to contain prescription drugs that are very much like Viagra. As these are found by the FDA, the pills are recalled, but often after many men have taken them. These pills can be very risky because the man doesn’t know what he is getting. One danger is that he may take other medicines that interact in a way that can cause harm or death. Or he may take too much of a substance that is said to be harmless, then have some very serious effects and not know why.
Less intense orgasms
Some men treated for cancer notice that their orgasms get weaker or don’t last as long as before. Sometimes this is just part of normal aging. But weaker orgasms often go along with erection problems. In those cases, treating the erection problem does not always make the orgasm stronger.
Some common-sense advice: make sure you are as excited as possible during sex. Focus on your feelings of pleasure or on an exciting fantasy. Take a long time for foreplay. If you find yourself getting close to orgasm, ask your partner to tease you a little by slowing down. Let your excitement die down and rebuild several times before you let yourself climax.
You can practice this teasing by yourself, too. When you feel very excited, stop touching your penis, even if you lose part of your erection. Then start and stop a few times before your orgasm.
Whether alone or with a partner, make sure your erection is as full as can be before you bring on your orgasm. Some men learn to climax with a soft penis. But many find they have stronger orgasms if they can delay it until their erection is as firm as possible.
Pain
Pain can reduce your desire for sex and make you feel tired. It can also cause problems if it flares up during sex. If you are having pain anywhere in your body, these tips may help.
- Plan sex for the time of day when you feel the least pain. If you are using pain medicine, take it an hour before sex so it will have time to work. Try to find doses of medicine that relieve pain without making you too sleepy.
- Find a position for touching or sex that puts as little pressure as possible on the sore areas of your body. If it helps, support the sore area with pillows. If a certain motion is painful, choose a position that avoids it. You can guide your partner on what you would like.
- Focus on your feelings of pleasure and excitement. With this focus, sometimes the pain fades into the background.
If you keep having pain, talk with your doctor about treatment. No matter what kind of pain you have, there are medicines that should help keep it under control.
Loss of one or both testicles
Testicles are symbols of manhood. Though some men are not upset about the way they look, others fear a partner’s response. This may be more true for men who are not in long-term relationships.
To get a more natural look, a man who is having one or both testicles taken out can have implants put in his scrotum. If the scrotum is all there, testicular implants can look a lot like normal. But if part of the scrotal skin must be removed, they will look less normal.
Smaller penis
After prostate surgery, a man may be shocked to find that his penis is shorter than before. For up to about 6 months after surgery, it may even seem to have shrunk inside the body, much like when a man is in cold water. Penile shrinkage is common after surgery, but it is often not something a man is warned about. The cause of penile shortening is unknown. There is no way to prevent or treat it at this time.
Grief and loss
It is normal to feel grief over the losses from cancer and its treatment. You may give up your old ideas of yourself and start finding new ways to cope with the changes in your life. You may also notice sadness and anger, even toward those close to you. Cancer changes the way you think of your body and yourself. This can disturb your well-being, and affect how you see yourself sexually. It can also affect your relationships.
It may take time for you to even notice some of the losses and changes from cancer. It can help if you can share your grief with someone close to you. If there is no one close that you want to confide in, you might want to see a counselor. Just as it is important to take care of pain in your body, painful feelings also need to be dealt with.
Depression
Depression is feeling empty or sad most of the time. It happens to a lot of people with cancer. Staying active is a good way to reduce stress and lower your risk of depression. Talk to your doctor about the kind of exercise that is right for you. As long as you don’t overdo it, exercise will help you feel better during and after treatment.
Side effects can also get you down. You can reduce the pain and nausea that some cancer treatments cause by learning skills to help you relax. Many relaxation methods can be learned from DVDs, CDs, or books, although training by a mental health professional may work best. Sometimes professionals may offer other methods to help improve your sleep, appetite, energy, and ability to feel pleasure. In turn, this can help your self-esteem and desire for sex.
If you notice poor sleep, feeling hopeless, not enjoying life, trouble thinking, or other signs of depression that last more than 2 weeks, talk to your doctor. Depression can be treated with medicine and in other ways.
Keep in mind that some of the newer anti-depressants may make it harder to reach orgasm. If this becomes a problem for you, talk to your doctor about it. There are other anti-depressants that may not have that effect on you.
Anxiety about sex
Many couples believe that sex should happen on the spur of the moment, with no planning. But sometimes you are dealing with a cancer-related symptom or treatment side effect that makes it impossible to happen like it did in the past. The most important thing is to bring up the topic and talk with your partner.
Some people delay getting back to sex because they want to satisfy their partner. One way to find out if you are ready to enjoy sex is to start by touching yourself and bringing yourself to orgasm. That way, you can find out if cancer treatment has changed your sexual response without feeling that you must please your partner. It can also help you find out where you might be tender or sore.
If you are OK with the idea, try stroking not just your genitals, but all of the sensitive areas of your body. Notice the different feelings. The books listed in the "To learn more" section can help you feel more relaxed about sex and touching yourself. Later you can teach your partner what you learn about your body. Even if cancer treatment has not changed your sexual responses, you may find some new ways to spice up your sex life.
Every now and then we all have sexual thoughts or feelings, but sometimes we ignore or forget about them. Your sexual thoughts can be used to improve your sex life.
Pay attention to the times you have sexual thoughts. Try to notice patterns, like the time of day, where you are, people, music, activities, movies, or fantasies. When you notice patterns, you can plan things that will help put you in the mood for sex.
If these and other efforts don’t boost your sexual interest, think about getting counseling. For more information, please see the “Professional help” section.
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