Dealing with sexual problems after cancer treatment

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’ll 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. If you do have a sexual problem, your health care team can often find the cause and give you an idea of your chance for recovery. 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. You might ask your doctor about other treatment options. But you can bring up the subject any time during and after treatment, too.

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.

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.

Some men have their first orgasms after cancer treatment while asleep, during a sexual dream. If this happens to you, it’s proof that you are able to have an orgasm. It’s also helpful if your partner notices that you have erections during sleep. Because sleep erections aren’t affected by mood or state of mind, they give you an idea of the best erection your body can produce. Now it’s up to you to set things in motion when you are awake.

Erectile dysfunction (impotence)

Pills: The drugs Viagra^®, Levitra^®, and Cialis^® all help a man get and keep an erection by helping more blood to flow to the penis. If you are having trouble with erections (ED), these pills are often the first type of treatment that’s tried.

Men with nerve damage from prostate cancer treatment might not respond as well to these drugs as those with ED from other physical causes. But some research suggests that men who use one of these drugs fairly often, starting within 6 months of prostate surgery, might have better erections over time (as long as the nerves were spared).

Many drugs are known to cause problems if you take them while you are taking Viagra, Levitra, or Cialis. Be sure your doctor knows about all medicines you take, even those you take rarely. Learn about the drug’s side effects before you try it.

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 produce a firmer and longer-lasting erection. Penile injections work for most of the men who try them.

Because the shot can have side effects, the first one is usually done in the doctor’s office. Rarely, a man will get an erection that won’t go down. If this happens, he will need to go to an emergency room right away for treatment. Another side effect is that some men can get scars in the spongy tissue after many injections, causing the penis to curve.

Pellets: Another way for a man to get the same drug used in the shots is from a tiny pellet he can put in the small hole at the tip of his penis. Although easier than shots, the pellet does not always work as well. It can have the same 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.

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.

A penile implant is a pump system placed entirely inside a man’s body. When a man is ready for sex, he squeezes a pump in his scrotum. The pump moves salt water from a small tank into tubes that have been put inside his penis to create an erection. 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.

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 if he chooses implants.

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 by teasing yourself, too. When you feel very excited, stop touching your penis, even if you partly lose 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 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.

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 can 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 if they are removed, 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. They will look less normal if part of the scrotal skin must be removed.

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. This is common after surgery, but men aren’t often warned about it. The cause of the shrinkage is unknown. There’s no way to prevent or treat it at this time.

Grief and loss

It’s normal to feel grief over the losses from cancer and its treatment. You might have to give up your old ideas of yourself and start finding new ways to cope with the changes in your life. You might also feel 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. These feelings and thoughts can 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’s no one close that you want to confide in, you might want to see a counselor. Just as it’s important to take care of pain in your body, it’s important to deal with painful feelings.

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’s right for you. As long as you don’t overdo it, exercise can 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, eating, 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 can make it harder to reach orgasm. If this becomes a problem for you, talk to your doctor about it. Other anti-depressants might not have that effect on you.

Worrying 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 be sure they can 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 you must please your partner. It can also help you find out where you might be tender or sore.

If you’re 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 might 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 on this, please see the “Finding professional help for sex problems during and after cancer treatment” section.