Your sex life can be affected by prostate cancer and its treatment. We all agree that sexual function plays a key role in our quality of life, regardless of our age. Impotence after prostate surgery may be a frightening thought for many men.
It is true that the resumption of sexual function after prostate surgery can take time. Erectile dysfunction (ED) symptoms just after prostate removal are a normal part of recovery and are not an indication of permanent change. Sexual issues are often temporary and treatable. Most patients are able to resume normal sex lives with complete erectile function in 12 to 24 months. Younger patients may experience faster or improved results.
It is Dr. Samadi’s unique SMART Surgery that enables these improved recovery results and helps patients return to an enjoyable sex life after prostate removal. His preservation of the endopelvic fascia and neurovascular bundles, as well as the elimination of cautery, all work to reduce nerve damage and speed sexual performance recovery. Compared to SMART Surgery, radiation therapy or another type of surgery may damage the nerves or muscles that help you have an erection. Hormone therapy works by lowering the amount of testosterone and may result in a low libido (sex drive).
There are several treatment options to assist you during recovery or to address ED that continues beyond 24 months.
You may also experience:
- Dry orgasm (no semen)
- Low sex drive
- A smaller penis
There are various ways in which you can work on regaining a normal sexual potency.
Oral ED Medications
During your recovery, it is important to celebrate your victories. You are cancer-free! Take time to enjoy intimacy with your partner and reestablish your physical and emotional connection. The easiest first step is to try oral medications to assist with achieving and maintaining an erection. These include prescriptions such as Viagra® (sildenafil citrate), Levitra® (vardenafil), and Cialis® (tadalafil). Most patients experience very positive results with these ED drugs. These medications may help only if your nerves were not damaged by surgery or radiation.
Penile Injection Therapy
If ED medication is not successful, don’t be discouraged. Sexual activity and “exercising” the penis is an important part of sexual recovery. Some research shows that erections can enhance the oxygenation of tissue and suppress scarring. It could take time for your nerves to regenerate and recover enough to respond to medication assistance. In the meantime, penile injection therapy is a very reliable and effective option for achieving an erection. Injection therapy may also improve your return to normal function. It works best if it is given 5 to 15 minutes before you want to have an erection.
Penile Implants
In some patients, the erectile function may not return after radical prostate removal. These men are encouraged to explore highly successful penile implant surgery. A penile implant offers a permanent solution to ED and delivers a very high satisfaction rate for patients and their partners.
This procedure involves adding a prosthetic device into the penis and scrotum. There are several types of penile implants available. The doctor and the patient will have to choose between a three-piece inflatable pump, two-piece inflatable device, and semi-rigid rods. If needed, Dr. Samadi will refer patients with advanced ED to a specialist with expertise in penile implant surgery.
Orgasm and Ejaculation
The prostate is responsible for producing the fluid that keeps the sperm alive. It contracts during ejaculation and squirts its fluid into the urethra. Also, the seminal vesicles are attached to the prostate and add extra fluid to the semen before it transported through the urethra. During ejaculation, the prostate contracts and speedily pushes the semen out. Once the prostate is removed, ejaculation ceases. You will still be able to achieve and enjoy orgasm after robotic prostate surgery. At the moment of orgasm, little or no semen will go out, also known as “dry orgasm”. For some men, orgasm without semen feels normal, while for others it feels even more pleasurable. In most cases, this is not an issue unless the couple wants children. In this case, the couple should consider sperm-banking before surgery.
Bibliography
1. How to return to an active sex life, Cancer Centre, Web, 29 Sept 2017
2. How to improve your sex life after prostate cancer, Medical News Today, Web, 14 Jan 2019
3. Life after prostate cancer treatment, PubMed Abstract, Web, 15 Jun 2017
4. Help for ED after prostate surgery, Prostate Cancer Foundation, Web
