Sexual relationships can take a hit after treatment, a recent study shows, but a From the moment Chris Pearce and Mary Milburn began dating several Pearce initially chose a nerve-sparing robotic prostatectomy to help.
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- Preserving intimacy after prostate cancer
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- Prostate cancer and relationships: The partner's story - Harvard Health
- How to return to an active sex life after prostate cancer treatment
Five-year survival rates were 81 percent for radical prostatectomy, 81 percent for external beam, 83 percent for seeds and 77 percent for combined therapy. Who develops ED after treatment? It depends on luck, the tumor's location in the prostate, the aggressiveness of its cells and two main risk factors:. Whether you have prostate cancer or not, ED risk increases with age. The same goes for men with the cancer — that is, as your age at treatment increases, so does your risk of ED. Surgery causes somewhat more ED than radiation. National Cancer Institute researchers followed 1, men for five years — had surgery, radiation.
Sexual function declined in both groups, but was more pronounced after surgery. Twenty-one percent were potent after surgery, 36 percent after radiation. Other studies generally agree that prostatectomy causes somewhat more erection impairment than radiation. Prostatectomy-related ED develops immediately, but some men recover some function over time.
Preserving intimacy after prostate cancer
After radiation, fewer men report sudden ED; over time, however, it becomes more common. Prostate-cancer treatment causes ED because the nerves involved in erection border the gland. Surgery often cuts these; radiation frequently damages them. A special surgical approach called nerve-sparing prostatectomy can push your ED risk below that of radiation.
Studies report "functional" erections in 60 to 80 percent of men who have nerve-sparing surgery. Just don't expect miracles: At best, nerve-sparing surgery leaves men with erections not quite as firm as they were before surgery.
In addition, nerve-sparing surgery may not be possible if the tumor is located near a nerve line. Several studies show that erection drugs help restore erectile function, but usually only after nerve-sparing prostatectomy. Erection medications work by coaxing more blood into the penis. If a man doesn't have enough nerve function to enable erection, the amount of blood in the penis won't matter; no nerve function means no erection. Nerve-sparing surgery, by contrast, allows a man to retain nerve function, so erection drugs can help.
Italian researchers analyzed 11 studies of men who took erection drugs after prostatectomy. After conventional surgery, erection medication helped 15 percent of them. That's because conventional surgery sometimes preserves the nerves. After nerve-sparing surgery, however, the drugs helped about 50 percent of the men. For the best chance of preserving sexual function, opt for nerve-sparing surgery, then use erection medication.
Different nerves control erection and orgasm. So even when prostate-cancer treatment damages or destroys the erection nerves, those that govern orgasm usually remain intact. Yes, it's an adjustment to have a flaccid penis stimulated to orgasm. But in an erotic context with sufficient stimulation by hand, mouth or vibrator, it's entirely possible.
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A recent Canadian study shows that sex therapy helps couples resume sex after prostate-cancer treatment. The 77 couples who participated in the study enjoyed "significant gains in sexual function. Michael Castleman , publisher of the website GreatSexAfter Members save on in-home caregiving services. Asked what wisdom she could pass on to other couples, Ellen mentioned another important relationship: She says, "We did a lot of research before involving the kids.
We needed to get a handle on the facts before telling them.
Prostate cancer and relationships: The partner's story - Harvard Health
We knew that they'd have lots of questions, and we needed to have the answers. We told them that we didn't know what the end result would be, but because we had done our homework, had made appointments, and had a plan of action, the girls were reassured. That was important to us. Surgeons strive to protect nerves that control erectile function when removing the prostate.
However, sparing nerves is not always possible, depending on a prostate tumor's location. If nerves are spared, they may be damaged or traumatized during surgery. Even if the nerves recover, which can take up to two years, other damage may have occurred by then, preventing the return of erections. Asked how she and her husband of 16 years, Tom, decided on a radical prostatectomy to treat his prostate cancer, Catherine bluntly says, "Our priorities were breathing, continence, and sex, in that order. We were both in agreement on that. But we had a bias toward surgery.
We just wanted the cancer out. We've had lots of family members who've had cancer, and this had been their approach. We never talked to a radiation oncologist about radiation therapy because we knew what the possible side effects were. At that time, in , radiation wasn't as focused as it is now, and we really wanted to avoid rectal problems and fecal incontinence, which were more likely with radiation. Tom ended up needing radiation therapy anyway.
The lymph nodes were clear, but cancer had penetrated the prostate capsule, because his PSA never dropped to zero as it should have. Tom's doctor recommended radiation, which Tom started several months later, after his urinary continence returned. It worked, and his PSA has been nonexistent ever since. A man can create an erection with a vacuum pump. A man lubricates his penis and puts it into an airtight plastic cylinder attached to a hand-held pump.
Air is pumped out of the cylinder to create a vacuum, which increases blood flow to the penis and causes an erection. An elastic band placed at the base of the penis maintains the erection. Tom's potency, however, still has not returned. I miss it, too, because he was very good.
But we cuddle as often as we always have, and he helps me achieve orgasm. It's different, but if it were a choice between this and not having him at all, well, there's no contest. Even so, Tom has sought solutions for his erectile dysfunction. He tried penile injections at a specialist's office, but the result paled in comparison to "the real thing," and the needles proved to be a mental hurdle.
How to return to an active sex life after prostate cancer treatment
But I don't want him to get an implant for me. One thing Tom and Catherine regret is that no one talked with them about using sildenafil Viagra or the other PDE-5 inhibitors right after Tom's surgery. See "Early therapy to recover erections. Maybe that would've changed things, but that wasn't the thinking five years ago. Catherine's relationship advice for other couples: What does each person want?
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What are their needs? Things are going to be different, but if you can't talk about it, you can't fix it. And keep saying 'I love you. There's so much information out there. It can be hard to cull through it and figure out what you really need to know, so consider going to a support group meeting before making a choice. Listen to people who have gone through it. People at the group meetings tend to be more candid than physicians — and you'll feel like you have more control over the process.
Research suggests that when the penis is flaccid for a long period, and therefore deprived of oxygen-rich blood, the low oxygen level causes some muscle cells in erectile tissue to lose their flexibility and gradually change into something akin to scar tissue. This seems to interfere with the penis' ability to expand. PDE-5 inhibitors — sildenafil Viagra , tadalafil Cialis , and vardenafil Levitra — help dilate blood vessels and promote oxygen flow into penile tissues.
One study of 22 patients found that starting sildenafil upon discharge after surgery, followed by injection therapy several weeks later, aided the return of erections. International Journal of Impotence Research ; Kate, 48, met her boyfriend, David, at a friend's Thanksgiving dinner in The two had an almost instant connection and started dating. Because they spent so much time talking about their lives and discovering all that they had in common, they quickly grew close.
So Kate didn't find it odd when David, 54, told her on their first date that he had been treated for prostate cancer four years earlier. So, I knew before our first sexual encounter and didn't think twice about it. David revealed that he opted to have his prostate removed. The cancer, which was detected through screening, was small, and its location meant that the nerve bundles could be left intact. After the operation, he suffered from incontinence for a few months, and he had to wear a pad when he went running. He also started taking tadalafil, but after a few months, that wasn't necessary.
He could have an erection without it. Most men who opt for a penile implant choose a two- or three-piece model shown above. Three-piece implants consist of a fluid-filled reservoir in the abdomen, a pump with a release valve in the scrotum, and two inflatable cylinders in the penis.
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Two-piece implants combine the fluid-filled reservoir and the pump in the scrotum. Pumping the fluid into the inflatable cylinders creates an erection. It never occurred to me that a man would not ejaculate after prostate surgery, but I thought it was wonderful," says Kate with a laugh. No cleanup would be necessary, and I wouldn't have to reach for the box of tissues afterward!
Her sense of humor probably helped ease any tension after they tried to have intercourse for the first time. I didn't know what to think because he seemed so aroused. But he also seemed frustrated and unnerved. He kept saying he wanted to share that experience with me, and he seemed genuinely surprised by his inability to stay hard.