BY RALPH BLUM
There is no doubt that all the main prostate cancer
treatments—surgery, radiation or hormone therapy—are likely to affect
erections. And although many men who are diagnosed with prostate cancer are
older, and may therefore already be subject
to the ordinary fatigue and malfunction of
nature’s ultimate erector set, the degree to which sexual function returns—or
fails to return—after treatment is still a matter of major concern for a number
of us.
There is no set formula or predictable schedule for recovery
of sexual function after prostate cancer treatment. If you choose surgery, your
chance of recovering potency is partly dependent on the experience and skill of
your surgeon. The minuscule nerves that control erections are located dangerously
close to the prostate, and damage to or actual removal of those nerves during
surgery causes permanent erectile dysfunction. Viagra or Cialis only works if
the nerves can be spared. And even with successful nerve-sparing surgery
it can take up to 12 months for the restoration of the natural ability to have
an erection.
The
radiation options—seed implants or IMRT—are associated with a significantly
better chances for maintaining erectile dysfunction. But the reality is that
radiation therapy still can cause
erectile dysfunction because of the inflammation or scarring that occurs around
the nerves.
Hormone
therapy, another treatment alternative, causes total dissolution of sex drive, and you don’t even care that it’s gone!
Fatigue, joint pain, depression and hot flashes are not exactly a turn-on
either. And yet even without a libido, an erection can be achieved through the
manipulation of modern pharmacology—that is if you can dredge up enough desire
to give it a try for your partner’s sake—but even with a pharmacological
assist, personal satisfaction is often seriously diminished.
There
is, moreover, a “use it or lose it” caveat: many doctors who specialize in
erectile dysfunction encourage sexual activity as soon as possible after
treatment (or in the case of hormone therapy during treatment) on the grounds that the nerves and muscles that
control erections can atrophy if they are not used for a long period of time.
If
prostate cancer has already affected your ability to achieve erection, there
are various options that might help—penile injections, a vacuum pump device,
implantable pellets, or penile implants. I will present the pros and cons of
these methods for inducing an erection in my next Blog. In the meantime, keep
in mind that there are ways you can express your love for your partner and
attain sexual gratification that don’t include penetration. Ways that include
intimacy and tenderness, lest we forget.
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