Thursday, December 24, 2009

Sex after prostate surgery? Anne Katz answers reader's question

Cancer -- not a sexy topic, and not what you'd expect me to write about on Christmas Eve. But cancer knows no seasons and respects no holidays. Maggie, age 62, wrote to me:

Recently, I met a nice guy who after dating for a while, told me that he had surgery for prostate cancer 7 months ago. He went on to tell me all the bad news that the Dr. had told him about side effects. My question is, do you know any where that I can get some straight answers on what we are looking at, possibility wise? The information I have found online so far has been very negative, almost always putting the pressure on the woman if things were going to work or not. He advised me that he would never be able to have an ejaculation & that sex for him would never be the same. I got the idea that he would never feel the pleasure of having a climax again. My fear is that if this is true, what would be the point of him having sex? I am a very sexual woman & would just like to know if there is any chance that there can be a sexual relationship? Any guidance that you could offer would be greatly appreciated.

I sent Maggie's question to cancer and sexuality specialist, Anne Katz, RN, PhD. Here is her response:

There are a number of possibilities in this situation, some of them good and some of them not so good. Here are the facts:

1. Having surgery for prostate cancer (a radical prostatectomy or complete removal of the prostate gland) will result in significant changes in a man's ability to have an erection. Depending on what his erections were like before the surgery and the amount of damage done to the nerves responsible for erections during the surgery, the man may be able to have erections after the surgery but he is most likely always going to need some help (from medication like Viagra, Cialis or Levitra). These medications only help about 50% of the time but there are other erectile aids (the vacuum pump or penile injections) that can help too. Some men are able to have an erection but it may not last very long. Some men can only achieve a thickening of the penis and this may not be sufficient for penetration. Progress in regaining erections may continue for up to two years after surgery but what he has at that point is usually as good as it is going to get.

2. Orgasms are still possible, even with a flaccid penis. The orgasm will not be accompanied by ejaculation however (the prostate gland makes the fluid portion of the ejaculate and so when it is gone, so is the emission). Some men report more intense orgasms after this surgery; some say they are much less intense.

3. Libido (or sexual desire) is not affected by removal of the prostate but the mind is a very important part of a man's sexuality. Repeated failure to have an erection sufficient for penetration may cause him to lose some interest. Although some men just keep on trying and trying and trying - the human spirit is a powerful force and many men retain hope for many years despite little success.

4. Many couples find a way around these difficulties. There are more ways than just penetration for both the man and the woman to achieve orgasm and satisfaction and some creativity goes a long way. This may be challenging for a new relationship. But the lust and attraction in a new relationship may also provide more impetus than a 30 year relationship! There is no right way or wrong way in this; a lot depends on how you want to look at the situation.

5. If you read anything that you feel puts the onus on the woman (or male partner) to fix things, then stop reading! This is a couple's issue and both partners have to work on finding a solution. Communication is a very important part of sexuality. You should be able to talk openly about what works for him and what doesn't. You should be able to talk about what you want and what creativity you can both bring to sexual activity. In your letter you state that you "got the idea" - you will have to ask questions and not rely on innuendo to help you understand what is possible and what is not.

New relationships are challenging and exciting and inspiring and joyful. When illness or injury have occurred it puts a lot of pressure on this new partnership. Good luck!


Anne Katz, RN, PhD, is the author of the award-winning text book Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers . Dr Katz has also written three books for consumers: Sex When You're Sick: Reclaiming Sexual Health after Illness or Injury; Woman Cancer Sex, and Man Cancer Sex. She is the sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, where she provides counseling to men and women experiencing sexual difficulties as a consequence of cancer and its treatments. Visit her website at http://www.drannekatz.com/.



1 comment:

  1. I am nearly 58 years old and I had my prostate removed 6 weeks ago and I am working through these issues with my wife. I am fortunate that I was able to have nerve sparing robotic laparoscopic surgery and my doctor believes that my nerves were spared. However, even with spared nerves the nerves are traumatized, and require time and therapy to get back to normal function.

    My doctors started me on a therapy program right away using daily doses of Cialis to encourage blood flow and using a vacuum pump to engorge my penis with blood daily. Keeping blood flowing is a key to avoiding atrophy and scar tissue in the penis while the nerves heal.

    I have switched from Cialis to Levitra, because Cialis gives me muscle cramps, but with 5 mg Levitra nightly I often have spontaneous erections at night. These erections are short lived and not very strong. If I do take a strong dose - 20 mg - of Levitra to attempt intercourse I have had better success. My wife and I do take time at least weekly to have relations, and two weeks after my surgery, with the aid of Levitra I was able to have an semi-erection and an orgasm.

    I have managed intercourse only once so far, usually my erections are not firm enough but with manual stimulation we can both have enjoyable time together and we are keeping sexually active to be sure that I keep improving. My wife has been very helpful and understanding, and that has helped me to cope.

    As a man, having weak, short lived erections is frustrating, even though I understand that it should get better over time. It is also strange having dry orgasms. The loss of ejaculation makes me feel like something is missing, although the feeling of an orgasm is still very good.

    Still, at least so far I believe that my progress has been good and I am keeping up with my therapy, using the vacuum pump daily and taking 5 mg of Levitra nightly. I'm not sure how long this therapy will be needed, but so far i'm coping.

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