Adapting to enjoy full sexual intimacy

Dr Anthony Smith expands on ways to adapt after prostate cancer treatment so sexual function can be improved and sexual intimacy enhanced.

The prostate’s anatomy is central to the nerves, muscles and vessels that supply the genitals so any damage to this area can have profound consequences. Its therefore no surprise that men fear this cancer and its potential to substantially damage their sexuality and masculine identity. So, let’s look at the side effects.

Surgical treatments

A cornerstone of treatment is a radical prostatectomy, now done as a nerve-sparing procedure which has improved the outcome such that up to 75% of men can expect to retain some degree of erectile function after the operation. 

Nevertheless, the operation takes place in a highly-sensitive area of multiple important vessels and nerves. Problems that can result include difficulties in achieving or sustaining an erection, a dry ejaculation as the glands responsible for secretions are removed along with the prostate, or urinary incontinence which diminish the feeling of desirability and sexual confidence. 

However, while these side effects are at their worst directly after surgery, they will usually improve significantly over the weeks and months that follow. 

Radiotherapy

Erectile dysfunction is less common with radiotherapy overall but because of the delayed effect of the treatment, it may develop over time. Radiotherapy may be more desirable than surgery because of its non-invasive nature, but prostatic pain, fatigue and erectile dysfunction that gets worse before it gets better can be a challenge to cope with. 

Hormonal treatments

Testosterone blocking medications can result in diminishing libido, promote weight gain and augment breast tissue. These problems can negatively impact a man’s sense of himself as a sexual person and compromise his desire for sex. 

The overall impact of these treatments will depend on the man, his sexual and masculine identity, his sexuality, be it heterosexual, gay or bisexual, his status as partnered or not, and his underlying mental health status. 

Ways to improve sexual function and intimacy

Like with all serious illnesses, it helps to have the best information to plan ahead. While the side effects can be disheartening, there is still much to be optimistic about and multiple ways in which sexual function can be improved upon and sexual intimacy enhanced. 

1.  Preparation

Knowing what you are in for will give you a realistic expectation of what may happen (often your worst fears aren’t realised). An open discussion with your doctor and your partner can allow the sharing of fears and concerns, plus reassurance and lay the foundations for later conversations when more practical measures may be needed. 

2.  Penile Rehabilitation

This is based on the understanding that an erection is dependent on nerve and blood supply to the penis, and that anything impairing these will have a negative effect. Stimulating the penis, continuing with sexual relations and ensuring that disuse doesn’t contribute to the problem is all important. 

Medications like low-dose phosphodiesterase inhibitors taken daily can help with vascular supply and higher occasional doses are helpful too if needed. 

Pelvic floor exercises, with the advice of a specialist physiotherapist, can help as well as eradicating medications which may impair erectile function. 

Non-invasive shockwave therapy is a new modality offered, but not routinely available in South Africa.

3.  Physical and mental well-being 

Potency isn’t confined to the penis alone, but is a full body experience, enhanced by a physically well body and mind. Looking after your body, with regular exercise, attention to diet, avoidance of alcohol and smoking, and getting the right amount of sleep will all enhance self-image and self-esteem, leading to a greater feeling of desirability and sexual confidence.  

Similarly, it’s important to pay attention to mental health. A diagnosis of cancer can be a mortally threatening event and can result in anxiety and depression, both of which have negative consequences on sexual health. Paying attention by treating these with the correct medications, or going for talk therapy is strongly recommended. 

4.  Open communication

An important lesson is for you, the man, to open up and discuss these issues. Talking  with your partner will help you to adapt to sexual problems, deepen your connection and to realise that sexual intimacy goes well beyond penetration. 

Final thought

A diagnosis of prostate cancer can induce fear because of the possible negative consequences to a man’s sexual health. But most problems will improve, and men and their partners can achieve high levels of sexual satisfaction, even if there has been some change to genital functioning. There is no reason why couples can’t adapt to enjoy full sexual intimacy and highly satisfying sexual lives beyond prostate cancer.

This article is sponsored by Ferring Pharmaceuticals. The content and opinions expressed are entirely the medical expert’s own work and not influenced by Ferring in any way.

Header image by Freepik