Like all cancers, prostate cancer can change a man’s image of himself. Not only can it trigger depression and force him to confront his mortality, but the most well-adjusted man may also find that the emotional stress of living with such a cancer interferes with sexual desire and performance. In some cases, his natural concern with its intimate location will render him psychologically impotent.
Even men who can cope with the emotional burden of prostate cancer have to cope with the physical treatment, which can also affect sexuality. Many men see it as an assault on their genitals, their hormones and their sense of masculinity. Depending on the type selected, it can limit erectile function, eliminate ejaculation or reduce libido.
The big question all men want answered is whether impotence is an inevitable consequence of treatment. The answer is no, but it must be remembered that 30 per cent of men with prostate cancer are impotent before any treatment commences. These men will remain impotent.
In the case of the others, different treatments have different outcomes. After treatment some men lose their potency immediately, some lose it gradually and some regain it gradually.
The four main treatment options are surgery, radiotherapy, hormone therapy and watchful waiting (being vigilant but having no active treatment).
The prostate lies in the body surrounded by nerves and blood vessels. Cutting it out without damaging these nerves and vessels is difficult, and it is the extent to which these structures are damaged that determines the degree of potency after the operation.
Surgeons have to balance their enthusiasm for protecting nerves against the certainty of getting rid of the cancer. They don’t want to protect the nerves and leave some cancer behind. Sparing nerves is only possible in some cases.
Nerve-Sparing Radical Prostatectomy After a nerve-sparing radical prostatectomy (removing the prostate with as little nerve damage as possible), 40 to 70 per cent of men are still potent.
Each man’s potential potency depends on his age, the number of nerves spared and his erectile function before the operation. After surgery, erections take between 3 and 18 months to return and are not as strong as they were before. They are said to be 60 to 80 per cent as good, but this assessment is very subjective.
Radiation Therapy Radiation therapy slowly damages blood vessels, and after 5 months of this treatment men may begin to notice an effect on their potency. About 50 per cent of men who have had radiation therapy will be impotent five years later. Ejaculation and orgasm are also affected; the overall result depends on how sexually healthy the man was before the radiation began.
Hormone Therapy Hormone therapy is usually reserved for men with advanced prostate cancer and is essentially a form of chemical castration. It leads to loss of desire, impotence in 80 per cent of patients, decreased ejaculation and less intense orgasm.
Watchful Waiting Men who opt for watchful wailing have to live with the knowledge that they have this cancer and are not actively treating it. This influences (heir self image and may affect their sexuality in the long term.
On a positive note, neither prostate cancer nor its treatment affects the skin of the penis, and sensations there remain unchanged. Furthermore, orgasm is a mental event and can occur without ejaculation. It is a myth that intercourse is the only really grownup form of sex. Much gratification is possible without penetration and with ‘outercourse’. This includes any form of sexual activity that is commonly thought of as foreplay.
Sex therapists say that although foreplay satisfies many women, men often don’t regard it as real sex and their ‘outer-course’ repetoire is limited. Like babies, adults have ‘skin hunger’ and need to be held and touched. There are numerous ways of feeding this hunger. Holding hands, lying together or massaging each other is a good start.
Men missing the closeness of intercourse could regain it using a technique described as ‘soft sex’. This requires the woman to sit astride the man and use her pelvic floor muscles to achieve partial penetration. This can give pleasure to both partners but the woman does need to have a strong pelvic floor.
Following treatment for prostate cancer, many men lose their desire for sex and don’t feel like initiating it. However, they may regain their interest if they realise how many aspects of sex they can still enjoy.
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