Considerable emotional and mental processing comes with a prostate cancer diagnosis. “Prostate Cancer strikes a personal part of a man’s body, and for most, it is a glaring sign of aging and a reminder they are not as young as before,” says Dr. Mark Pomerantz, an oncologist with Harvard-affiliated Dana-Farber Cancer Institute.
Then there is the stressful decision about treatment. Yet many men don’t realize how much their choice may influence their sex life.
“Common treatment options often affect sexual function and desire in some way, from erectile dysfunction to low libido,” says Dr. Pomerantz.
|Seek out therapy
Keep in mind that any sexual issues from your Prostate Cancer treatment also can affect your partner. “A man’s partner can become frustrated and stressed from a sudden and sometimes long-term change in sex life, too,” says oncologist Dr. Mark Pomerantz of Harvard’s Dana-Farber Cancer Institute.
He recommends that couples seek out counseling, either alone or together, to help both address concerns and formulate a strategy that helps everyone. This approach is quite successful. A 2011 study in the journal Prostate Cancer found that prostate cancer patients and their partners improved their sexual satisfaction and function after couples counseling and sex therapy.
“Managing prostate cancer is difficult for many men,” says Dr. Pomerantz. “Knowing how it may cross over to other parts of their life, especially their sexual one, can help in the decision-making process.”
Problems and solutions
There are four ways to approach initial prostate cancer treatment and management: active surveillance, radical protectorate, radiation therapy, and androgen deprivation therapy. Here is a look at how each can affect your sex life and what you can do about it.
Active surveillance. With active surveillance, you monitor your prostate-specific antigen (PSA) levels for changes and undergo regular digital rectal examinations and occasional prostate biopsies. Your doctor may also suggest a biopsy if your PSA level rises or an exam shows a new or enlarging growth. If a biopsy shows any changes, your doctor may want to continue with active surveillance or begin treatment.
While active surveillance doesn’t directly affect your sex life, it can increase stress levels that can lower your libido.
“Some men have trouble dealing with the uncertainty of whether their prostate cancer may worsen,” says Dr. Pomerantz. “This can make it harder for men to relax since they have to monitor their condition constantly.” He suggests adopting stress-relieving techniques, like meditation, yoga, or a hobby; devoting more time to exercise; and meeting with a sex counselor.
Radical prostatectomy. This surgical procedure involves removing the entire prostate gland and surrounding affected tissue. Since this is a delicate operation, there is a risk of cutting essential nerves involved in getting and maintaining an erection.
“Technology and surgical expertise have improved much over the past 20 years,” says Dr. Pomerantz. “Still, a prostatectomy involves technical challenges, and there is a chance a man will have some nerve damage afterward.”
The good news is that any problems often can be treated with standard erectile dysfunction (ED) drugs. “This helps for a large percentage of men,” says Dr. Pomerantz.
However, ED drugs won’t help if too many nerves were damaged to completely remove an aggressive Prostate Cancer . In this case, alternative treatments like penile injections or implants are needed to help the man produce and maintain an erection.
Radiation therapy. In general, radiation treatments tend to cause less nerve damage compared with radical prostatectomy. The amount of damage depends on the dosage needed and the number of sessions. If nerve damage from radiation affects your ability to have or maintain erections, the treatment options are the same as after surgery: ED drugs and, if necessary, injections or implants.
Androgen deprivation therapy (ADT). Prostate Cancer can be fueled by testosterone; ADT aims to slow cancer growth by shutting down testosterone production. Since testosterone (the sex hormone) is cut off, men often experience fatigue and diminished libido.
“Most men who have ADT don’t lose their desire for intimacy or to maintain a loving relationship, but they do have a drop in sex drive,” says Dr. Pomerantz. The upside to ADT is that the therapy can end if the cancer goes into remission, and men’s libido will soon return.
“For certain patients, it is safe to go off and on the therapy as needed. If Prostate Cancer returns, ADT can begin again,” says Dr. Pomerantz.
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