Click here to download a copy of WAPC’s new fact sheet Prostate Cancer, Sexuality & Intimacy: Everything You Wanted to Know But Didn’t Know to Ask.

Rehabilitation and Recovery

Q. Are there techniques for enrichment in intimacy after prostate surgery?

A. There are a number of techniques to improve intimacy after prostate surgery and couples may have to try several different options or a combination of options before they find something that works for them. Before surgery you will want to discuss penile rehabilitation with your physician (see next question) to enhance the ability to get an erection. Bear in mind that impotence is a common side effect of prostate surgery and it can take a year or more for the nerves damaged during surgery to recover. Meeting with a sex therapist may also help you discover creative ways to be intimate including using toys, masturbation and other methods. Additionally, men may also experience fluctuations in libido following surgery often due to psychological stress.

Q. What is penile rehabilitation?

A. Penile rehabilitation is used to treat erectile dysfunction caused by cancer therapy. It is an active
intervention to intermittently stimulate the penis during the recovery period. Penile rehabilitation should start immediately following the catheter removal. With many physicians, the use of oral pills, vacuum erections
devices, or penile injection therapies are the first to be pursued. However, the optimal regimen is still unclear and may vary by patient. Patients may try PDE-5 inhibitors (i.e. Viagra, Cialis, Levitra) and keep in mind that oral medicine will not work for everyone. Only about 90% of patients will respond to medicine, even in those who had normal sexual function prior to surgery,

Q. How long does sexual recovery take?

A. This probably comes as no surprise, but the time it takes for full sexual recovery is different for everyone and is impacted by the therapy they choose. Full recovery is achieved when the quality of erection is as good as it was prior to surgery. However, potency following surgery is usually defined as the ability to have intercourse in more than 50% of attempts.

Erectile Dysfunction (ED)

Q. Will there be ED post-radiation treatments (Proton, IMRT, EBRT)?

A. Maybe, the percentage of men with ED following radiation varies by the treatment regimen and can range between 10% – 60% of men.

Q. What are the available treatments for ED?

A. The most common treatments for ED include counseling/sex therapy, oral medications, penile
injections and vacuum erection devices. You can speak with your physician about obtaining a prescription for oral medications, penile injections or a vacuum erection device. In addition to or in place of these methods you and your partner may choose to visit a counselor or sex therapist who is specially trained to help people work through their sexual and intimacy problems through talk therapy.

Q. Will my partner suffer from depression due to ED?

A. It is common for patients to suffer depression from the inability to get or maintain an erection. Remember to show your support for him during this time by lending your ear and communicating your own feelings openly and honestly. Consulting with a sex therapist may help in this process.

Vacuum Erection Devices (VEDs)

Q. What is a VED and are erections different with VED’s?

A. A vacuum erection device or VED uses a vacuum to fill the penis with blood. Then, a rubber ring is placed at the bottom of the penile shaft to maintain the erection. Some men may feel discomfort from squeezing sensation at the base of the penis.

Penile Injections

Q. Are penile injections painful?

A. The injections usually sting a little. It is also very important to work with your doctor to determine the correct dosage in order to avoid priaprism which is a well known side effect caused by too high a dose or incorrect mix of medications for the injection. Priaprism is a persistent, usually painful, erection that lasts more than four hours without physical or psychological sexual stimulation. It make take some time to determine the correct dosage for each individual.

Q. How long will erections last?

A. Typically erections last 30 minutes to 1 hour, but may last longer. This may depend on a number of factors including a man’s general health and whether the correct dosage was injected properly. If an erection lasts more than 4 hours call a doctor or go to the emergency room immediately.

Orgasms, Incontinence & Toys

Q. Can you have an orgasm without an erection?

A. Yes orgasm can be achieved without an erection.

Q. Can vibrators help men acheive better orgasms?

A. While no studies have been done on this particular topic, couples are encouraged to try different methods such as incorporating vibrators to see if they work for you.

Q. Do penis rings help maintain an erection?

A. Yes, penis rings may help maintain and prolong an erection.

Q. Can there be urinary incontinence on arousal or orgasm?

A. Urinary incontinence is common during the early phase of recovery following surgery and over time the incontinence should decrease or stop all together, although there is a small chance that it may not. Be sure to speak with your doctor about the side effects of your chosen treatment method.

Stress, Anxiety & Depression

Q. Will my loved one become depressed or anxious as a result of prostate cancer?

A. It is likely that he will, this is why partners should always be encouraged to come to the initial consultation for prostate cancer treatment so that they have a better understanding of what the patient is experiencing. Remain patient and loving during this time and seek support through friends, family, faith communities or support groups.

Q. How can depression affect our relationship?

A. Depression has an impact on any relationship. Open and honest discussion is always recommended, and when necessary counseling or therapy can be helpful. One of the most difficult aspects of depression is that the signs and symptoms can creep up in many different areas including mood, appetite, sleep patterns, sex drive, behavior, memory, concentration, and more.

Q. How can i ease stress & anxiety related to intimacy after prostate cancer diagnosis or treatment?

A. Always maintain the perspective that restoring potency following prostate cancer treatment is part of the recovery process. In other words, as with all treatments, recovery takes time. It has been reported that erection can return as far out as 4 years after surgery. You can also encourage your partner to see a therapist or attend therapy with your partner. As stated earlier, it may be helpful to find support through friends, family, faith communities or support groups.

If you have additional questions that you would like to see answered on this page, please submit them toinfo@womenagainstprostatecancer.org

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