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Sexual Function after Prostate Surgery

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Erectile Dysfunction

Nearly all men undergoing robotic radical prostatectomy will experience difficulty getting an erection (erectile dysfunction, or “ED” for short) for a period of time after surgery, even if they have a “nerve-sparing” operation.

The nerves responsible for erection (the “cavernous nerves”) travel very close to the prostate gland and may be injured during removal of the prostate (Figure 1). This fact may get lost in the process of dealing with the initial diagnosis and treatment of the cancer, and men often become more acutely aware of their erectile dysfunction after they have successfully cleared these initial hurdles in treatment.

Psychological Support

Roswell Park offers the opportunity for couples who are considering surgery to meet with members of our Psychology Department, who may be of assistance in helping cope with this issue and its potential impact on a relationship. The relative importance of sexual function between couples is highly variable and dependent on many factors.

Our Psychology Department staff can also help with the greater issue of cancer treatment in general and the unexpected strains it might place on a relationship in hopes that couples who prepare for those challenges in advance will be better able to deal with them.

Recovering Erectile Function

The degree of recovery of erectile function depends on multiple factors, including the type of operation you had (one, both, or no nerves spared), your age, and your erectile function before surgery. It is important to understand that time may be the most important factor in the recovery process. We know from studies of thousands of men who have had nerve-sparing prostate surgery (open or robotic) that the natural healing process often takes 18 to 24 months or more. This is due in part to the length of time required for healing of nerve tissue after surgery. It is also very common for a man to need medications after surgery to assist with erectile function even though he did not need them before surgery.

Through the use of standardized questionnaires, your questions and your surgeon’s inquiries, information is gathered at each visit to help evaluate your overall progress and make any changes in your treatment plan as needed.

Rehabilitation

There is some evidence that early rehabilitation designed to increase blood flow to the penis, starting about six weeks after surgery may speed up the ability to resume sexual activity. There are various methods available, depending on your particular case, your level of motivation, and the judgment of your surgeon.

See the included table and diagrams for descriptions and pictures of how some of these therapies are administered, and pros and cons of each. Instruction and assistance with these treatments would be supervised by the physicians and dedicated staff in the Urologic Oncology Clinic.

Support organizations, such as Us TOO International, are available to provide a forum for men who experience some of the common issues surrounding prostate cancer treatment, including erectile dysfunction. We have included a list of websites, books, and organizations that can offer assistance.

Treatments for Impotence

Oral Medication (Viagra®, Levitra® or Cialis®)

Pros:

  • Pills taken by mouth
  • Effective in many men

Cons:

  • Not effective unless nerve-sparing approach used
  • Side effects including headache. Viagra and Levitra may cause blurry vision. Cialis may cause joint or back pain
  • Should not be used in some patients
  • 30-60 minute wait for response
  • Cannot be taken with some medications

Intra-Urethral Suppository (MUSE)

Pros:

  • Small pellet placed in the urethra without needles
  • Few systemic side effects
  • Effective in 43-62% of men

Cons:

  • Can cause penile or urethral pain
  • Requires simple training
  • Refrigeration required
  • May require tension ring placed at base of penis for best effects
  • Side effects include (rarely) painful & prolonged erection (more than six hours), fainting, dizziness

Penile Injection

Pros:

  • Highly effective
  • Few systemic side effects
  • Works in three to five minutes

Cons:

  • Some medications require refrigeration
  • Requires injection
  • Requires office training
  • Can cause penile pain
  • Can cause prolonged erection and penile fibrosis or scarring

Vacuum Device

Pros:

  • Least expensive
  • No systemic side effects
  • Effective in 66-71 percent of patients

Cons:

  • May cause numbness or bruising
  • Less “natural” erection
  • Some find awkward to use

Penile Prosthesis

Pros:

  • Highly effective
  • For men who have failed or are not satisfied with medical treatment of impotence

Cons:

  • Small risk of infection
  • Requires anesthesia and surgery.
  • May require replacement after many years of use.

Books

  • The Lovin’ Ain’t Over: The Couple’s Guide to Better Sex after Prostate Disease, by Ralph and Barbara Alterowitz. Health Education Literary Publisher, Westbury, NY, 1999. ISBN: 1883257034
  • Our Journey Through Prostate Cancer, by Jim and Julia Miller. JJM Publishing, San Francisco, CA, 2003. ISBN: 0974317209
  • Couples Confronting Cancer: Keeping your Relationship Strong, by Joy L. Fincannon and Katherine V. Bruss. American Cancer Society, Atlanta, GA, 2003. ISBN: 0944235255

Websites

  • Us TOO International
  • Phoenix 5 – Phoenix 5’s mission statement is to help men and their companions overcome the effects of prostate cancer.
  • Prostate Cancer Intimacy (PCAI) – PCAI offers an open and frank discussion about the problems associated with intimacy and prostate cancer.

Other Sources

American Association for Marriage and Family Therapy
112 South Alfred Street
Alexandria, VA 22314-3061
Phone: (703) 838-9808 Fax: (703) 838-9805

American Association of Sex Educators, Counselors, and Therapists
P.O. Box 5488
Richmond, VA 23220-0488

Sexual Function Health Council American Foundation for Urologic Disease, Inc.
1000 Corporate Blvd Suite 410
Linthicum, MD 21090
Phone: (410) 689-3990 or (800) 828-7866
Fax: (410) 689-3998

The Sexuality Information and Education Council of the United States (SIECUS)
130 West 42nd Street
Suite 350 New York, NY 10036
Phone: (212) 819-9770

Sexual Medicine Society of North America, Inc.
1111 N. Plaza Drive
Suite 550
Schaumburg, IL 60173
Phone: (847) 517-7225 Fax: (847) 517-7229