Yes, Prostate Cancer May Affect Sexual Performance. No, It’s Not Necessarily Permanent.

It’s an unavoidable and unnerving truth about prostate cancer: Having a prostatectomy can cause problems for a man’s sexual health, ranging from diminished libido to challenges getting or maintaining an erection.

However, it’s not as bleak as it sounds. For many men these symptoms are temporary. With time and patience, most sexual functions return to normal. New procedures lessen the risks, and new post-surgical treatments offer further help. Ultimately, your chances of recovering sexual functions depend on factors like your age, overall health, and lifestyle factors including smoking, diet and exercise.

These side effects threaten a core aspect of many men’s identity, further underlining the critical importance of early detection.

The prostate’s role

To understand the connection to sexual health, it’s helpful to understand that the prostate is an important part of the male reproductive system. Its key function is producing a fluid that makes up part of semen along with sperm, which is produced in the testicles. The prostate helps force semen into the urethra and expel it outward during an ejaculation.

In some cases the mere presence of prostate cancer, absent any treatment protocol, can cause sexual problems, including:

• Difficulty in getting an erection
• Lower production of semen
• Reduced fertility

Some of the treatments can also affect the nerves and blood supply around the penis, leading to difficulty in getting an erection. Some treatments also diminish the amount of semen you produce. For example:

• A radical prostatectomy, in which the surgeon removes the entire prostate, can damage the nerves, muscles and blood vessels surrounding the gland, which can cause erectile dysfunction (ED). Modern techniques, including laparoscopic or robotic-assisted laparoscopic surgery, help increase the likelihood of being able to avoid damaging nerves, though it also depends on the location of the cancer tumors. Men who have undergone a radical prostatectomy also will no longer be able to ejaculate semen, although they can still achieve orgasm.
• Similarly, radiation therapy can affect healthy tissues surrounding the prostate, leading to nerve damage, depending on the type used. It also tends to diminish the amount of ejaculate.
• Hormone therapy, also called androgen deprivation therapy, aims to reduce androgens including testosterone that help prostate cancer grow. But blocking them may diminish a man’s sex drive, reduce his fertility or lead to ED.
• Chemotherapy, which involves the use of powerful drugs for advanced cases, may affect sperm production. Usually it returns, but often in lower quantities.

Recovery tactics

Recovery is possible, and recent studies suggest that chances of regaining function are higher the sooner after a radical prostatectomy rehabilitation work begins. Generally speaking, men under age 60 are more likely to recover the ability to get an erection, while being in good physical health, getting regular exercise and following a healthy diet can also help. Men with certain comorbidities, like diabetes, obesity or cardiovascular problems, will have a harder time regaining normal sexual function.

When sexual function is affected, physicians typically employ a number of tactics to support recovery.

• There are non-medical ED treatments including a physical exam, performing blood and urine tests. They may also recommend doing an overnight erection test to see how many erections you get while sleeping, how long they last and how strong they are. Doctors may also recommend a mental health evaluation or lifestyle changes such as quitting smoking, getting more exercise or eating a healthier diet. Some may even recommend Kegel exercises to strengthen the pelvic floor muscles.
• They often turn to ED medications such as Viagra or Cialis to improve blood flow to the penis.
• If that doesn’t work, doctors may try injection therapy to stimulate blood flow.
• Some men may be good candidates to try a vacuum erection device to stretch the penis and get it back into shape.
• Finally, there are devices that can be surgically implanted in the penis to induce an erection.

In some cases, men who’ve undergone treatment for prostate cancer and are experiencing ED or other problems with sexual functions may benefit from psychosexual counseling. We’ve also rounded up a list of prostate cancer support groups that may be helpful.

Cancer of any type is an intensely personal experience, and that’s especially true for prostate cancer, which strikes at an elemental facet of a man’s identity. Detecting prostate cancer early, when it is easier to treat, is critically important. Not only does it ensure a 99% five-year survival rate and decrease the risk of the cancer spreading to other parts of the body, but catching cancer early makes it more likely to be eligible for less invasive treatments that help preserve sexual function.

Ultimately, there is no one-size-fits-all answer regarding the affects of prostate cancer on sexual health nor how to approach it. We encourage you to discuss any concerns you may have with your doctor.