This is not an indelicate question; it’s an important one.
For those who receive any of the three major treatments for prostate cancer (surgery, external radiation, seed implantation), at least some will have a problem with impotence.
This may be the inability to have any erection; a partial erection; a total erection. Most of the time – and this is important to know – any impotence after treatment of this kind in this area of the body is a physiological problem, not a mental or emotional one. But every now and then, the fear of impotence or the stress of having one’s body affected in the very seat of male power is enough to cause some emotionally-related impotence. For this reason, alone, it is always worth having some psychological counseling whenever any impotence arises.
(I urge psychological counseling even if there is no impotence, since the fear of cancer, especially in the genito-urinary area, is an attack on the system.)
The usual question by a urologist or prostate specialist after treatment is, “Are you able to have sufficient erection to enable you to have orgasm?”
If you answer, “No,” the assumption is that you need some help. The help that is usually suggested is Viagra or Cialis, or one of the newer drugs. If that doesn’t “work,” then a urologist or impotence specialist is likely to suggest an implant or a pump. Penile implants are inserted surgically into the scrotum. Some use a tube and a bulb by which a man can inflate his penis from inside. Others use a rod which semi-permanently rigidifies the penis. Both enable intercourse. The external pump – often sold in “adult stores,” but also on the internet, and through your physician, allow blood to be infused into the penis sufficiently long to have intercourse.
But, as we know, intercourse is not the only form of sexual pleasure. Both men and women know this.
But did you know that an erection is not the necessary to achieve an orgasm. No physician ever told me that, or asked me how I achieved orgasm. Nor has anyone else told me their urologist was kind enough to pursue the question further. (Suffice it to say, good as they may be at surgery or radiation, physicians don’t like the role of sex counselor!)
But here’s what one college friend told me: “Hey, I never knew you could have an orgasm without an erection. It never occurred to me. It took some re-learning on my part, and on my wife’s, but my sex life is almost as good as it was before.”
In fact, what a lot of men have learned is that sex can be satisfying to both partners (and I refer to male-male unions, as well as male-female ones) without intercourse. Orgasms can occur in many ways, whether by manual or oral stimulation, and it would help if doctors were comfortable enough with their own sexuality to discuss this with prostate cancer patients.
There’s something else that happens to some men who have had partial impotence after treatment: they regain more of their ability to have an erection months and months after that treatment.
I’ve asked urologists and radiation specialists this question: has impotence ever reversed itself? I have yet to have anyone say, “yes.” Yet, interviews have told me the opposite – that whatever damage was done to the blood flow during treatment may be reversed to some degree later on. Of course, this may be the combination of physiological and psychological punch I talked about up above: the “I’m going to be impotent” fear turning into actual impotence. But it may be something that not enough men report to their oncologists; so the doctors don’t have the data to investigate or understand the spontaneous recovery of the ability to have a full or partial erection.
So, whether it’s an implant, a pump, medications, or psychological counseling, yes, there is sexual life after prostate cancer, and even after impotence.
Published On: August 29, 2006