Having your prostate removed is a highly effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location - in the midst of the busy urinary and genital tracts, connected to the bladder on one end, the urethra on the other end, touching on the rectum, and nestled behind the pubic bone in a well-protected nook of the body - prostate removal can cause some unwanted sexual side effects.
Disruption of nerves, blood vessels, and muscular tissue during surgery can compromise erectile function and urinary continence. Generally patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer, and the risk of rectal injury. However, there are other complications that can dramatically affect your quality of life that are often glossed over or not mentioned at all, perhaps because they are not considered that important in the grand scheme of cancer care, with quantity of life being the primary concern.
For many prostate cancer patients, radical prostatectomy, the surgery to remove the prostate, is a scary, but necessary, life-saving procedure. The fear of post-surgery sexual side effects can be lessened by learning what to expect and how to alleviate the symptoms.
Here are some common side effects of radical prostatectomy:
1. Ejaculation of Urine During Sexual Climax
After radical prostatectomy, ejaculations are typically “dry” because of the removal of the prostate gland and the seminal vesicles, as well as the clipping of the sperm ducts, the structures that supply the contents of the ejaculate. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to decrease with time.
2. Urinary Incontinence at the Time of Sexual Stimulation
Urinary leakage is not always restricted to the moment of ejaculation, as some patients can experience it during foreplay. Once again, this is a potential great bother and embarrassment to both the patient and his partner. Like ejaculation of urine, this issue is most commonly experienced the first year after radical surgery and thereafter tends to improve.
3. Altered Sensation During Sexual Climax
The majority of men after radical prostatectomy experience an altered perception of orgasm. Some men experience decreased pleasure with orgasm, often with a feeling of diminished orgasm intensity. Some men are bothered by the dry orgasms. On occasion a man may be unable to experience an orgasm at all. In rare instances, a radical prostatectomy patient notices an increase in orgasm intensity.
4. Pain With Climax
Up to 20% of men after radical prostatectomy experience pain with climax, which is perceived in the penis, testes or the rectum. Although with time both the intensity and frequency of pain typically decrease, a small percentage of men have persistent pain with climax that persists beyond several years following the surgery.
5. Penile Shortening and Deformity
After radical prostatectomy, it is common to experience an alteration in penile size with a decrease in flaccid length, erectile length and erectile girth. The loss in penile length occurs during the first several months after radical prostatectomy and because of scarring in the erectile cylinders of the penis, the situation is likely irreversible. Up to 15% of men after radical prostatectomy experience a penile deformity resulting in what appears to be a “waistband” or alternatively a penile curvature with erections and sometimes scar tissue that can be felt, consistent with Peyronie's disease.
Once the cancerous prostate is removed, the patient faces his next challenge - the physical and emotional sexual side effects. Here are some tips for before and after surgery to improve your sexual quality of life after a radical prostatectomy.
1. Educate Yourself
It is very helpful to speak with other patients who have gone through radical prostatectomy and can offer first-hand advice. Your urologist may be able to give you names of patients willing to speak to you. The UsTOO Prostate Cancer Education and Support Group (www.UsToo.org) has over 300 support groups worldwide and is a wonderful forum for gaining knowledge from those who have already been treated.
2. Speak With Your Doctor
Ask your doctor specifically about sexual side effects that may occur after prostate surgery, including the effects on erection quality, ejaculation, orgasm, as well as penile size.
3. Do Pelvic Floor Exercises Before And After Surgery
Pelvic floor muscle training strengthens the superficial and deep pelvic floor muscles. More robust superficial muscles helps drain the residual urine in the urethra that may contribute to urinary leakage during foreplay or climax. Since these muscles contract rhythmically during climax and are the power behind ejaculation, keeping them fit may improve the sensation with orgasm. Hardier, deep pelvic floor muscles contributes to the strength of the voluntary sphincter muscles that help provide urinary control after radical prostatectomy and may improve leakage during climax. The Private Gym Program offers guided pelvic muscle building through an interactive DVD and patented resistance weight equipment for your penis.
4. Other Strategies
Always urinate immediately before sex and then contract the pelvic floor muscles several times to clear the urethra of residual urine. If this fails to remedy the ejaculation of urine, you can use a condom during sexual activity or a constrictive penile loop that pinches the urethra closed.
Andrew Siegel, M.D., Urologist, Cofounder of The Private Gym, and author of the highly acclaimed book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.
Reference: Frey AU, Sonksen J, Eode M: Neglected Side Effects After Radical Prostatectomy: A Systematic Review. J Sex Med 2014; 11:374-385
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