Will prostate removal kill my libido… at 78?

I AM 78 years old – and was recently diagnosed with prostate cancer, and had surgery.

My question is, will the operation affect my sex drive?

I’m in a relationship and I’m worried now that should I be called on to take things further, I’ll not be able to.

The doctors and nurses didn’t say anything to me about it. Maybe they don’t think at my age I care?

YOU are absolutely right to ask this question. It should have been addressed before you decided to have the operation, along with all the other possible risks of surgery.

The important nerves that allow sexual function for a man run very close to the prostate gland, which sits just below the bladder and is about the size of a walnut.

Surgery to remove the prostate, known as a radical prostatectomy, often results in some damage to these nerves.

It’s very common for this procedure to cause erectile dysfunction, at least in the short to medium term. This does depend on the extent of the surgery and the size and position of the tumour in relation to these vital nerves.

It’s such a key issue in prostate surgery that I’m surprised it was not discussed.

At this stage, I would talk to your GP – they’ll be able to find out more about exactly how the operation you had was carried out, and what you can expect in terms of getting back to normal. After prostate surgery, it can take anything from a few months to two years for sexual function to return, and it may not be as strong as before.

There are many options to help. As well as a different range of tablets (there are four you can try), there are vacuum pumps, injections and creams: as someone who has had surgery, you could be seen at a specialised erectile dysfunction service.

In terms of your ‘drive’, surgery itself doesn’t dampen desire – however, other medications given to men with prostate cancer change hormone levels, and reduced libido can be a side effect.

It’s also important to be reassured that there are many ways to enjoy sexual intimacy, even if erectile dysfunction is a problem. SIX months ago I was a fit healthy 73-year-old keeping fit with Pilates, power hooping (a keep-fit class involving hoola-hoops) and walking. But then I began to experience painful cramps in my legs, neck and shoulders, and pins and needles in my arms. It’s worse at night, and they wake me up at night.

I have seen four GPs and I’m waiting for an appointment with a rheumatologist. Is there anything I could be prescribed to ease my symptoms in the meantime?

THESE are significant symptoms and certainly warrant specialist review. Such a dramatic change in your health as well as pain that wakes you at night would be considered red flags for disease.

On the other hand, cramps may result from fluctuations in levels of minerals such as sodium, calcium or magnesium in the circulation: this can easily be reviewed on a blood test.

We are seeing more and more magnesium deficiency now due to the use of anti-acid medications such as omeprazole, which can limit absorption from food during digestion.

Ask your GP to look at your regular medications as a potential cause. Other medications are known to cause cramps, including statins, asthma medications, diuretics for blood pressure and the osteoporosis medicine raloxifene.

Significant cramps may also arise from autoimmune diseases such as thyroid disease and the rarer sarcoidosis.

Anyone experiencing symptoms like this should ask their GP about motor neurone disease. Although uncommon, it does appear in people in their 60s and 70s, and cramps are a known early symptom.

While waiting for specialist assessment, pain control is key. Quinine can be taken at night to ease leg cramps.

Ask a pharmacist about building up normal analgesia with paracetamol to start with, anti-inflammatories such as ibuprofen and possibly something topical.

Do not wait for the pain, but use medications regularly to enable your mobility and help you sleep.