Prostate troubles don’t mean the end of sex
Reflecting on sex
The prostate gland is one part of the male anatomy that is completely invisible, tucked away inside the pelvis, along with the seminal vesicles.
These two sex organs are responsible for most of the fluid which makes up the ejaculate, without which an orgasm would be a non-event. Contrary to popular belief, the testicles contribute no more than 2-4 per cent of this ejaculation fluid.
Some prostate problems are caused by the fluid being inadequately expressed, or when infection occurs. Cancer or enlargement of the gland from whatever cause will eventually block the passage of urine.
There are questions about whether routine tests for prostate cancer do more harm than good, but medical opinion supports the use of a PSA test, plus rectal exam, from the age of 40. In this way, a man’s future risk of prostate cancer can be predicted, and symptoms can be monitored early.
What is necessary for prostate health? Suggestions include releasing the buildup of fluid with routine ejaculation. Gentle prostate massage can also help, but more important is maintaining an appropriate body weight and ensuring your diet includes blue and red berryfruits.
Advice includes exercising your PC (pelvic floor) muscles regularly, and walking for 30 minutes each day.
Will prostate cancer mean the end of your sex life? Not necessarily. But you may need to make some changes in the way you express your sexuality.
We know now that half of all grown men have an early form of prostate cancer called microcarcinoma, which usually stays where it is and you are unaware it is there. When it does grow, it usually remains inside the prostate and is not aggressive. However some forms of prostate cancer can be very aggressive, so the challenge is often around whether to ‘‘watch and wait’’ or treat it.
Choices about treatment include surgery to remove the prostate; radiotherapy to eradicate the cancer; brachytherapy (implanting radioactive beads into the prostate); or hormone therapy. At some stage, all these treatments are likely to affect a man’s erection and therefore intercourse. Some treatments also affect sex drive and orgasm.
Consequences vary with the treatment chosen. Radiotherapy affects erections over time, as scarred tissue become less flexible and blood flow to the penis is lessened. Brachytherapy lessens this side effect considerably.
Hormone treatment reduces the levels of male hormones in the body, limiting the growth of prostate cancer cells, but it affects erections and sexual desire.
Surgical removal of the prostate can damage the nerves necessary for the function of erections. New surgical techniques minimise this damage. It also helps to remember that although you will be impatient to regain your erections, nerves heal slowly and can take up to three years to recover.
It is important to limit the deterioration of penile tissues after prostate surgery, in order to optimise the return of erections. If nerves have been spared during surgery, ‘‘exercising’’ the penis is very important. You can use a vacuum pump for this, and ensure the circulation of blood through the tissues. As well, you or your partner can try manual stimulation, along with low but regular medication such as Cialis and Viagra.
This may also assist the erections you are capable of, although there may be little evidence of these in the beginning. Men with cardiac medication (nitrates) must not take this medication – so seek advice from your specialist, a sex therapist or your local prostate support group.
Prostate cancer treatment may be experienced as a loss within the relationship to both partners. The absence of erections may also have a negative impact on masculine identity, but the cultural myth of an erect, reliable penis as the essence of manliness is just that – and possibly not a partner’s priority for good sex.
The treatments outlined above do not eliminate a man’s ability to feel sexually aroused. Just as men can have an erection without experiencing arousal, so, too, they can experience arousal without an erection. If erections are not reliable enough for intercourse, changes will be necessary to the way both partners express their desire for intimacy, masturbation and orgasm. While help may be needed to work out some new strategies, the changed relationship is likely to flourish with patience and understanding.