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Sex After Prostate Cancer

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User
Posted 24 Jan 2024 at 15:52

I just came across this research paper and thought some members may be interested to read it. I have been doing a literature survey on this and similar topics for some time. In my opinion this is the definitive piece of work on the effects of various treatments for prostate cancer on men’s/couple’s sex lives. Men in the process of deciding on their treatments may find it a useful source of information to supplement any advice they obtain from urologists, oncologists and members here.

 

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

Richard J. Wassersug, Andrew Westle & Gary W. Dowsett

https://www.tandfonline.com/doi/full/10.1080/19317611.2016.1204403

 

Edited by member 24 Jan 2024 at 17:10  | Reason: More comments and generally tidying up the format

 

‘Physics is like sex: sure, it may give some practical results. But this’s not why do it’

Richard Feynman (1918-1988) Nobel Prize laureate

 

Edited by member 24 Jan 2024 at 18:17  | Reason: Not specified

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 25 Jan 2024 at 08:02

Hi Steve

I have been a member of this and other similar forums since 2013 and in my experience and also when I read about other men's experiences I had suspicion that those undergoing prostatectomies  - may be other treatments as well - the vast majority of men's erectile functions don't return to  their pre-surgery level. This research seem to back that up. However the vast majority of men still continue to enjoy their sex lives and also find that they enjoy couple-relationships in different ways; often better than before because they experience a different sort of closeness with their wives/partners. If the research is to be believed the following quote from the paper is quite significant. 

' Even with a nerve-sparing procedure, erectile dysfunction (ED) is common after a radical prostatectomy (Tal et al., Citation2009). More recent reports suggest that only 16% of PCa patients recover the erectile function they had before their prostatectomy (Nelson et al., Citation2015), although age and the degree of nerve-sparing during surgery are key factors affecting recovery (Krishnan et al., Citation2014). ED develops more slowly after radiation treatments, but still occurs in the majority of men within a few years of treatment (White et al., Citation2015). ADT, used either to enhance the efficiency of radiotherapy or as a systemic therapy in the case of advanced disease, produces not only ED but also reduces sexual desire (Walker et al., Citation2013), leading to delayed orgasm or anorgasmia (Fode & Sønksen, Citation2013; Schover, Citation2015).'

I hope those who read this thread do not make their decisions on the basis of this paper entirely, neither should they feel discouraged. If you have prostate cancer you have to treat it, of course, so it is a question of what treatment? There are so many variables that men need a lot of advice and discussions with their urologists and oncologists and read about other men's experiences and then decide on their treatments; this is what all the members of this forum advise new members who have been diagnosed with PCa to do before deciding on their treatments

 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 24 Jan 2024 at 17:28
Arf arf
User
Posted 24 Jan 2024 at 21:59
That's an interesting article that is worth taking the time to read - it's a bit scientific :)

The one take away I have from it is just how important a willing and positive attitude partner is and how you have to readjust your expectations to your 'new reality'. Dwelling on what you have lost isn't the way to deal with it but focus on new ways to enjoy your sex lives.

User
Posted 25 Jan 2024 at 07:40

I agree adrianus it's never the same as before we tried but decided to give it up all the fun is gone now but at least I am still here and we have become much closer nowadays they didn't explain the sexual side effects I can easily get and maintain a erection but with no ejaculation it seems pointless 

User
Posted 26 Jan 2024 at 07:28

Adrainus

"Does 'the vast majority of men who still enjoy it' include blokes like me who still enjoy it, but much, much, less than I used to?"

I think that hits the nail on the head for me. It's not enjoyable as it used to be and it is  frustrating at times

 

User
Posted 26 Jan 2024 at 11:36

Hi Adrian

Statistics are what it says on the tin. It provides a sort of 'average' but an individual is on a spectrum from the 'worst' case to the 'best' case, as it were. A proper study, as this one appears to be, is anonymous, asks relevant questions and uses a large sample of men questioned. I think this study, as well as the one you have just posted, has investigated large samples.

The trouble, of course, is whether the outcome of these studies helps a particular person who is trying to pick the right treatment is another question. When I was diagnosed our first question was whether I can be cured and sex did not come into it. 

Edited by member 26 Jan 2024 at 11:37  | Reason: spelling

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

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User
Posted 24 Jan 2024 at 16:50

Originally Posted by: Online Community Member
I just came across this research paper

Bloomin 'eck! If it's that good. I'll have a shufti.

Edited by member 24 Jan 2024 at 18:17  | Reason: Typo

User
Posted 24 Jan 2024 at 17:28
Arf arf
User
Posted 24 Jan 2024 at 21:59
That's an interesting article that is worth taking the time to read - it's a bit scientific :)

The one take away I have from it is just how important a willing and positive attitude partner is and how you have to readjust your expectations to your 'new reality'. Dwelling on what you have lost isn't the way to deal with it but focus on new ways to enjoy your sex lives.

User
Posted 24 Jan 2024 at 22:47

Originally Posted by: Online Community Member
 Dwelling on what you have lost isn't the way to deal with it but focus on new ways to enjoy your sex lives.

Evening Steve.

 I read the report, and to me a lot of it  seemed more like an x rated agony aunt's problem page. I compare being unable to get an erection to losing a limb. You can get round the problem but it'll never be like it was before. 

It's clear on here, that some will do anything to try and recapture what they had before, while others think it's just not worth the hassle. 

I'm one of the lucky ones who can, with injections, still get an erection, but it's still nothing like lovemaking once was. That's why I've now got a big enough stockpile of Invicorp to straighten the Leaning Tower of Pisa.

There's a huge difference between faffing about with pumps, injections or other aids to do something that was once so natural and spontaneous. Something that was so easy you could do it in the dark with your eyes closed and your hands tied behind your back; and many of us did. 😉

Of course, it'll be up to individual couples to decide how important sex is to them and how far they're prepared to go to maintain an active sex life.

Edited by member 25 Jan 2024 at 00:26  | Reason: Typos

User
Posted 25 Jan 2024 at 07:40

I agree adrianus it's never the same as before we tried but decided to give it up all the fun is gone now but at least I am still here and we have become much closer nowadays they didn't explain the sexual side effects I can easily get and maintain a erection but with no ejaculation it seems pointless 

User
Posted 25 Jan 2024 at 08:02

Hi Steve

I have been a member of this and other similar forums since 2013 and in my experience and also when I read about other men's experiences I had suspicion that those undergoing prostatectomies  - may be other treatments as well - the vast majority of men's erectile functions don't return to  their pre-surgery level. This research seem to back that up. However the vast majority of men still continue to enjoy their sex lives and also find that they enjoy couple-relationships in different ways; often better than before because they experience a different sort of closeness with their wives/partners. If the research is to be believed the following quote from the paper is quite significant. 

' Even with a nerve-sparing procedure, erectile dysfunction (ED) is common after a radical prostatectomy (Tal et al., Citation2009). More recent reports suggest that only 16% of PCa patients recover the erectile function they had before their prostatectomy (Nelson et al., Citation2015), although age and the degree of nerve-sparing during surgery are key factors affecting recovery (Krishnan et al., Citation2014). ED develops more slowly after radiation treatments, but still occurs in the majority of men within a few years of treatment (White et al., Citation2015). ADT, used either to enhance the efficiency of radiotherapy or as a systemic therapy in the case of advanced disease, produces not only ED but also reduces sexual desire (Walker et al., Citation2013), leading to delayed orgasm or anorgasmia (Fode & Sønksen, Citation2013; Schover, Citation2015).'

I hope those who read this thread do not make their decisions on the basis of this paper entirely, neither should they feel discouraged. If you have prostate cancer you have to treat it, of course, so it is a question of what treatment? There are so many variables that men need a lot of advice and discussions with their urologists and oncologists and read about other men's experiences and then decide on their treatments; this is what all the members of this forum advise new members who have been diagnosed with PCa to do before deciding on their treatments

 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 25 Jan 2024 at 08:57

If you've got time, this is an interesting read.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159135/

A recent survey of men aged over 18 years in UK revealed 41.5% had ED, 7.5% had severe ED. 

As most of us are over 60, I reckon many of us, even if we didn't have prostate cancer, would have had ED issues.

Its over 44% in Wales (must be the cold and all that rain)

I was surprised that the Italians did worse than us at over 50%.

 

User
Posted 25 Jan 2024 at 09:10

Originally Posted by: Online Community Member

I agree adrianus it's never the same as before we tried but decided to give it up all the fun is gone now but at least I am still here and we have become much closer nowadays they didn't explain the sexual side effects I can easily get and maintain a erection but with no ejaculation it seems pointless 

Are you saying that you don't get an orgasm either? After RT and HT I too can easily get a full erection but I no longer ejaculate. However, I can still climax and it's just as pleasurable as it always has been with the same pumping contractions at the point where semen would have normally appeared. Agreed, it used to be satisfying to see an ejaculation at times (partner used to like it) but as you say at least we're still here. 

 

User
Posted 25 Jan 2024 at 11:43

Hi Adrian and gaz 61

I agree with you guys that sex after PCa is not the same as before, when one’s penis had a life of its own - my wife calls it my second brain! Following my RARP we were determined to re-establish our sex life. For many reasons we did not wish any invasive options for creating an erection and so I decided to try a VED. Needless to say that this approach is most unnatural and takes a lot of practice, can be uncomfortable, the hinge effect limits how you use your penis and it requires determination, a sense of humour, imagination and uninhibited communication to be practical and enjoyable - a desperate problem needed a desperate solution! Relational adaption is the key; a mutual desire to comfort and please each other.

We all know that after PCa couples need to adapt their sex life to suit whatever method used to solve an  ED problem; the VED approach is undoubtedly the most demanding and a difficult option. At our age, our sex life was no longer a matter of a few minutes of kissing - groping - penetration – orgasm and a well-deserved peaceful sleep! But our intimate relationship now is what we think of as ‘slow-burn-sex’:  tantric-sex with amazing slow-long-delayed-orgasms. You may have read my post ‘Re-establishing Sex Life’ in this forum. The VEDs have become a part of our erotic foreplay; I certainly enjoy pumping myself up in our en-suite bathroom and come into the bedroom with a ‘designer erection’ depending on whether we are going to have penetrative or oral sex which is going to last the best part of 30 minutes. I sound like a VED sales rep!

 

 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 25 Jan 2024 at 12:25

Originally Posted by: Online Community Member

..... but with no ejaculation it seems pointless 

It just goes to show just how different we all are. I have never enjoyed the actual ejaculation and I suppose never been in one of those 'porn style' relationships where my partner has enjoyed it being sprayed everywhere. For me it was just a mess to clean up and it used to dribble out afterwards for several minutes.

Since the RARP, I have been enjoying floppy willy orgasms that last much longer through masturbation (self and mutual), as well as oral. No longer needing to tap someone on the shoulder to warn of the impending explosion lol

We have tried the VED but found the constriction rings too painful and the hinge effect making it tricky - the fear of getting it twisted at the wrong moment is a bit offputting!!

Tomorrow I am going for my visit Carverject injection to see how I react - this might (or might not) be a bit of a game changer for us :) 

User
Posted 25 Jan 2024 at 19:06

Ditto I can still orgasm but no end product is not the same I agree we should be thankful we are here sex is probably a small price to pay 👍

User
Posted 25 Jan 2024 at 19:11

Hi Pratap I love your articles they are truly inspirational and make me smile as well keep up the good work gaz 👍

User
Posted 25 Jan 2024 at 23:17

Hi Pratap. This is an interesting read. If nothing else it shows there are thousands of us out there going through the same problems and finding solutions. However one thing it doesn't touch on is the impact of urinary incontinence during sex. I know you have mentioned it previously and I wonder if we are in a minority. Incontinence has only a small impact on my life except for when it comes to sex. I just need to think about it and I dribble. ED we can live with. Sometimes we have successful penetrative sex and sometimes not but we still have some fun. But when you start dribbling over the bedsheets and/or over your wife then that really spoils the moment. We are both starting to have difficulty coping with it. Are we in a minority or are there people out there who are able to deal with it?

User
Posted 26 Jan 2024 at 00:01

Originally Posted by: Online Community Member
However the vast majority of men still continue to enjoy their sex lives and also find that they enjoy couple-relationships in different ways; often better than before because they experience a different sort of closeness with their wives/partners.

Hi Pratap

Is the bit I've quoted  your opinion or text from the report?

Either way, I'd dispute that the vast majority of men with ED following radical treatment, still continue to enjoy sex. I know many blokes, in that position, who simply don't bother with sex anymore. 

On this forum it may appear that most still enjoy sex, because they're the ones who post their 'successes' It's a manly thing to do. It shows resilience, ability to adapt and gives hope to others.

However, very few will have the courage to post their sex life's is cr*p, because it could be seen as a weakness, an embarrassment and an admission of failure.  Men aren't good at disclosing their vulnerabilities. 

To a degree, I've been guilty of this. I've often praised the efficacy of Invicorp. It gives me an erection and I can have sex, but do I now enjoy it?

How do you define enjoy?

Does 'the vast majority of men who still enjoy it' include blokes like me who still enjoy it, but much, much, less than I used to?

 

Edited by member 26 Jan 2024 at 07:52  | Reason: Typo

User
Posted 26 Jan 2024 at 07:28

Adrainus

"Does 'the vast majority of men who still enjoy it' include blokes like me who still enjoy it, but much, much, less than I used to?"

I think that hits the nail on the head for me. It's not enjoyable as it used to be and it is  frustrating at times

 

User
Posted 26 Jan 2024 at 08:40

I've found a link to a survey of how men rate their sexual satisfaction following radical surgery.

https://www.sciencedirect.com/science/article/pii/S1743609520310572

 

User
Posted 26 Jan 2024 at 11:36

Hi Adrian

Statistics are what it says on the tin. It provides a sort of 'average' but an individual is on a spectrum from the 'worst' case to the 'best' case, as it were. A proper study, as this one appears to be, is anonymous, asks relevant questions and uses a large sample of men questioned. I think this study, as well as the one you have just posted, has investigated large samples.

The trouble, of course, is whether the outcome of these studies helps a particular person who is trying to pick the right treatment is another question. When I was diagnosed our first question was whether I can be cured and sex did not come into it. 

Edited by member 26 Jan 2024 at 11:37  | Reason: spelling

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 26 Jan 2024 at 17:36

Has anyone tried Viridal Duo injection, is it the same as Invicorp and Caverject? I have an appointment with the urologist next week to try it.

 
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