Prostate cancer treatments, while life-saving, often bring significant sexual side effects that can impact intimacy and quality of life. Erectile dysfunction (ED) is the most prevalent side effect, followed by the loss of libido. Other effects include dry orgasms, altered sensations, penile shortening, and infertility. The options for managing these challenges include medications, penile rehabilitation, and counseling to address physical and emotional difficulties. However, not all treatments carry the same risks. For example, brachytherapy which has been associated with fewer side effects in many patients.

Here’s a closer look at these effects and how they can be managed. 

Erectile Dysfunction (ED) 

Erectile dysfunction affects 50% to 80% of men after prostate cancer treatment ⁽¹⁾. This occurs due to damage to the nerves and blood vessels responsible for erections, often during surgery or radiation therapy. ED can range from mild to severe, depending on the extent of nerve preservation during treatment. 

Medications like PDE5 inhibitors (e.g., Viagra, Cialis) are often the first line of treatment. They have shown efficacy in improving erectile function, especially when nerves are intact. For those who do not respond to these drugs, vacuum erection devices (VEDs), penile injections, or surgical implants can provide effective solutions. The research also indicates that strengthening pelvic floor muscles through exercises like Kegels can improve erectile function and urinary control. 

Loss of Libido 

Hormone therapy, which reduces testosterone levels to slow cancer growth, frequently leads to a diminished sex drive. This can be emotionally challenging for the patient and their partner since it affects the desire for intimacy. 

Adjusting hormone therapy under medical supervision may help mitigate this side effect. Additionally, lifestyle changes like regular exercise and a healthy diet can improve overall energy and well-being, potentially boosting libido. Counseling or sex therapy can also help couples navigate these changes. 

Dry Orgasms and Altered Sensations 

After prostate cancer treatment, many men experience dry orgasms—orgasms without ejaculation—due to the removal or damage of the prostate and seminal vesicles. Some also report changes in the intensity or sensation of orgasms. 

Exploring new techniques and forms of stimulation can help adapt to these changes. Open communication with a partner and guidance from a sexual health specialist can also make a significant difference. 

Penile Shortening 

Penile shortening, though less common, is reported in about 3% of cases. This can occur due to scarring or reduced blood flow following surgery or radiation. 

Regular use of vacuum devices may help maintain penile length and prevent tissue shrinkage. Discussing concerns with a healthcare provider can also lead to tailored solutions. 

Fertility Challenges 

Prostate cancer treatments can result in infertility, as the prostate and seminal vesicles play a critical role in semen production. This can be a concern for men who wish to have children. 

Sperm banking before treatment is a viable option for preserving fertility. For those who have already undergone treatment, assisted reproductive technologies like in vitro fertilization (IVF) may be explored with the help of a fertility specialist. 

Additional Considerations for Rebuilding Intimacy 

Rebuilding intimacy after prostate cancer treatment involves a holistic approach that addresses emotional, physical, and relational aspects. These considerations can make a significant difference in fostering connection and sexual satisfaction: 

Psychological Support 

Counseling and sex therapy offer safe spaces for men and their partners to explore challenges, develop coping mechanisms, and enhance communication. The research underscores the role of psychosexual factors in achieving sexual satisfaction, making therapy an essential part of recovery. 

Lifestyle Changes 

Adopting healthier habits can positively impact sexual health. A balanced diet rich in fruits, vegetables, and omega-3 fatty acids supports overall well-being and boosts sexual function. Physical activity improves circulation, enhances mood, and may alleviate some side effects of treatment ⁽²⁾. 

Stress Management 

Techniques such as mindfulness, meditation, and yoga reduce anxiety and create a sense of calm, which can help foster intimacy. 

Partner Involvement 

Open communication strengthens relationships. Couples therapy enhances emotional closeness and satisfaction. 

Prostate cancer treatment can significantly impact sexual health and relationships, presenting unique challenges for men and their partners. Addressing these impacts demands a comprehensive approach, combining personalized medical solutions, compassionate support systems, and honest communication with healthcare professionals. Treatments like brachytherapy which precisely target the cancer while minimizing damage to surrounding tissues, have been associated with fewer side effects, making it worth discussing as part of the care plan. This journey requires resilience, but with the right resources and strategies, it is possible to rebuild intimacy and find fulfillment.  

References 

1. Erectile Dysfunction After Prostate Cancer | Johns Hopkins Medicine 

2. Exercise and Psychosexual Education to Improve Sexual Function in Men With Prostate Cancer