How can the various treatments affect my sexual function and sensation?

Martin Sweeney - Prostate Patient Advocate:
“Radical treatment for prostate cancer (usually surgery or radiotherapy) will impact on your sexual function and wellbeing, at least temporarily during and following your treatment. Most men report a lower interest level in having sex, as well as a different physical sensation during sex. For example, following a prostatectomy (surgical removal of the prostate) a man will no longer be able to ejaculate sperm, and the feeling at orgasm will change. Usually, the sensation is not as pleasurable as beforehand. It is advisable that you raise any issues or concerns regarding your sex life with your consultant/oncologist before you decide on your treatment. You should also seriously consider involving your partner in all these discussions as well.”

Paul Hegarty - Consultant Urological Surgeon:
“Orgasmic function can change in several ways. Some report less intensity, or shorter orgasm. Some men report orgasm is stronger and that a pain they had prior to removal has now disappeared. Some men leak urine at climax so I advise they put a towel down in the bed prior to intercourse. Erectile function may improve in time, especially if there was a nerve sparing prostatectomy. Nerve regrowth is slow (approximately 1mm per day) so it may take over a year for function to return. A urologist may help with rehabilitation during that period.”

Why was I not given information about how the treatment might impact my erection? I am devastated.

Martin Sweeney - Prostate Patient Advocate:
“Your consultant will usually raise the issue of erectile dysfunction at the time of diagnosis but sometimes they do not. It is vital that you let him/her know what issues are most important to you (e.g. sexual wellbeing, incontinence) at the earliest opportunity. Erectile problems are very common following radical treatment for prostate cancer, and it is highly recommended that you ask your consultant, nurse or GP for treatment options. Pills such as Viagra, as well as devices such as penile pumps and penile injections can help greatly with getting your sex life back.”

How do penile pumps work?

Martin Sweeney - Prostate Patient Advocate:
“Penile pumps work by helping blood flow into the penis, to create an erection. A few minutes prior to wanting an erection, you place a vacuum device over the penis and wait for the blood to flow into it. Then you remove the device and, all going well, your penis will be erect and you should be able to engage in penetrative sex. Penile pumps are very effective for some men. They can take a bit of practice to get used to, and can be awkward to work, but they are definitely worth trying.”

Paul Hegarty - Consultant Urological Surgeon:
 “I advise men to source the vacuum erectile device from medical suppliers, as these are robust pumps and the supplier should follow up with how to use the pump effectively. There is some trouble-shooting needed in most cases.”

How do penile injections work?

Martin Sweeney - Prostate Patient Advocate:

“Penile injections help you to have an erection and have a high success rate. You must inject a tiny needle into the shaft of the penis - it is not nearly as painful as it sounds! - and the drug then goes to work, and within a few minutes you should have an erection strong enough for penetrative sex. There are rare side effects that you need to know about and of course it is very important to apply the needle in the correct place and the correct way, so talk to your consultant, GP or nurse before trying them. For most men, they work well.

Men are taught how to make up the medication, self-inject and dispose of the needles safely. Getting the dose right is important, titrating up from lower doses. Men are also instructed on what to do if the erection does not go down post-climax. This is a priapism and needs urgent attention, there are some manoeuvres that can dissipate the erection. Otherwise medical attention is needed, typically  in the Emergency Department of the nearest hospital.”