This blog is dedicated to helping prostate cancer patients and their partners understand prostate cancer treatments and how to address issues related to treatment such as sexual dysfunction and incontinence. This blog is not meant to in anyway to replace medical care or advice with a healthcare provider. You should not use this blog or the information in books or handouts as the guide for medical treatment. Each person needs to meet with his own provider one-on-one to discuss their condition and treatments. Due to constant changes and developments in information resulting from research and clinical experience, reasonable differences in opinions among authorities, unique aspects of individual clinical situations and the possibility of human error, each reader must exercise individual judgment when making clinical decsions under the care of a qualified healthcare professional.
Erectile function is not always understood by many men. You may not realize it, but men get erections every day. The penis is erect, typically, for about 2 hours out of every 24 hour period. This mostly occurs during deep sleep. That is why sleep is essential for proper erectile function. While a man is sleeping his penis is literally working out because the penis is primarily made up of blood vessels surrounding by smooth muscles. The smooth muscle relaxes and the blood vessels engorge (fill) and then the smooth constricts and the increased blood flow returns to the body.Tthis happens about 4-6 times per night in perfectly healthy men. This penis muscle “work out” keeps the structure of the penis functioning properly for erectile function. When the night-time and morning erections stop, the muscles can atrophy (shrink) leading to worse erectile dysfunction.
Erections require blood flow and nervous conduction (communication between the brain and penis). Once a man is excited the brain sends a message down to the penis causing certain chemicals to be activated and leading to smooth muscle relaxation and vasodilatation in the penis. The penis begins engorged with blood and that swelling within the corpora cavernosa pushes against superficial veins locking the blood in the penis. Any disease that impacts blood (high blood pressure, high cholesterol, being overweight, cardiovascular disease, diabetes, etc…) flow or nervous conduction (diabetes, chronic spinal disc issues, stroke, etc…), could potentially affect the ability to get a full erection. The most common medical conditions can lead to erectile dysfunction (if not well controlled) and that is why about 1 out of every 5 men will have erectile dysfunction in their life time.
To learn more go to videos I made for men & women with sexual dysfunction at:
Everyday I see patients who are struggling with the issues of sexual dysfunction and/or incontinence after prostate cancer. Every time I speak to a group of men, many of them come up afterwards to tell me how important this information is to them and their partners.
In terms of sexual dysfunction, several issues occur after prostate cancer treatment. First, men typically do not ejaculate fluid after prostate removal (surgery) and/or radiation. The prostate plays a vital role in contributing some of the volume to ejaculate as well as mixing everything together before it is expelled and that is why a man will typically not ejaculate after prostate removal or radiation.
Second, the penis may atrophy (shrink) up into the body after prostate removal or radiation. This is related to unchallenged sympathetic tone (nerve influence which becomes out of balance after surgery or radiation). This may resolve within a few months, but the lack of regular night time and morning erections can lead to further atrophic (muscle shrinkage) changes causing a more lasting effect.
Third, the nerves for erections lay on the back of prostate and so they are traumatized by either surgery or radiation leaving many men with an inability to get and keep an erection sufficient for penetrative sex. Sometimes this situation resolves as nerves may recover from the trauma and sometimes it does not. If the surgeon is concerned about getting all the cancer during surgery, he may need to remove the nerves leading to permanent erectile dysfunction. Even when nerves are sparred, they often take an average of 1-2 years to recover from the trauma.
The good news is that there are several different treatments for erectile dysfunction. Each treatment has pros and cons and what is right for one man, may not be right for another.
If you are interested in learning more about the topic, you may want to go to the website for my book “Reclaiming Sex & Intimacy after Prostate Cancer Treatment”. The book was written out of a request from so many men for the information. It is available at www.drjeffalbaugh.com
The concern for many men is that prostate cancer treatment is not without side effects, the most common being sexual dysfunction and urinary problems. All medical treatments have positive and negative effects, and prostate cancer treatments are no different. For many men, quality-of-life after prostate cancer treatment is their greatest concern.