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Cancer Treatment

There are many cancers, such as prostate, colon and testicular cancer, associated with effective therapies such as radiation, surgery, chemotherapy and hormonal ablation therapy that result in long-term survival. As such, quality of life after cancer treatment can be an important issue for some men and their partners. Men treated for various cancers are likely to experience side-effects consistent with reduced sexual interest, reduced erection, absent or reduced ejaculation, absent or muted orgasm, penile shortening, penile curvature or occasional sexual/perineal pain. While the oncologist focuses on eliminating the cancer, there may be limited attention paid to restoring sexual function.

A thorough sexual/medical/psychosocial history, physical examination, psychologic assessment and laboratory tests are required to ascertain the basis for the sexual problem and the contribution of psychologic and biologic factors.

For example, bladder and colon cancers may involve wearing a collection bag, such that the patient and his partner must adapt both physically and psychologically to these changes. In prostate cancer, excision or radiation (external beam or seeds) of the prostate gland eliminates or decreases ejaculation respectively. In both cases, however, orgasm is possible, even with a poor quality erection, however the intensity of the orgasm is often reduced. In men whose nerves surrounding the prostate are injured during surgical excision, there is a loss of morning erections and the ability for erection based on sexual arousal. After prostate cancer surgery there is often shortening of penile length. Strategies such as stretching with a prescribed vacuum erection device can help preserve penile length.

In an ideal situation discussion of the sexual consequences of cancer treatment occurs before the treatment. If the patient has choices of treatment, the knowledge may either influence his choice or help prepare him for the consequences of the treatment. Furthermore, there is growing interest in the process of penile rehabilitation, or erectile function preservation. In such situations the patient is provided with strategies to help maintain and restore erectile function immediately after cancer treatment. Penile rehabilitation has been shown to successfully increase the chances of preserving erectile function after cancer treatment. Some cancers, such as prostate cancer, have hormonal dependency therefore hormone therapy, often indicated for hypogonadism may be contraindicated. Management of sexual dysfunction after cancer treatment is best performed with the patient working with both his sexual medicine physician and oncologist.

Sexual Medicine Treatments