Prostate Cancer Survivorship program helps men maintain sexual health
After cancer treatment ends, patients expect life to return to normal. But what they often find is that normal means something different than it did before cancer. That can be particularly true for men who undergo surgery for prostate cancer.
Erectile dysfunction is one of the long-term side effects of surgery to treat prostate cancer. But there are many ways to help men return to an active sex life. To help address concerns like this that men face during their recoveries, the University of Michigan Comprehensive Cancer Center in collaboration with the Department of Urology has established a Prostate Cancer Survivorship Clinic.
We talked with Daniela Wittmann, a social worker and certified sex therapist with the clinic, about how couples can work toward restoring their sexual health.
Q: How likely is it that men who undergo surgery for prostate cancer will experience erectile dysfunction?
A: Many factors are involved, so recovery depends very much on the individual. Broadly speaking, the degree to which erectile dysfunction will be a problem depends on whether the nerves that surround the prostate were spared. Before a man undergoes surgery, his doctor will talk to him about the stage of the cancer, what type of surgery will be performed and how many nerves may be involved. After surgery, the doctor will tell the patient how many nerves were spared. A mans age and how strong his erections were before surgery may also play a role.
Q: When can couples consider resuming sexual activity?
A: The first survivorship visit is six weeks after surgery. At that point, they are usually considered well enough to attempt penile rehabilitation and sexual activity.
Q: What is penile rehabilitation?
A: It's a method to ensure the tissue in the penis stays healthy while the spared nerves recover. Any part of the body that you don't exercise tends to atrophy. The goal of penile rehabilitation is to make sure all the blood vessels are open to the blood flow that produces erections. To encourage the blood flow, the doctor or nurse practitioner prescribes a half-dose of Viagra every other day for three months. We also recommend men use two vacuum devices -- a soft one called Prelude daily and a vacuum pump two or three times a week for six months. We suggest that men masturbate daily to promote blood flow and the capacity to climax.
Q: What if the nerves don't recover?
A: We definitely have options to help men stay sexually active, even if men aren't able to produce erections on their own. The vacuum pump is a good option as well as penile injections and suppositories. Obviously, before we prescribe any medications, we evaluate patients for other health concerns -- such as a heart condition -- that could be worsened by these therapies.
Q: How successful are these interventions in restoring patients' sexual health?
A: Many couples do well with the recovery. Often, we help by working with patients to manage frustration about the slow rate of progress. Occasionally, coping with the sexual side effects of prostate cancer surgery is an opportunity for a couple to uncover long-standing issues, either sexually or in terms of communication, that might encroach on their sex lives. Many couples have used the recovery period to address these issues. One of the things I have learned in working with men after prostate cancer surgery is that you have to include their partners.
Q: What types of issues come up?
A: Sometimes it's emotional distance within the couple that makes sexual recovery difficult, so they start working on being more involved with each other. Maybe the partner had a chronic illness that made sex difficult, so they begin trying to address it. Most often, if the partner is a postmenopausal woman, she may be having her own sexual challenges already. For female partners, we recommend water-based lubricants or vibrators to stimulate blood flow to maintain healthy vaginal tissues. If appropriate, we also refer women to their gynecologists to address localized hormone replacement or vaginal dilators.
Q: Are patients shy about raising concerns?
A: I have found that, on the whole, they are not at all uncomfortable talking about these issues and are appreciative of the opportunity. Maybe they wouldn't bring it up themselves or feel it is appropriate for a medical visit, but they feel they don't have anywhere else to discuss these issues and are very glad to talk about it.