by Jeffrey Albaugh, PhD, APRN, CUCNS, Director of Sexual Health, NorthShore University HealthSystem

It’s probably no surprise that most men highly value sex and intimacy, and that includes men with prostate cancer. The prostate is a gland that’s about the size and shape of a walnut. Located below the bladder and in front of the rectum, it produces a fluid that mixes with sperm. Prostate cancer treatment side effects can include erectile dysfunction and urinary incontinence, which can have a negative impact on sexual health, intimacy and overall quality of life.

Sex and intimacy are a vital part of the human journey. We are hardwired for an intimate connection with other human beings. If you are in a close, loving relationship, sex may be an important part of the lives of you and your partner. As men grow older, health issues can impact sexual function. Some of the more common health issues that impact sex are diabetes, high cholesterol, high blood pressure, heart disease, and/or side effects related to the treatment of prostate cancer. According to the American Cancer Society, prostate cancer is the most common non-skin cancer in men affecting about 1 out of 9 men in their lifetime. Prostate cancer has no symptoms in the initial stages but can be detected early through screening with a combination of the digital rectal exam and the prostate specific antigen (PSA) blood test. Annual screening for prostate cancer should begin by age 50 or 40 if a man has a family history of prostate cancer or if he is African American. An elevated PSA level can indicate common issues associated with aging, including benign enlargement of the prostate, prostate cancer or potentially both.

If you have been treated for prostate cancer, the most common long-term negative impact of treatment is sexual dysfunction. This can greatly impact life satisfaction for some men, specifically in regards to capability for penile erections. The penis is full of blood vessels, which fill to capacity during an erection, making the penis hard. Healthy men achieve multiple erections every day, mostly during deep sleep and sexual arousal. Erectile dysfunction is defined as the inability to get and keep an erection sufficient for penetration. The majority of men who undergo prostate cancer treatment will struggle with erectile dysfunction. Some of these men may have had erectile dysfunction prior to treatment and some may have not. The effects of prostate surgery on erectile function are immediate and can improve over time as the nerves recover. This can take an average of 2 years and up to 5 years. On the other hand, the effects from radiation are delayed and erectile dysfunction occurs 6-12 months after treatment.

The good news is that there are treatment options for erectile dysfunction and you don’t need an erection for you and your partner to climax. Contrary to popular misconceptions, women climax primarily from clitoral stimulation and therefore do not need a hard penis or intercourse to climax. In fact, men can also climax without an erection. Erectile dysfunction treatments include non-invasive vacuum devices, oral medications, a tiny suppository inserted in the urethra, penile injections and/or penile implant surgery. Since each treatment has pros and cons, it’s important to understand these factors in order to make an informed decision about treatment that is right for you.

Even after a prostatectomy, the majority of men are able to enjoy the climax feeling even though no semen is ejaculated, although the sensation of an orgasm, like erectile function, may take time to recover. The orgasm itself may feel diminished or different and could potentially impact the sexual experience and distract from pleasure. I recommend being fully present and engaged in intercourse with your partner to attain a more pleasurable experience. As many patients and partners have shared with me over the years, it is possible to still enjoy sex and intimacy after prostate cancer treatment. If you are willing to be open to exploring various ways of enjoying sex including oral stimulation, manual stimulation, and vibratory stimulation, an orgasm can occur without intercourse or a fully erect penis. According to the thousands of patients I have cared for over the years, sex can again be fulfilling and wonderful after prostate cancer treatment. It will be different, but it can bring you closer to your partner, increasing intimacy. Some couples have rediscovered and strengthened their relationships via these new and exciting expressions of sexual satisfaction and pleasure.