What do these terms have in common?

✓ Sexual adjustment
✓ Masculine self-esteem
✓ Unmet sexual supportive care needs

Chances are, prostate cancer (PCa) patients treated with radical prostatectomy (RP) will discover that those terms, and others, commonly apply after their surgery. For some, such challenges are resolved within 6-12 months after treatment. For others, they linger two or more years.

Understandably, invasive abdominal surgery takes the glow out of sex for a while. The recovery period may be uncomfortable. Mental and emotional symptoms often occur in the aftermath, especially procedures connected with sexual well-being and self-esteem; for instance, women who have surgery for cervical cancer often experience lingering depression and anxiety.^[i],[ii] Let’s face it, feeling sore, sad and tense are hardly ideal conditions for arousal, let alone a passionate interlude in the bedroom.

Today’s robot-assisted RP has a shorter, easier recovery than traditional open surgery. The picture much the same, however, when you consider internal healing. For starters, since the humble prostate makes the fluid that carries sperm out of the body, removing the whole gland leads to dry orgasms, something a man may need to adjust to. More importantly, the nerves that control erections are always impacted by gland removal, in one of two ways:

1. Depending on the grade and extent of a man’s PCa, the surgeon may need to remove one or both nerve bundles that make erection possible. No nerves = no erections (but orgasm is still possible, even with a soft penis–something that doctors sometimes forget to tell patients).
2. If a patient is a candidate for nerve-sparing surgery, the surgeon is tasked with gently teasing the nerve bundles away from the prostate capsule on one or both sides where they hug its outer surface. Nerves are delicate and somewhat fussy. They don’t take kindly to being tugged, stretched or otherwise disrupted. Even though the transmission line is not severed, nerves can go into a sort of state of shock. In many cases, they gradually recover but this can take months, even years.

RP’s impact on a couple’s sex life

Robotic-assisted RP has somewhat eased the burden of post-RP impotence, but many potent patients who expect quick sexual recovery after nerve-sparing RP are crushed as months with no penile response drag on. As Mt. Sinai Hospital cautions, “Most men who have normal sexual function and receive treatment for early prostate cancer regain erectile function and can have satisfying sex lives after robotic prostatectomy. However, it is a gradual process and may take up to a year.” Of course, this affects partners. The use of pills, injections, devices, etc. can diminish a couple’s previous spontaneity and expressions of pleasure. A 2015 study captured couples’ remarks about recovering sexual intimacy after RP. Here are quotes from the paper published by Wittman, et al.^[iii] :

• I also feel like reaching an orgasm is just like, oh really hard for me. And it was hard for me before… all this paraphernalia, it just doesn’t seem worth it to me.
• Well, that seems like another apparatus that it’s like so much work, you know…
• I know, I like threw the vibrator across the bed. I am sick of this. Sick of it. Sick of it.
• I mean it’s now there’s stages you can’t achieve, but it’s not diminished our being intimate or being physical.
• …I am feeling more guilt because I feel that I should be initiating and … the motivation isn’t there yeah and it should be ‘cause he needs it.

The study authors point out that most of the couples (95%) were sexually active and viewed their sexual relationship as important. Prior to surgery, most were confident that they either would recover their sex life quickly, or would cope well if need be. Yet, the authors report that “…they did not plan: 80% postponed thinking about the recovery.” They were unprepared for the sexual impact.

Positive readjustment outcomes

Fortunately, couples don’t have to have their sex lives ruined. Doctors who treat PCa now recognize that they need to not only offer penile rehabilitation to their RP patients, they need to provide empathic and positive programs to support the needs of couples. Couples interventions (e.g., nurse-led education, peer support groups) promote sensitive communication, encouragement for patients and partners, and more consistent utilization of aids like medications, devices, sex toys, etc.^[iv]

And, there’s even better news across the evolving landscape of PCa treatment options. Today’s focal therapies, such as our Center’s MRI-guided Focal Laser Ablation (FLA), TULSA-PRO, and Exablate MRI guided Focused Ultrasound. All three procedures not only offer rapid, comfortable recovery, but have minimal-to-no risk of sexual function for patients who are potent at baseline. Contact us to learn how we evaluate candidates for FLA.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Lu D, Andrae B, Valdimarsdóttir U, et al. Psychological distress is associated with cancer-specific mortality among patients with cervical cancer. Cancer Res 2019;79:3965–72.
[ii] Printz C. Psychological stress is associated with a higher risk of cervical cancer mortality. Cancer 2020;126:240–1.
[iii] Wittmann D, Carolan M, Given B, et al. What couples say about their recovery of sexual intimacy after prostatectomy: toward the development of a conceptual model of couples’ sexual recovery after surgery for prostate cancer. J Sex Med. 2015;12(2):494-504.
[iv] Chambers SK, Occhipinti S, Stiller A, Zajdlewicz L et al. Five-year outcomes from a randomised controlled trial of a couples-based intervention for men with localised prostate cancer. Psychooncology. 2019 Apr;28(4):775-783.