Enhancing Sexual Health After Cancer

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Christopher Deibert, MD, urological surgeon

Receiving a cancer diagnosis can be difficult for anyone to endure. But even after treatment is over, some people may still have to deal with the lingering health effects that cancer treatments may cause.

Cancer can dramatically change a person’s life. It can affect your self-image. It can physically change your body’s appearance. It can suppress your sexual desire, and for men, it can reduce testosterone production. All of these can lead to erectile dysfunction (ED).

Cancers in the pelvic area such as the prostate, bladder, rectum or colon, typically have the greatest impact on a man’s sexual health. That’s because surgery or radiation therapy for these cancers are more likely to affect the nerves and blood vessels that are responsible for an erection. Some chemotherapies can also cause some degree of ED. These issues can be short or long term. If nerves are damaged during surgery, sometimes they may heal with time and your ED issue will be resolved.

The good news is in many cases, we can improve the situation with one of several treatments.

When I evaluate a man for ED after they’ve completed cancer treatment, I like to discuss the types of changes they are experiencing and try to quantify these. The type of cancer treatment you received, as well as any history of diabetes or high blood pressure are also discussed. This includes physical changes, sexual desire and erectile issues. I may recommend testosterone testing to determine if it’s a hormonal problem.

At the Nebraska Medicine Men’s Health Program, we can offer many options to help you. Sometimes putting men on testosterone replacement therapy is all that is needed. However, if ED is not due to decreased testosterone production, there are other possible treatments. Oral medications that fall into a class of drugs called phosphodiesterase inhibitors (Viagra and Cialis), can relax muscles and increase blood flow to the penis, making it easier to get an erection and maintain it. Another procedure involves a vacuum erectile device that slides over the penis. The device pulls air out of the cylinder, which helps pull blood into the penis. A suppository can be placed inside the penis to stimulate an erection or medication can be injected with a tiny needle into the penis. If none of these medical options are effective or they have stopped working, surgery may be an option. Surgery involves the placement of a prosthetic implant inside the penis that includes an activation pump that will produce an erection when activated.

As part of the treatment and recovery process, men need to recognize that they may experience significant sexual changes and these need to be discussed with their doctors. I also encourage men to have frank, sexual-intimacy conversations with their partners. They should discuss how their body image has changed, what their desires and expectations are and how they feel mentally and physically. Sometimes intimacy in the relationship may change but it can still be meaningful even if it doesn’t look the same. When this is discussed with their partners, and both understand these issues, many couples can continue to have a deep and rich intimate relationship.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

About the Author

Christopher Deibert, MD, urological surgeon
Urological surgeon, co-director, Men’s Health Program

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