The VA Offers Support for Sexual Dysfunction After Prostate Cancer Treatment
- VA’s Erectile Dysfunction Clinic at West LA VA offers evaluation and treatment for veterans with sexual performance issues, including ED.
- Prostate cancer treatments can lead to sexual dysfunction due to nerve damage from surgery or radiation.
- Common issues after treatment include ejaculation problems, reduced libido, discomfort during sex, and changes in penis appearance.
- Nerve-sparing surgery lowers ED risk for early-stage prostate cancer but has risks.
- Treatments include oral meds (e.g., Viagra), injectables, pumps, and implants, chosen based on ED severity and preference.
Maintaining a healthy sex life may not be the first thing you discuss with your doctor, but it is an important topic.
Read MoreThe VA’s Erectile Dysfunction Clinic
“We have an entire erectile dysfunction clinic here at West LA VA, that is focused on helping men recover their sexual function after surgery,” Garraway explains. “We have trained specialists who will show you how to use all of these different medications and really try to get your sexual function back.”
The clinic, which is part of the larger VA healthcare system, is a service that provides evaluation and treatment for veterans who have problems with sexual performance or satisfaction, including erectile dysfunction (ED). It also offers primary care, mental health, and specialty health services to veterans in the Los Angeles area.
The clinic provides various services to help veterans with ED, such as:
- Prescription medicines for ED
- Erectile aids
- Surgery
- Counseling
- Education and support for veterans and their partners
To access the erectile function clinic, you need to be enrolled in VA health care and registered as a patient at VA Greater Los Angeles health care. You’ll also need a referral from your primary care or mental health provider.
If you don’t live near the clinic, there’s a good chance your local VA has many of the same services available.
Check in with your care team to find nearby support. And keep reading to learn more about sexual dysfunction and the types of treatment that are available to help preserve and improve your sex life after prostate treatment.
Related: A Step-by-Step Guide for Veterans: Seeking Care for Prostate Cancer
Why does prostate cancer treatment affect sexual function?
“One of the greatest concerns after prostate surgery or even radiation therapy is erectile dysfunction,” says Garraway.
Sexual dysfunction is a common side effect of prostate cancer treatments because of the critical role of nerves surrounding the prostate, which are vital for erections. These nerves can be inadvertently harmed during surgical removal of the prostate or affected by radiation therapy.
Such treatments, while doing a good job of targeting cancer, may harm the nerves’ ability to function properly. This can lead to challenges in getting or keeping an erection.
Despite these potential changes, Garraway stresses that they are often temporary and treatable. You can still have satisfying sex life — though it may be different.
What sort of problems can occur?
Ejaculation Issues
A radical prostatectomy — surgery to remove the entire prostate gland and some surrounding tissue — can limit semen ejaculation. Although your testicles continue to produce sperm cells, these are reabsorbed into your body, a phenomenon your doctor will refer to as retrograde ejaculation.
When this happens you will experience a “dry orgasm”. You will still get the sensation of climax remains, but without the release of fluid.
Opinions vary on the experience of a dry orgasm, with some men finding it normal, while others describe it as less intense and pleasurable. Additionally, you may be bothered by the absence of visible ejaculation.
Related: An Overview of Prostate Cancer Surgery
Loss of Libido
Losing interest in sex, or a reduced libido, is fairly common after prostate cancer treatment. Hormone therapy, often used to treat prostate cancer, can lower testosterone levels, which can dampen sexual desire. Stress and emotional challenges following a cancer diagnosis don’t help either.
Pain or Discomfort During Sexual Activity
Pain during sex can also occur after treatment, especially if radiation irritates the area or surgery has creates scar tissue in the surrounding area. This discomfort can make sexual activity less enjoyable and more stressful.
Reduced Penis Size or Shape Change
Though this is a less common aftereffect of prostate cancer treatment, some men notice their penis looks smaller or changes shape. This can happen due to surgery or radiation, which might affect blood flow or damage tissue. While it’s not harmful, it can have an impact self-esteem and sexual satisfaction.
Can I avoid problems with sexual function?
Having a nerve-sparing surgery can lower the risk of sexual dysfunction.
Not everyone is a good candidate for this type of surgery. It’s usually considered if you have early-stage prostate cancer which has not spread to other areas in the body.
During the surgery, your doctor will remove the prostate gland while saving the critical nerves that control erectile function. Although less invasive compared to more traditional prostate removal methods, nerve-sparing surgery is still a complex procedure that carries some risks like nerve damage, bladder control issues and chances of infection.
Following a nerve-sparing surgery, 40% to 50% of men typically regain their pre-cancer sexual function within a year. Some, though not all, experience the restoration of their function within two years post-surgery.
Related: Preserving Sexual Function: Ask Your Surgeon About Nerve-Sparing
What are the therapies for sexual dysfunction?
“For you to have the best care you deserve, it’s essential that you have a multidisciplinary team along the way. This means that you’re not getting just one opinion, you benefit from the knowledge and experience of several specialists,” Garraway says.
For example, at the VA clinic in LA, Garraway says the following specialists are on hand to guide veterans to the best solutions for sexual dysfunction:
- Urologists
- Surgeons
- Psychiatrists and psychologists
Treatments they offer will likely include:
- Oral medications: Usually taken in pill form, drugs like Viagra (sildenafil) and Cialis (tadalafil), are good for mild-to-moderate ED. Most oral meds are PDE5 inhibitors that boost blood flow to the penis, making it easier to get an erection. They are easy to use and work quickly, but they may cause side effects like headaches, flushing, stomachaches, or prolonged erections.
- Injectable medications: Drugs such as alprostadil or drug combo Trimex are injected directly into the penis to expand blood vessels and facilitate erections. They are effective for men who don’t respond to oral medications. The main benefit is their high effectiveness, but a downside can be discomfort or pain at the injection site, along with the risk of prolonged erections. And some men are not thrilled about getting a shot directly into the penis, although most report it isn’t overly painful.
- Vacuum Pumps: These devices pull blood into the penis to create an erection, followed by placing a ring at the base of the male organ to maintain hardness. They offer a non-invasive, drug-free approach to achieving erections, with the benefit of being usable by almost all men. However, they can kill the mood because they can be awkward to use.
- Surgical Penile Implants: Surgical implants provide a permanent solution to erectile dysfunction, allowing controlled and reliable erections. They usually eliminate the need for taking any drugs and patients report a high satisfaction rate. However, like any surgery, implantation carries risks like infection or device malfunction. It is also irreversible.
Are there things I can do to help myself?
Certainly, says Garraway. There are lifestyle changes that may help improve ED such as the following:
- Regular exercise
- Healthy diet
- Quit smoking
- Limited alcohol use, especially because excessive and prolonged drinking can impair erectile function
- Manage stress and fatigue
- Discussing your feelings — with your partner or healthcare team
Questions to Ask Your Doctor
Although many men find the topic of sexual dysfunction embarrassing, it can be comforting to know that problems due to prostate cancer treatment are common and usually treatable. Have an open and honest discussion with your healthcare team. Make sure you ask questions, like the following, to have your concerns addressed.
- What is the underlying causes of my erectile dysfunction? Are my nerves damaged?
- Are there lifestyle changes, such as diet and exercise, that may help improve erectile function?
- What treatment options does the VA offer?
- What are the potential benefits, risks, and costs associated with each?
- What is the role of hormones in erectile function, and would hormone therapy be a potential option for me?
- How soon after starting treatment can I expect to see improvements in my erectile function?
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