Sexuality is important to many patients deciding on the best prostate cancer treatment that can keep them alive. For many, choosing a treatment for their prostate malignancy is dependent on whether or not they will retain sexual function after the procedure. While choosing a treatment based on the quality of life alone is ill-advised, I understand. That said, is it possible to have it all? Can one get prostate treatment with curative intent and still retain sexual function?
Research shows that 30 to 40% of men treated with External Beam Radiation (EBRT) experience erectile dysfunction (ED). After surgical removal of the prostate (prostatectomy), if the neurovascular bundles are preserved and sexual function is optimal before surgery, about 70% of patients regain sexual function after the procedure.
It is important to note that our understanding of sexual function needs to evolve post-treatment for prostate cancer. For instance, why would you have even heard of a “dry orgasm” until now, much less know first-hand what it is? Yes, a brave new world, but also a potentially good one that is worth the effort to maintain and even improve. As context, the neurovascular bundle (NVB) is a combination of nerves and blood vessels that innervate the penis for sexual function, so keeping at least one bundle intact is essential for any chance of an erection occurring. I’ve seen thousands of patients treated for prostate cancer, which equips me with the first-hand experience to what works and what doesn’t in regaining sexual function after prostate cancer. Here’s what I know.
The surgeon’s skill in preserving the NVB is imperative to regaining sexual function after prostatectomy. Sometimes the surgeon can preserve one side and not the other due to cancer found in one of the NVB’s. If that is the case, a man can still have a sexual function with only one NVB preserved. The next important component here is sexual health before surgery, as the research suggests. If you are good to great sexually before surgery and keep at least one of the NVB, potency is possible after prostate surgery. Here’s a video that I recently recorded on regaining sexual function after prostate surgery.
After EBRT, the rules are the same; the healthier sexual function before surgery, the better. Radiation can harm the NVB as well, but many patients retain sexual function after treatment.
The most challenging prostate cancer treatment to retain potency is Androgen Deprivation Therapy (ADT), also known as hormone therapy. There are two reasons for this:
1. Testosterone is essential to support penile tissue; and
2. The lack of testosterone reduces libido and thus the desire for sexual activity.
How can you regain your sexual function after prostate cancer treatment?
Assuming you were sexually healthy and that at least one NVB is preserved, there is work we can do to improve sexual activity after prostate cancer treatment. The goal is to keep blood flow going into the pelvic area to nourish the vital penis tissues with oxygen and nutrients. For instance, a low dose of PDE-5 pharmaceutical (Cialis, Viagra, etc.) daily may be necessary and at a low dose, adverse effects are far less likely.
In addition to a low dose PDE-5, I suggest a high-quality nutraceutical supplement that helps to bring more blood to the pelvic area. Many of my patients do quite well with taking two capsules of XYVGGR twice per day away from food.
In extreme cases of dysfunction, a vacuum erection device (VED) can be explored as an option to also help bring blood to the penis, so ask your urologist for a good VED. Even more extreme cases may warrant the consideration of the injection of three medicines into the penile muscles or even a penile prosthesis (also known as a penile implant). Yes, extreme options but successful for some men.
Lastly, at XY Wellness, our mission is to provide men with prostate cancer with valuable and actionable information to help them live well after diagnosis. We strive to help men regain, reclaim, and renew their health, including sexual health, despite the disease. For us, prostate cancer is not the end, but the beginning of a journey — a fresh start to living a healthier life and if needed an opportunity to redefine intimacy and rebuild sexuality after treatment.
Best of Health to You,
Medical Director & Co-Founder