In the office, some questions get stuck in your throat. After being diagnosed with prostate cancer, a man can think about his survival, then, almost immediately, about his relationship, his desire, his body. “Am I going to die?” And “Will I still be able to make love?” can arise together.
These questions are neither secondary nor inappropriate.
Sexuality can be modified by illness, stress and certain treatmentsbut not in the same way in all patients. Before starting treatment, it is legitimate to talk about erection, desire, ejaculation, orgasm and possible help if difficulties appear.
Does sex life necessarily change after prostate cancer?
Not necessarily in the same way, nor with the same intensity. The National Cancer Institute recalls that prostate cancer and its treatments can influence sexuality. As soon as the announcement is made, worry, fatigue or the shock of the diagnosis can already lead to a reduction in desire.
Then, certain treatments can cause erection difficulties. Hormone therapy, for example, can reduce libido and promote erectile dysfunction. After surgery, radiotherapy or other treatments, problems can also occur, with a variable frequency and progression depending on the initial situation, the treatment chosen and the general condition of the patient.
The nuance is important: this is not an automatic effect for all men. The choice of treatment depends in particular on the type of cancer, its extension, age, other possible diseases and the patient’s preferences. This decision is discussed with the medical team.
To better understand the specific subject of erection, you can consult our file “Prostate cancer and erectile dysfunction”.
After prostate removal, what happens to orgasm and ejaculation?
Confusion often arises. After a total prostatectomy, that is to say the complete removal of the prostate in the context of cancer, there is no more ejaculation. This impossibility is definitive, because the prostate and the seminal vesicles participate in the production of seminal fluid.
But this does not automatically mean the disappearance of orgasm, nor the end of all sexual life. The INCa specifies that the sensation of pleasure can be preserved, even without ejaculation. On the other hand, the erection can be impaired, particularly when the nerves involved in the erection have been affected or when their recovery is slow.
This distinction deserves to be clearly formulated before treatment. No longer ejaculating, needing help with erection, feeling desire differently or going through a period of withdrawal do not mean the same thing. And each of these situations may call for a different response.
True Medical also mentioned a treatment in 5 sessions designed to better preserve sex life than traditional surgery, without this replacing the personalized advice of the team who follows you.
What questions should you ask before treatment?
The good reflex is not to wait for difficulties to appear to talk about them. Three questions can serve as a starting point in consultation: what consequences are possible for my sexuality? What can we do to limit them? Who can help me if they appear?
These questions can be asked of the urologist, the oncologist, the attending physician or the prescribing nurse depending on the course. They can also come back during follow-up, because the side effects are not always experienced at the same time: some are immediate, others appear or become more visible over time.
The INCa reminds that several aids can be offered: treatments for erectile dysfunction, sexology consultation, psychological support. Ameli mentions in particular tablets, intracavernous injections or, in certain situations, a penile prosthesis. The choice depends on the medical context and the patient’s expectations.
The partner can also participate in the consultations, if you wish. This can help to put fears into words, avoid hurtful interpretations and rebuild intimacy in a different way, at the couple’s pace.
Finally, patient associations such as AnamaCap) also prove useful for advice and support: talking with other men concerned can help express concerns that are often kept to oneself.
You don’t have to choose between talking about your survival and talking about your privacy. Both subjects can be addressed in treatment, from diagnosis, then throughout follow-up.