Erectile Dysfunction After Prostate Surgery
Erectile dysfunction (ED) is very common, so common that in my experience, 100% of men have ED after surgery and cannot achieve an erection or even part of one. The statistics are a little brighter with 16% of men having a radical prostatectomy regaining their pre-surgery level of erectile functioning. However this is hardly positive when this means that 84% of men will never achieve an erection again.
Understandably ED after surgery for prostate cancer causes significant distress for the man and or the couple together and there is a significant link associated with depression.
Men are in the most part well informed of this side effect of the surgery to help rid them of cancer however the term 'nerve sparing' to help spare the nerves which are responsible for achieving an erection are often misleading and can lead to false hope that there won't be a problem once the basic level of healing after the operation occurs. Basic healing of nerves can take up to 2 years after surgery rather than the standard 6 weeks recuperation that men are most often informed about.
Treatments for ED are commonly medications, known as PDE5 inhibitors are meant to target the cavernous nerves and are designed to help encourage oxygen and circulation into the penis and assist in the nerves regenerating and recovering.
Unfortunately because where, in most cases, the cavernous nerve has been damaged this medication will not work leaving only 12-17% of men to respond to this medication. The next option is to move onto penile injections. Perhaps unsurprisingly 50-80% of men introduced to injections stop using this treatment.
A recent study investigated men's experiences of injection therapy for ED and they reported that men have described this form of treatment as anything from "not normal" to "barbaric" and "brutal" and "the most negative thing I have ever done". However on the flip side, men who managed to persevere with the initial fear and trepidation of learning to use injections have found injections to be "fantastic" and a "life saver" (Nelson, J., et al., 2015)
The Authors recommend a form of therapy called Acceptance and Commitment Therapy (ACT) to help with the fear and avoidance which comes with a sudden experience of impotence and the treatment options for the ED.
The first step in this cycle is to start with thinking about the longer term goal of achieving intimacy and sexual function in their sex lives, rather than the short term goal of just having the injection to get the erection. There has to be an acceptance that there will be some hassle involved, possibly some discomfort, and notably what ever embarrassment may occur to start with and that also there may not be success, to start with or ever time. However the second step of the cycle is committing to the long term goal and persevering.
The authors found that humour and laughter were a key to helping men deal with the emotion surrounding this issue and to share their experiences with other men in the same situation.
I have seen this first hand with the local Prostate Cancer Support Group. A safe haven for all men and partners who have experienced prostate cancer. The ability of these men to talk openly about their experiences, to laugh and joke where things have gone wrong and to support each other through tough times is beyond inspiring.
If you know someone who is experiencing difficulties after prostate cancer then encourage them to attend their local group. If they live in the UK they can find them through Macmillan. Macmillan can often also direct men to counselling services and for help through therapies such as ACT which can help restore confidence and a life back to men who have been likely suffering in silence.
Don't suffer in silence - there are people out there who can help!
Reference:
Nelson, C., Lacey, S., ... Mulhall., J. (2015). Men's experience with penile rehabilitation following radical prostatectomy: A qualitative study with the goal of informing a therapuetic intervention. Psychooncology, 24(12) 1646-1654.
