Prostate cancer is plaguing our Black community. It takes a harsher toll on Black men than other American men, including other men of color. Prostate cancer makes up about 37% of all cancers in Black men. Around 1 in 6 will be diagnosed with the disease and if someone has a father or brother with it, their risk will more than doubled.
Prostate cancer can remain symptomless for a long time, so people need to educate themselves about the risks and have regular screenings with a doctor. Early detection is critical as prostate cancer is always treatable and often curable. Black men should be screened more proactively. Given the higher risk of developing prostate cancer and dying from the disease, Black men are more likely to be saved by screening. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for swelling and inflammation, and a PSA test, which measures the level of prostate specific antigen (PSA) in the blood.
Getting diagnosed with prostate cancer and opting for radical prostatectomy, or the removal of the prostate, may affect the ability to achieve an orgasm or to have an erection. The surgery’s outcome depends on the surgeon’s skill and the equipment they use, as less experienced surgeons may inadvertently, cause more extensive inflammation and nerve damage.
It is also important to note that men who enjoy receiving anal sex may notice differences during intercourse, as there is no longer a prostate to stimulate.
As with any major surgery, first, a patient should be fully healed before thinking about engaging in sexuality. EARLY postoperative medical therapy can also help to regain sexual potency. A conversation must take place between doctor and patient to come up with strategies that can help regain some measure of sexual function.
Penile Rehabilitation
If you have erection problems after prostate cancer treatment, your doctor may recommend “penile rehabilitation,” a term used to describe the use of any intervention or combination that may help you achieve and maintain an erection. Here are a few therapies that have helped with regaining sexual function after prostate surgery:
Oral Medication: Drugs like sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®) increase blood flow to the penis, making it easier to achieve an erection. Generic versions of these drugs may also be available. But these drugs may not help men achieve an erection if the nerves responsible aren’t healthy and may only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Medicated pellets: Alprostadil (MUSE®) is a urethral suppository—a medicated pellet inserted into the opening at the tip of the penis. It’s designed to stimulate blood flow and usually results in an erection within 5 to 15 minutes. Alprostadil, which may also be delivered as an injection directly into the side of the penis, is available as a cream for application directly into the head of the penis.
Penile injections: A tiny needle into the base of the penis, and medicine is injected. The injection will result in an erection that will remain ‘at attention’ long enough for sex. The erection can last between 30 and 90 minutes, and it becomes more rigid with sexual stimulation. However, it may not always disappear right away after orgasm. (Note: After prostatectomy, there is no ejaculation, because the organs that contribute fluid for semen are gone.) And sex and orgasm can practically feel as good as always. There may be nervousness about doing self-injection at first. But with practice, it will get easier. A healthcare provider can work with a patient on how to do self-injection. The injection’s success rate is between 70 and 80 percent. However, the main cause of failure is poor blood flow to the penis. Sometimes, although the shot produces an initial erection, it doesn’t last because the veins in the penis are damaged, because of heart disease, diabetes, or other health problems, in addition to the surgery.
Penile implant: Penile implants are devices placed inside the penis to allow men with erectile dysfunction to get an erection. Penile implants require surgery and are typically recommended after other treatments for erectile dysfunction have failed. This surgical procedure may restore a male’s ability to get erections through the use of silicone rods or inflatable devices.
Pelvic floor exercises: Exercising the superficial pelvic floor muscles helps enhance erections in men who have undergone prostate cancer treatment. Tightening their pelvic floor muscles as strongly as possible several times a day—by mimicking the action of stopping urination in midstream—improves the strength of the muscles that prevent blood from leaving the penis and increases erectile rigidity.
Penile rings and vacuum pumps: These are external medical devices that help you with your erections. Penile rings are best for men who can get erections but can’t keep them. The rings are made of rubber and are placed around the base of the penis to make it rigid enough for sex. A vacuum pump is for men who can’t get or keep erections. The vacuum pump is made up of a clear plastic cylinder and a pump that may be hand or battery operated. The vacuum pump is placed over the penis. As air is taken out of the cylinder, blood is drawn into the penis. This makes your penis enlarge. A ring is then placed around the base of your penis to maintain the erection. It may take up to two weeks for a man to be comfortable with using a vacuum pump. It is important that you use these devices the right way and that they fit the right way. Your doctor or healthcare team should explain how to use them and how to buy them.
Psychosexual counseling: Therapy has been shown to improve quality of life for men and their partners after cancer treatment. Men who are prepared for changes in sexual function are likely to cope better. Counseling may also help couples modify their sex lives to accommodate changes and place less emphasis on sexual intercourse.
For more info on prostate cancer, visit the American Cancer Society’s website–cancer.org