After cancer treatment ends, patients expect life to return to normal. But what they often
find is that normal means something different than it did before cancer. That can be
particularly true for men who undergo surgery for prostate cancer.
Erectile dysfunction is one of the long-term side effects of surgery to treat prostate
cancer. But there are many ways to help men return to an active sex life. To help address
concerns like this that men face during their recoveries, the University of Michigan
Comprehensive Cancer Center in collaboration with the Department of Urology has
established a Prostate Cancer Survivorship Clinic.
We talked with Daniela Wittmann, a social worker and certified sex therapist with the
clinic, about how couples can work toward restoring their sexual health.
Daniela Wittmann, a social worker
and certified sex therapist, gives
couples strategies for renewing
their sex lives after prostate cancer
Q: How likely is it that men
who undergo surgery for
prostate cancer will experience
Many factors are involved, so recovery
depends very much on the individual.
Broadly speaking, the degree to which erectile
dysfunction will be a problem depends
on whether the nerves that surround the
prostate were spared. Before a man undergoes
surgery, his doctor will talk to him
about the stage of the cancer, what type of
surgery will be performed and how many
nerves may be involved. After surgery,
the doctor will tell the patient how many
nerves were spared. A mans age and how
strong his erections were before surgery
may also play a role.
Q: When can couples consider
resuming sexual activity?
The first survivorship visit is six weeks
after surgery. At that point, they are usually
considered well enough to attempt penile
rehabilitation and sexual activity.
Q: What is penile rehabilitation?
It's a method to ensure the tissue in the
penis stays healthy while the spared nerves
recover. Any part of the body that you
dont exercise tends to atrophy. The goal of
penile rehabilitation is to make sure all the
blood vessels are open to the blood flow
that produces erections. To encourage the
blood flow, the doctor or nurse practitioner
prescribes a half-dose of Viagra every other day for three months. We also recommend
men use two vacuum devices -- a soft one
called Prelude daily and a vacuum pump
two or three times a week for six months.
We suggest that men masturbate daily to
promote blood flow and the capacity to
Q: What if the nerves don't recover?
We definitely have options to help men
stay sexually active, even if men arent able
to produce erections on their own. The
vacuum pump is a good option as well as
penile injections and suppositories. Obviously,
before we prescribe any medications,
we evaluate patients for other health
concerns -- such as a heart condition -- that
could be worsened by these therapies.
Q: How successful are these
interventions in restoring patients' sexual health?
Many couples do well with the recovery.
Often, we help by working with patients
to manage frustration about the slow rate
of progress. Occasionally, coping with
the sexual side effects of prostate cancer
surgery is an opportunity for a couple to
uncover long-standing issues, either sexually
or in terms of communication, that
might encroach on their sex lives. Many
couples have used the recovery period to
address these issues. One of the things I
have learned in working with men after
prostate cancer surgery is that you have to
include their partners.
Q: What types of issues
Sometimes it's emotional distance within
the couple that makes sexual recovery
difficult, so they start working on being
more involved with each other. Maybe the
partner had a chronic illness that made sex
difficult, so they begin trying to address it.
Most often, if the partner is a postmenopausal
woman, she may be having her
own sexual challenges already. For female
partners, we recommend water-based lubricants or vibrators to stimulate blood
flow to maintain healthy vaginal tissues. If
appropriate, we also refer women to their
gynecologists to address localized hormone
replacement or vaginal dilators.
Q: Are patients shy about
I have found that, on the whole, they
are not at all uncomfortable talking about
these issues and are appreciative of the
opportunity. Maybe they wouldn't bring
it up themselves or feel it is appropriate for
a medical visit, but they feel they don't have
anywhere else to discuss these issues and
are very glad to talk about it.
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