A prostate cancer diagnosis can turn a man's world upside down, bringing fears about survival, treatment and what the future holds.
From difficulty getting an erection to losing sexual desire, prostate cancer treatment can bring changes that affect a man's confidence, intimacy and quality of life. However, a diagnosis does not necessarily mean the end of a satisfying sex life.
Prostate cancer affects the prostate gland, which produces some of the fluid that makes up semen. Depending on the treatment used, men may experience erectile dysfunction, reduced sexual desire, changes in orgasm and difficulties fathering children.
Dr Winstar Ombuki, a consultant urologist at Aga Khan Hospital, says the effects can begin even before treatment, as men grapple with the diagnosis and its implications for their health and relationships.
“Anxiety about their health, families and sexual performance can make it difficult for men to achieve or maintain an erection, even before treatment begins,” he says.
Fatigue and pain can further affect sexual performance, while some treatments may reduce sexual desire. Nevertheless, Dr Ombuki says men should not assume that their sexual lives are over following a prostate cancer diagnosis.
The extent of the impact largely depends on the treatment used. During prostate surgery, the nerves responsible for erections may be injured because they run close to the gland. Surgeons try to preserve these nerves where it is safe to do so, but they may still be stretched or bruised during the procedure.
“Recovery depends on several factors, including a man's age, erectile function before surgery, general health and whether the nerves can be preserved,” Dr Ombuki says.
Prostate cancer disproportionately affects men of African descent.
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Some men regain erectile function over time, although recovery can take months or even years. Others experience lasting difficulties, particularly when the nerves have to be removed to ensure that all the cancer is cleared.
Radiotherapy can also affect erectile function, sometimes gradually, while hormone therapy may reduce both sexual desire and the ability to achieve an erection.
Understanding these possible effects is important when choosing a treatment plan. Men should discuss the potential impact on their sexual health with their doctors before deciding on the best course of action.
The changes are not limited to erections and sexual desire. Prostate cancer treatment can also affect how men experience orgasm and ejaculation.
Following a radical prostatectomy, an operation to remove the prostate gland, men can still experience orgasm but no longer ejaculate semen. This is because the prostate and seminal vesicles, which produce most of the fluid in semen, are removed during the procedure.
Dr Ombuki says orgasms may feel different after surgery, sometimes becoming less intense or even painful. Radiotherapy may also reduce semen production, while hormone therapy can lower sexual desire.
Another concern for some men is a perceived reduction in penis length following prostate cancer treatment, particularly surgery. Changes in penile tissue and reduced erections may contribute to this, although the extent and duration of the change vary from one man to another.
Despite these challenges, several options are available to help men manage sexual difficulties after treatment.
According to Dr Ombuki, these include medication, vacuum erection devices and injections into the penis. A penile implant may also be considered when other treatments are unsuitable or have proved unsuccessful.
Counselling can also help men cope with anxiety, changes in body image and relationship concerns arising from altered sexual function. Open communication between partners can make it easier to navigate these changes and maintain intimacy.
Dr Ombuki encourages men to discuss their sexual health concerns with their doctors before starting treatment rather than waiting for difficulties to arise. Those who experience changes in sexual function afterwards should also seek medical advice, as help is available.
