Sexual Function Recovery at the VA After Prostate Cancer Surgery
- The VA has any options to help treat sexual dysfunction after prostate cancer treatment and costs are generally covered if they are service-related.
- Prostate cancer treatments, including surgery and radiation, can affect sexual function, with many men experiencing erectile dysfunction (ED) as a result.
- Options like nerve-sparing surgery can help preserve erectile function, but success varies based on individual factors like age and overall health.
- Treatments for ED post-prostate cancer range from oral medications and injectable therapies to vacuum erection devices and surgical implants, each with its own set of considerations.
- Psychological counseling can play a crucial role in addressing the emotional and relational aspects of sexual dysfunction after prostate cancer treatment.
It’s completely normal to feel concerned about the impact of the disease and its treatment on your sexual function. Recovering sexual function can be one of the most deeply sensitive and personal parts of your healing process.
Read MoreWill the VA cover the cost of treatment for sexual dysfunction after prostate cancer treatment?
The VA Health Care system provides a wide array of in-house specialty services for prostate cancer, but subspecialties such as urology can vary by location.
If your local VA does not have the services you need on site, they will refer you to a community urologist that they are contracted with. The VA will cover the costs of your tests and treatments, and will continue to monitor your care at other facilities.
Typically, the VA does cover the cost of sexual dysfunction treatment after prostate cancer, as long as the condition is service-connected. This is true, even if the care is provided outside the VA system, so long as your receive approval.
However, the type and extent of coverage may vary depending on your specific situation and the treatment option you choose. You should work with your care team make sure you understand all of your options as you move forward with your care.
How common is sexual dysfunction after prostate cancer treatment?
“Erectile function is so sensitive when we’re dealing with prostate cancer because of the fact that the nerves that are critical for this function wrap around the prostate, they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, tells SurvivorNet.
“Over time, those nerve cells can be damaged, and so as a result, the erectile function can be very difficult to achieve after treatment,” she adds.
Erectile dysfunction (ED) means you have difficulty achieving or maintaining an erection sufficient for sexual activity.
Treatments for prostate cancer, especially surgery, can damage nerves and blood vessels essential for erectile function, leading to ED.
- 10-46% of men experience ED effects 12 months post-robotic prostatectomy
- By 24 months, this rate decreases to 6-37%
- ED rates vary depending upon preoperative function, age, and health conditions.
Is there a way to preserve sexual function after prostate cancer surgery?
“One of the greatest concerns after prostate surgery or even radiation therapy is erectile function,” says Dr. Garraway.
“The nerves that are critical for erectile function wrap around the prostate. They are so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment over time,” she adds.
Opting for nerve-sparing surgery can reduce this risk, though it may not be suitable for everyone. Nerve-sparing surgery involves removing cancer without harming the nerves, but if the cancer is near the nerves, they may need removal.
Within a year of nerve-sparing prostatectomy, 40% to 50% of men are back to their pre-cancer sexual function. Most, but not all, will get their function back within two years of surgery.
Related: Everything You Need To Know About the VA’s Clinical Trials and Research Studies
How is erectile dysfunction treated?
“Well, there are many different treatments that go from the least invasive to the most aggressive,” Garraway explains, adding that doctors will tailor the approach to each individual’s situation.
Oral medications
Oral medications — usually a pill — work for mild to moderate ED by enhancing blood flow to the penis to bring on an erection. Usually doctors recommend a class of drugs known as PDE-5 inhibitors.
“So the first thing we usually try, our first line of treatment, is oral medications. Medications like Viagra, Levitra or Cialis can help achieve erectile function or restore erectile function and help augment what is left after surgery,” Dr Garraway says.
PDE-5 inhibitors increase erectile function by preventing the breakdown of cGMP, a chemical vital for relaxing the penis’s smooth muscle tissue. This action helps increase blood flow to the penis, making it easier to get and keep an erection during sexual arousal, without directly causing an erection.
These medications won’t cause an immediate erection. To achieve arousal, some foreplay is usually needed. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours.
Common side effects of PDE-5 inhibitors are usually mild. They include headaches, facial flushing, indigestion, nasal congestion, and dizziness. Serious side effects happen rarely and include allergic reactions, hearing or vision loss, or a prolonged erection lasting more than four hours.
Injectable medications
“If the oral medications do not work, there are other medications that we can use that are a little bit more invasive.” – explains Dr. Garraway.
Injectable medications means giving yourself a shot directly into your penis to get an erection. This sounds daunting, but with proper training and care, most men report being ok with it.
These medications, such as alprostadil or a combination drug known as Trimix, work by expanding blood vessels and increasing blood flow to the penis. They mimic the natural process of getting an erection.
A low medication dose is injected once or twice a week, promoting the return of erections when the nerves are preserved. Regular penile “exercising” can expedite this process, either with a partner or individually.
This method is particularly useful for men who do not respond well to oral PDE-5 inhibitors.
Common side effects include injection site pain, prolonged erections, fibrous tissue formation, and bruising or bleeding. Precise dosage is critical to prevent prolonged erections (priapism) and potential scarring in penile tissues.
Having an “exercising” routine aids in oxygenating erection tissues, reducing the risk of deterioration from lack of use and low oxygen levels.
If natural erections improve during injection therapy, many men can can retry an oral treatment.
Vacuum erection devices
Vacuum erection devices use vacuum pressure to draw blood into the penis, inducing an erection.
To use the device, you place the plastic tube over your penis and then use the pump to create a vacuum that draws blood into your penis, causing it to become erect.
Next, you place a band at the base of your penis to maintain the erection. Once erect, apply lubricant, gently slide the retaining band down to the lower end of your penis, and remove the pump. The band can safely remain in place for up to 30 minutes to support successful intercourse.
Your doctor might recommend combining the vacuum pump with PDE5 drugs. Alternatively, you may use the vacuum pump alone or in combination with other treatments, such as injections.
Note: using a vacuum erection device may cause bruising, numbness, discomfort, decreased ejaculation force, and temporary discomfort from the base band.
Surgical options
“Penile prosthesis basically is a prosthesis that replaces the erectile tissue that no longer works in a man’s body.” – says Dr. Garraway.
There are many different penile prosthesis options available. The two main types are inflatable implants, which are the most common and allow for a more natural erection, and malleable implants, which are bendable rods that provide a constant state of rigidity.
“The most natural type is called an inflatable penile plastics prosthesis. It involves not only putting the prosthesis into the corporal bodies, which are the erectile tissue that is no longer functional. But it also includes a pump which is implanted into the pelvis so that you can have transfer of fluid from a little bulb in the pelvis to those erectile bodies,” explains Dr. Garraway.
“They can press [a little pump] that’s discreetly placed in the scrotal sack actually, and then they can access that. They can pump up whenever they’re ready and the fluid is transferred to the erectile bodies and they have an erection.”
Penile implants usually work quite well. They can offer a long-term solution for those who haven’t found success with other treatments. While they don’t “cure” the underlying causes of ED, they do provide a reliable means of achieving and maintaining erections, restoring sexual function and satisfaction for many users.
However, the procedure is irreversible and destroys natural erection tissue. And there is some risk with implants including infection, mechanical failure, and altered sensation.
Psychological counseling
Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.
In counseling, individuals and couples can discuss concerns, explore sexual aids and techniques, and find ways to maintain intimacy.
While effectiveness varies, many do benefit from this support and find that it does help improve their sexual well-being.
Research suggests that combining sexual counseling with other medical treatments for sexual dysfunction can significantly boost sexual satisfaction and quality of life for patients and their partners.
Related: National Guard Vet & Prostate Cancer Survivor Urges Others to Get Screened
Questions for your doctor
Because sexual function is such a deeply personal for most patients, you will want to discuss all of your options with your doctor so you know what to expect. Some potential questions include:
- What are the chances of preserving erectile function after prostate cancer treatment, and how do they vary with different treatment options?
- If I do lose function, what are my options and how do they align with my specific condition and overall health?
- Are the potential side effects I should be aware of?
- Where can I receive this treatment and how much of the cost will the VA cover?
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