FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PROSTATE SURGERY DOESN'T HAVE TO MEAN END OF SEX LIFE

Question: Eight months ago I had my prostate removed because of prostate cancer. I haven't been able to have an erection since then. Is there any way I can have sex again?

Answer: The prostate is an important part of the male reproductive system and is, therefore, important in the male sexual response. But the sexual response requires the smooth and coordinated operation of many body systems emotions, circulation, nervous system, etc.

I think my answer will be clearer if I take a moment to present some information about the prostate. The prostate gland is an essential part of the male reproductive system which makes most of the liquid of seminal fluid. During ejaculation, the sperm are propelled through the prostate by muscle contraction of the epididymis - a small sack-like storage area on the backside of the testicles. The fluid from the prostate is mixed with the sperm as they are forced through the gland and then out of the body through the urethra (the tube inside the penis).

Cancer within the prostate can be treated by several methods, including several types of surgery. An inability to have erections is a common complication of some of these procedures. This occurs not because the prostate is necessary to have an erection, but because the nerves that control the process and the blood supply that fills the penis to make it erect are damaged. Removal of the entire prostate gland, called a radical prostatectomy, is often accompanied by this complication.

At times, it is possible to have a radical prostatectomy with what is called "a nerve-sparing method," but after this surgery it may take up to a year for the ability to have an erection to return. Perhaps you are in this group.

In many the ability to naturally have erections is permanently lost. Men in this situation can still have intercourse with the assistance of several different medications or devices. One of the safest and simplest method for producing an erection requires the use of a plastic chamber that isn't significantly different than a large test tube. First, the penis is placed into the chamber. A vacuum pump lowers the pressure within the chamber so that blood is drawn into the penis, thereby making it erect. A small band is then placed around the base of the penis to keep it that way. The plastic chamber is removed during intercourse.

There are medications that can be injected into the penis to temporarily produce an erection. This works, but it is usually not a very satisfactory solution for such a long-term problem.

Penile implants are another solution for this type of erection problem. There are basically two types: Those that are semi-rigid, and those that are inflatable. Penile implants require significant surgery, as you would guess. Both types of implants have their own set of particular problems as well as benefits.

Regardless of the type of assistance used to obtain an erection, the sexual sensations will be somewhat different than they were before surgery. This is not surprising, since the extra preparation can affect the emotions involved with sex, and the surgery itself removes the prostate, and injures the nerves to a greater or lesser extent. Despite this, many men return to a mutually satisfactory sex life after prostate surgery.

Talk to your urologist about your concerns. He or she can't help you if you don't.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.