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Prostate Cancer

Impotence

Impotence (problems with erections) is a common long-term unwanted side effect of radical prostatectomy and hormone treatment, and sometimes it follows other treatments such as radiotherapy and brachytherapy. Occasionally it occurs when symptoms are improved using transurethral resection. All of the men interviewed who had undergone radical prostatectomy reported some degree of impotence, but their experiences varied. They tried practical ways to help them overcome their problem, some with more success than others.

 

Richard tried Viagra, Cialis and other treatments for erectile dysfunction. He was relieved to...

Richard tried Viagra, Cialis and other treatments for erectile dysfunction. He was relieved to...

Age at interview: 53
Sex: Male
Age at diagnosis: 47
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I went back to my consultant and then they try you on Viagra, Cialis, injections, there’s a whole host of things that you can try to get your erection back, because the reason you don’t have an erection, because there’s nerve damage when they remove your prostate that can’t be avoided, they just try and minimise the nerve damage, but there will be nerve damage, and you will lose the function for a period of time but the nerves apparently, they heal very, very slowly, nerves heal very slowly, and he, sort of tried to reassure me that you know, I’d probably get the erection back after maybe four years, you know, I was thinking, four years, I mean, that’s like a lifetime, so in the meantime you can try different things, and yeah, that was very difficult, and very difficult for my wife, yeah, but because she’s so supportive and so caring it was less difficult than it might be.

 
So you’ve no side effects now?
 
Not now, no, no, no. Two years after the operation was the first time I actually got an erection without any medication or injections or anything like that and it’s been fine since, but I think I’m one of the, a very small minority who have got you know, any function, much less full function back, but you don’t realise that, because when they say, “oh yeah it should be back in four years”, when you research it you realise that the majority of guys haven’t got it back at all, and some might have you know, maybe forty per cent back, if that, so I don’t think they tell you much about that in the beginning which I think is wrong.
 
So it is very unusual then for, to be in the position that you’re in?
 
Very unusual, yeah, very unusual.
 
And do you tell men that, when you’re speaking to other men?
 
Yeah definitely I do, yeah I do tell them about it, yeah, yeah because they’re not even aware of that side effect, and when they are told you can see their faces drop, but yeah it’s, yeah I’m just one of the fortunate ones I think.
 

 

 

During the time Richard had erectile dysfunction he found help via chat lines which he found on...

During the time Richard had erectile dysfunction he found help via chat lines which he found on...

Age at interview: 53
Sex: Male
Age at diagnosis: 47
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You got your diagnosis, and you were looking on the internet, what sources of information on the internet did you, get?

 
Mainly I was looking at the recovery from prostate cancer, especially when you’ve had your prostate removed, because I know there are side effects, but obviously for everybody the recovery’s totally different, you know, some guys you know, never recover, they don’t recover from erectile dysfunction, some get it back, some get it back, you know, just a proportion of it back, some never ever get it back, also I went on websites where you’ve got chat lines with guys who have had prostate cancer, and it was quite interesting to you know, to read those, some of the comments and be involved in some of the comments, and people gave me suggestions back and forth, what you could try, and yeah it’s quite sad, you know, some of the guys, you know, married, and it’s been like ten years and they haven’t been able to have you know, have sex with their partners because of the erectile dysfunction, so they were quite open on this chat line and I found that quite moving really, but very helpful.
 
Are you still involved in those chat lines?
 
Not in the chat line no, I’m not now, no.
 
So when did you stop being involved, in that?
 
I think once my erectile dysfunction disappeared, which was like two years after the operation, I think I stopped going on the chat line after that, but still you know, involved with talking to people about it, you know, but yeah, I didn’t go on the chat line anymore.
 
And have you been involved in any other support groups?
 
No, just the Prostate Cancer Charity, that’s the only one.
 

 

 

 

After surgery George did not have serious side effects, but he found that he did not have an...

After surgery George did not have serious side effects, but he found that he did not have an...

Age at interview: 68
Sex: Male
Age at diagnosis: 65
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And I have to say that they were, the surgeon who did my operation must be a very, very, very skilled person because I have had no real side effects at all, apart from the gentleman’s department shall we say, about the impotence factor. I found that my libido did not really change, and I found that the physical side, well, yeah, well I have to say yes, that did change, because I think psychologically you’re in a very difficult fragile condition, a lot of men won’t admit that because it’s a macho thing, you know. The possibility is still there. Now I have Cialis from my own doctor, which I very rarely take, but I can, I still achieve erection, I wouldn’t say as often as I used to, and that’s understandable because I’m not in the first flush of youth, you’re still, you’re still a man and that’s an important factor to you, and the, one of the biggest problems, is, (laughs) this sort of dimension, the sort of size, now most men are, most men like to think the size is everything, but you’ll find that, in the type of operation I had, it tells you in the literature, that, the penis will shorten, and I have to say, I you do shorten slightly, but it’s of no significance really, you know, I’m now sixty, I’m now sixty-eight.
 
Do you suffer from impotence at the moment?
 
No, no.
 
So you haven’t had to deal with that?
 
I can rise to the occasion shall we say, but no I don’t suffer from impotence, at the moment, at sixty-eight, you’re not as sexually active as you were a few years back, you know, but in my case, I, again, I don’t want to give too much of my own personal life away here, but I’m happy if it helps somebody, don’t think it’s the be all and end all, it’s not, there’s the emotions there, emotions and I think it’s just as important to have affection, to your partner.

 

 

After his radical prostatectomy John found that he could still get an erection but he could no...

After his radical prostatectomy John found that he could still get an erection but he could no...

Age at interview: 62
Sex: Male
Age at diagnosis: 57
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Well there, there are problems, the nerve sparing, the nerve sparing worked, but quite obviously, I have to be, I have to be fairly open about this, you no longer ejaculate, which may or may not be an issue of itself, but I do not, while I can get an erection, I, it is non-orgasmic, that has bothered me, it has bothered me, mainly because, for about, well once I was able, for a short period after I was able, post-op, it was orgasmic, but only for a short period. Now they don’t talk to you too much about that, even when you ask in the hospital, so, my interpretation, and it’s my interpretation, it’s not a medical interpretation, is that something survived the operation, which died shortly afterwards, and I’ve only recently, I’ve only recently discovered, talking to one of the, not the doctor, but one of the support nurses, I couldn’t tell you her title, who gave me a bit of a surprise whenever she said that the nerves which control orgasm and the nerves which control erection, are a different set of nerves, now, I have not gone into that, because all of a sudden it says, well, are they separate, were they treated separately, I didn’t want to go there, because at the end of the day, there’s nothing going to be able to be done about it, the doctor did his best in the operation, and if a set of nerves died as a consequence, that was a risk you were running, that was the risk, and you knew that risk, it wasn’t as if you weren’t told, you knew and that was part of your decision.

 

 

After his robot-assisted laparoscopic prostatectomy John was impotent. He tried Cialis, and a...

After his robot-assisted laparoscopic prostatectomy John was impotent. He tried Cialis, and a...

Age at interview: 57
Sex: Male
Age at diagnosis: 54
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The other side effect of my prostatectomy was loss of sexual function, and I think that, seemed to be more, more a problem for the people at the hospital than it was for me, I mean I’ve been married a long time, my wife and I have a very loving relationship, but I mean physically, we’re kind of not all that bothered, so neither of us felt it was a major problem, but the hospital tried me out with Cialis which is to try to increase the sexual function, and with a vacuum pump to encourage blood flow into the penis, and I was, to be honest, rather half-hearted about the whole thing and I’ve given up with all of that, now, and I think, that probably gets us up to pretty much where I am right now.

 
 

 

 

Comments on the use of Viagra and his dislike of MUSE after a radical prostatectomy.

Comments on the use of Viagra and his dislike of MUSE after a radical prostatectomy.

Age at interview: 56
Sex: Male
Age at diagnosis: 55
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Impotence I am impotent, we are now 9 months on and things have not really changed at all. I've tried Viagra, low dose Viagra, higher dose, and it makes not the slightest, I don't notice I've taken it, nothing happens anywhere, I don't get headaches or flushing or an erection, nothing happens.

Was that easy to get from the GP?

Yes, as soon as I explained what I'd had, that was immediate, there were no quibbles at all. 

Because one person said he wasn't sure if he could ask for it so...?

No there was no problem at all, I went, well I went back and said what did he suggest, I said 'I've got this impotence, I've had this operation,' and this wasn't the doctor who originally I saw, but it was at the same practice. And he looked up my notes and said 'Yes well if you've had that operation you are certainly entitled to try Viagra and that is the thing you ought to try first.' I don't know whether I could go up to a higher dose but as it made not the slightest effect on the second dosage there seemed no point in pursuing that. We've been fairly relaxed about it, although it would be lovely to get back to normal. There is still a sensation there although you don't get the erection, it's a very strange feeling. All sort of sexual feelings and lust or whatever are exactly the same, the only difference is and it may be a fairly major one but the only difference is you don't get an erection. You even feel as if you are coming as well sometimes which is very odd without an erection but it is a very strange thing. So it's disappointing but it's not a tragedy. I've also more recently been back and said the Viagra doesn't seem to be doing very much or hasn't done a thing for me. And I have gone on to another one called Muse, I don't know what Muse, MUSE stands for, but the prospect of putting this potion up your penis with a little adapter seemed so unpleasant that I haven't used it (laughs) so I've not done it. But it's still in the fridge waiting for action.

I haven't heard about that one yet.

Oh it's, I think the idea of doing is likely to put you off having any erection anyway. It's the most, it seems a most unpleasant way of doing things, I think I'd rather just stay as I am than try the Muse. But apparently it works in a very different way and it is a liquid that is put some inches inside, you insert it inside your penis and fairly soon that ought to give you an erection if it's going to work it works quite quickly. But for me the prospect of getting it where it ought to go is so unpleasant that I can't bring myself to do it. I have tried.

 

Explains how MUSE worked well against impotence but Viagra did not after a radical prostatectomy.

Explains how MUSE worked well against impotence but Viagra did not after a radical prostatectomy.

Age at interview: 57
Sex: Male
Age at diagnosis: 54
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The main side-effects after the operation to me were the incontinence and I can say I was impotent as well; I didn't get any erections, which I think people should know. But again it was a big operation and there are things that they can do for you, we've tried a couple of things. I hasten to add Viagra didn't help. What works to a certain extent is there's a thing on the market called Muse and that's an injection that you put into the penis. It can be very successful for some people, I would say for me it's 75% successful, so it hasn't ended altogether.

 

Describes how he has come to terms with impotence after radical prostatectomy.

Describes how he has come to terms with impotence after radical prostatectomy.

Age at interview: 63
Sex: Male
Age at diagnosis: 56
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And do you mind me asking were there any, was there any effect of sexual functions after the operation?

Yes initially we, and I say we because my wife and I felt it was very good there was a sexual experience after the operation, whether that was pure excitement or what I don't know, but the it became very limited, and from that point of view it's become almost impossible to either have an erection or maintain an erection. That isn't a huge problem to me and my wife, we've learnt to come to terms with it, it was something we didn't want and we would've preferred not to have had but I think the bonus with that has been in the fact of it's secondary to everything else. We are here, both of us are here, me perhaps mainly and we get on with our life.

National Institute for Health and Care Excellence (NICE) guidelines 2014 (CG175) recommends that men should be advised that long term hormone therapy can cause reduction in libido and possible loss of sexual function. Men and their partners should be told about possible loss of fertility and be offered sperm storage, and those starting hormone therapy should have access to specialist erectile dysfunction services and be considered for psychosexual counselling. 

Men who received hormones or a combination of hormone treatment and radiotherapy also described how treatment had affected their sex lives. A man who had had brachytherapy said that his operation had led to impotence and another man described how treatment of his symptoms by transurethral resection had led to some change in his sex life.

 

Explains that impotence has not altered the relationship with his wife.

Explains that impotence has not altered the relationship with his wife.

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Do you mind me asking do the hormones affect sort of sex drive at all?

Well I don't have any [laughs].

Was it the same before and after or different?

After the operation of course, no you don't lose your sexual instincts then, but since I've been taking, having this implant he did say to me 'You'll become impotent, impotent I should say,' and low and behold I have. But at 70 I'm not that worried, it hasn't altered any relationship between myself and my wife. I mean by the time we were reaching 70 it wasn't exactly the end of the world and it's just something, it just doesn't happen any more that's all. I mean you don't think about it, I mean I'm, I think our relationship is fine, we're just as affectionate as we always were but no there isn't any sexual activity.

 

Discusses the effect on his sex life after having treatment.

Discusses the effect on his sex life after having treatment.

Age at interview: 80
Sex: Male
Age at diagnosis: 77
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And the side effects of the injections, can you tell me a bit about that now?

Well this again it's not easy for me to talk about but I mean of course I am totally impotent and I'm even worse than that in that I am disgusted by anything sort of sexual.

Right.

If I see, and you can't avoid it on television, not explicit sex but very nearly, I'm disgusted. I think that you know this country is absolutely going down hill desperately fast. To me I have enjoyed what I hope my wife would confirm an exceedingly good sexual life no hang ups, no nothing like that. But now I think being impotent is a, you don't know it but I think it's psychologically affects you. I mean it's really got now that I am disgusted by anything at all of that nature.

How does that make you feel, would you prefer that things were different?

Yes, yes I mean I feel that I've lost all masculinity, I'm not a man any more. I mean I'm just not. I mean if I were walking along with my wife, very slowly these days, and somebody accosted her I would sort of run away. I have no masculinity left.

How does that make you feel?

Awful, I think that really, that is the worst side effect by far.

I think it's important that other men know how you feel about that.

Yes I think that is the most important thing, side effect of these injections which are always delivered well, competently, local hospital you know.

How does that make you wife feel, does it affect your relationship?

Well I wouldn't know. It's very funny women don't talk about things like that you know, I'd never ask her for fear of her, she's taken it magnificently but that worries me of course it does. I mean again I'm talking very freely, my wife's sister is in America and she and her husband came over and he said 'Oh you ought to have,' oh God what's 'Viagra, see your doctor, see your doctor.' Well I wouldn't have the nerve, I wouldn't dream of it. But that made me feel worse you know. You see she's younger than me, 9 years younger and it may be important to her, I don't know and I'd rather not ask. I mean we have enjoyed a very, very intimate life you know but (coughs) stop smoking.

Yes I can see that it must be very distressing.

No that worries me very much that you see I no longer fulfil my function as a husband you know. 

I'm sure you satisfy her in lots of other ways though.

I, well she said, 'Somebody is coming, you must hoover the hall,' I've done that while she was out.

 

Comments on his change in attitude after having female hormones.

Comments on his change in attitude after having female hormones.

Age at interview: 61
Sex: Male
Age at diagnosis: 61
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How did that make you feel as a man having female hormones?

Terrible, that's when your masculinity really goes. Forget about the sex drive when you get them implanted in you, you just get a crazy mixed up kid for want of a better word because you're doing these terrible things, you know it's not you, you know it's not part and parcel of your upbringing because as I said you'll snap, you'll rant and rave, you just, your total outlook on life is different. It changes your attitude and your attitude to the ones that you're living with, your attitude to your family, you just don't want to know them. And I suppose it's the fact that you're having foreign bodies implanted into your body because all your male hormones just disappear and because they say that the prostate cancer feeds on the male hormones so they replace it with the female hormones so as that's the initial start of the treatment that you're starving the cancer and then you go on to the, in my case onto the radiotherapy.

 

Explains how a younger man would have more problems with impotence than he would.

Explains how a younger man would have more problems with impotence than he would.

Age at interview: 70
Sex: Male
Age at diagnosis: 66
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And how do you think it makes men feel these side effects of hormonal treatment?

Well in a younger man I think the impotence would worry them because it might affect their married life, it depends how the relationship between the husband and the wife is. In my case as I say we've got 3 grown up daughters now and the wife isn't bothered in any way so it doesn't interest her any more so we get along quite well together you know. She says, actually the hormone, she thinks the hormone therapy has done me good because I'm more even tempered [laughs].

Oh does she.

She says I'm more relaxed now than ever I've been in all the years she's known me.

 

Explains how a transurethral resection led to some change in his sex life.

Explains how a transurethral resection led to some change in his sex life.

Age at interview: 65
Sex: Male
Age at diagnosis: 63
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After the operation, well yes it was explained that ejaculation wouldn't be the same as it had been previously. It wasn't, that was, that was extraordinary so the sexual life changed, not disastrously or anything like that but the way in which one behaves in that situation had changed in as much as there was not a complete or proper ejaculation. Instead there were a number of mini ejaculations so the whole thing of sex had changed in that direction. I would say a little of the pleasure of sex had disappeared, but that was the only side-effect. The great bonus I suppose was peeing and on the first occasion when suddenly after what obviously had been a long time the stream had been getting smaller and smaller there was a mountain stream gushing so it was quite incredible the change as far as that was concerned.

Newer surgical procedures and treatments such as robot-assisted laparoscopic radical prostatectomy, and HIFU are reported to cause fewer erectile problems and incontinence problems than radical surgery.

NICE also recommends that men with erectile problems following prostate cancer treatment should be offered PDE5 inhibitors (such as Sildenafil (Viagra®), Vardenafil (Levitra®), Tadalafil (Cialis®) and avanafil (Spedra)) and if PDE5 inhibitors fail to restore erectile function or are contraindicated, they should be offered vacuum devices, intraurethral inserts or penile injections, or penile prostheses as an alternative.
 
 
Last reviewed July 2017.
Last updated March 2015.
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