Dr Belinda F. Morrison, Contributor
Prostate cancer is commonly seen in Jamaica, accounting for the most common cancer in men. The question of the association of sex and prostate cancer is quite commonly asked. Indeed, there are many who inquire about frequent sex as a cause of prostate cancer. Others make a decision about screening for and treatment of prostate cancer based on perceived changes in sexual performance. This may be an all too embarrassing topic, associated with misconceptions and lack of facts. Therefore, several commonly asked questions must be answered.
Can frequent sex cause prostate cancer?
Several studies have looked at men who have a high frequency of ejaculation (whether by sexual intercourse or masturbation) and concluded that they may have a slightly lower risk of developing prostate cancer. However, the difference appears to be small and this is certainly a theory that is difficult to study. There is currently no conclusive evidence to link frequent sex and ejaculation to reducing the risk of prostate cancer.
Conversely, there are studies that link frequent intercourse and an increased risk of prostate cancer. This is thought to be directly related to the age of first intercourse and number of lifetime sexual partners. Increasing evidence suggests that a possible cause of prostate cancer is sexually transmitted infections and inflammation, and not sexual intercourse per se. This is an emerging area of interest in prostate-cancer research, with more information being obtained on specific agents and their effects.
Will my sex life change after my diagnosis of prostate cancer?
It has been documented that a man's decision to screen for prostate cancer may be influenced by perceived changes in virility and erectile function after diagnosis. Additionally, treatment choices for prostate cancer are influenced by changes in erectile function. A cautious answer to the question of change in sex life after a diagnosis of prostate cancer is guarded with statistics and probability. However, it is correct to say that not all men with prostate cancer will have 'impotence' or erectile dysfunction after treatment.
The prostate is encased in nerves that stimulate the penis to become erect. In addition, male hormones released from the testes play a role in generating and maintaining erections. Maintaining erections after prostate cancer treatment depend on a number of factors. These include the erectile function or potency prior to treatment, age of the man, the stage of the cancer, presence of medical illnesses, e.g. diabetes mellitus, that are already known to be associated with erectile function decline and type of treatment for cancer. For urologists that surgically remove the prostate, the technique of a 'nerve-sparing operation' is quite vital in preventing long-term erectile dysfunction. This technique aims to preserve the delicate nerves that stimulate the penis. Infertility and dry ejaculation are additional side-effects seen after treatment for prostate cancer.
Can my erections be improved after treatment of prostate cancer?
Penile rehabilitation is the buzz phrase referring to techniques that are used to improve erections after treatment of prostate cancer. These include exercise, dietary change, and maintenance of good blood pressure and glucose control, and early stimulation of penile tissue. The latter may be achieved by administering drugs that stimulate increased blood flow to the penis after treatment. Commonly used oral agents include vardenafil (Levitra). The drugs may be delivered as oral tablets, penile injections, penile vacuum pumps or urethral pellets. Studies have suggested that early penile rehabilitation may improve sexual function in men, following treatment.
Sexual function is intricately woven in the diagnosis and treatment of prostate cancer. Men should feel confident that the priority of treatment must be in eliminating the cancer. Sexual dysfunction after treatment of prostate cancer may occur; however, there are multiple strategies to prevent and treat this.
Dr Belinda F. Morrison is an urologist and lecturer at the University of the West Indies. Email: firstname.lastname@example.org.