Let's Talk about Your Sexual Health

Different sexual issues touch men and women. Erectile Dysfunction, or ED, is when a man has trouble getting or keeping an erection. Sometimes ED is the result of prostate cancer treatments like a prostatectomy (the surgical removal of all or part of a man’s prostate). Other health problems like high blood sugar, heart disease or trauma to the pelvic area can also cause ED. If you have problems getting or keeping an erection, have less of a desire for sex or other issues that keep you from enjoying sex, talk to your doctor. There are care plans that can help with many of these.

In women, sexual dysfunction may involve painful sex, low arousal or a problem reaching sexual peak. Health issues like cancer, high blood sugar or heart disease can contribute to these type of sexual problems. Changes in hormone levels, mainly after menopause, can also be a cause. Lower estrogen (female sex hormone) levels after menopause can lessen the amount of blood flow to the genital area. This can cause vaginal dryness, thinning or swelling. It can also lead to painful sex and make it harder for women to get aroused or enjoy sex. Hypoactive Sexual Desire Disorder (HSDD) is a diagnosis given to women when they have problems in their sex life that cannot be explained by pills, life events or other health issues. The good news is that many of these issues have treatment options that are available from your health care provider. There is also more attention and awareness to women’s sexual health today than ever before. The Office of Women’s Health is a government agency that offers national leadership and coordination to improve the health of women and girls through policy, education and model programs, many including sexual health. In the past, much of the sexual dysfunction research focused mostly on men. Many drugs and gadgets were approved to help men reach greater sexual intimacy. Today, women are being more proactive about their sexual health and advocating for ways to help them have meaningful sexual lives.

Mental and emotional issues such as anxiety, depression and past sexual traumas can also lead to sexual problems in both men and women. For instance, stress at work or in your relationships can make it hard to enjoy sex. If you are having these types of issues and they alter your sex life, then speaking with a mental health expert may help. Licensed social workers, psychologists and psychiatrists may also offer useful tips for you. During these sessions, you can talk about your feelings relative to sex and closeness. Some health care groups have sexual health programs where you can get referred to see a sex health expert. Ask your health care provider about such programs. For men, a primary care provider or urologist is a good place to start. For women, a primary care provider, urologist or gynecologist is a good place to start. Visit the American Association of Sexuality Educators, Counselors & Therapists (AASECT) at www.aasect.org for more facts. For further information about ED symptoms, causes, diagnosis and treatment, please visitUrologyHealth.org/Educational.Materials.

Having a meaningful sex life is likely, but it will take time. Most of the time, many women are worried about the health and well-being of their partners, first and foremost. Sex is not always top of mind. Getting through the surgery is a bigger concern. Ask questions so you’ll know what to expect in terms of your partner’s healing. 

“This can be a topic of debate – the thought that sexual function can be fully fixed by drugs and devices. Things like the quality of the surgery, present co-morbidities like high blood sugar, health status, and lifestyle habits like smoking and healthy eating also play a role in ED,” says Dr. Arthur L. Burnett, Professor of Urology, Oncology, Cellular and Molecular Medicine at Johns Hopkins Medicine.

Normal healing time for men post-prostatectomy can be between 9 and 12 months. For some men, it may take 2 – 3 years to be able to have full erections. There are drugs, like Viagra, that can help with ED, but they may not necessarily help men get erections right after surgery. For “on-demand” erections, penile injection therapy and vacuum pumps can be helpful. Most men should steer away from a Penile Prosthesis if it is possible that their natural erections may recover after surgery, notes Dr. Burnett.

Erection recovery is likely, but people need to know what’s involved. There needs to be a long enough time for healing after surgery. A positive surgery is vital, but men also have some responsibility for improving sexual function. Men should stay in shape, workout, eat well, not smoke, get routine exams and learn to manage their stress levels.

It’s also of great value to know how the man’s sexual function was before his prostatectomy, notes Dr. Burnett. For many men, there were already issues with erections due to high blood sugar, high blood pressure, or being overweight. It’s important for couples to be honest about their sexual life before surgery. This will help you and your health care team craft a realistic plan for possibly dealing with ED after prostatectomy.