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ED, Incontinence After Prostate Surgery: What Can a Partner Do?
January 10, 2019
This is the first of a two-part series on the effects of prostate cancer on relationships.
Ask any prostate cancer survivor and he’ll tell you there’s no price he wouldn’t pay to be cancer-free. Let’s start with the surest way to cure prostate cancer when the disease hasn’t spread: Removal of the walnut-size gland and surrounding tissue in a procedure called a radical prostatectomy.
The price many often pay, at least initially, is dealing with the surgery’s side effects, including erectile dysfunction and uncontrollable dripping or leaking of urine.
Here’s how a wife or partner can help a man after prostate surgery:
Erectile Dysfunction
Eighteen months after a radical prostatectomy, close to 60 percent of men said they couldn’t get an erection, according to a study published by the Journal of the American Medical Association. After two years, the percentage dropped to 41.9 percent.
Things do get better, but it takes time.
“Having realistic expectations about sexual functioning after surgery is critical,” says Dr. Ila Sabino, a Tallwood Men’s Health clinical health psychologist.
Because prostate cancer patients are typically at least 60 years old, many have already experienced erectile dysfunction, whether caused by medications, heart disease, high blood pressure or other health issue. Even if a man can achieve an erection after a radical prostatectomy, ejaculation is impossible because the seminal vesicles are removed in the surgery.
“This can have a psychological impact on men,” says Dr. Sabino, “who feel that ejaculating is very important and the absence of fluid means they aren’t a ‘real man.'”
A decrease in libido is a common byproduct of erectile dysfunction, says Dr. Sabino, which only amplifies the erectile dysfunction.
A partner should encourage the man to follow his doctor’s recommendation of penile therapy, using an oral drug called a PDE5 inhibitor that, following sexual stimulation, increases blood flow to the penis and causes an erection.
Also encourage him to keep an open mind about other treatments, such as penile injections.
“They do work,” says Dr. Sabino. “A recent study showed that men are more likely to use this treatment if their partner was interested in maintaining a sexual relationship.”
In another study, 35 percent of men who didn’t respond to oral medications declined other treatment, often leaving it to the female partner to seek, and accept, help. Many couples ultimately fail to find a new way of being sexual when intercourse is no longer possible. At that point, a sex therapist can help.
“It’s a solution-focused approach that stresses communication and trying new behaviors,” says Dr. Sabino. “It does not involve nudity or being sexual in the session. Therapists who treat these issues take a broad and holistic approach in treatment.”
Bladder Control
Urinary incontinence, or leakage, can turn a man’s life upside down. The fear of unintentional loss of urine can make you drop out of the summer golf league. It can make you fear going to an outdoor wedding. It can make you think twice about sexual intimacy. Yes, it can be embarrassing.
Most men regain bladder control within a year after a prostatectomy. But that’s 12 months of frustration and suffering.
“Men report feeling dirty or childlike and understandably dislike wearing the pads or diapers required to manage leaks,” says Dr. Sabino. “Some want to restrict social activities out of fear of embarrassment, which can be hard for the partner.”
Dr. Sabino’s recommendations:
- Be understanding of what is happening and positive that things will improve.
- Offer to buy pads or diapers.
- Cover the bed with plastic or rubber protective bedding to protect the mattress.
- Keep things in perspective: Accidents happen; everything can be washed.
- Use humor.
Next: How to get through prostate cancer, together. Click here.
To find out more about behavioral health services at Tallwood Men’s Health, click here. Or call 860.678.5700 for more information.