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Sexual dysfunction after radical prostate removal common but little considered
Many patients fear the loss of a fulfilling sex life after prostate cancer surgery. This is a justified concern, as a significant proportion of men who have undergone surgery suffer from sexual dysfunction, as a recent Danish study was able to show. But patients are often only informed about impotence before radical surgery.
"Preservation of potency is by no means a guarantee of a fulfilling sex life, says Dr. Pedram Derakhshani. Even if erectile function should be preserved after radical prostatectomy, men's sex lives are often severely impaired, says the urologist at the West German Prostate Center in Cologne. Involuntary urine leakage during orgasm and sexual stimulation, a painful climax or penile shortening can significantly disrupt sexuality - shame and unwillingness are often the result.
Unpleasant consequences of the surgery
While such problems are usually kept quiet by many urologists, a Danish research team has listed in detail all the sexual disorders that radical removal of the prostate can entail in a systematic review1. For example, up to 93 percent of men suffer from incontinence during orgasm or sexual stimulation. A weakening of the sensation of orgasm is perceived by almost 80 percent of the operated men. Pain during orgasm also occurs in almost a quarter of patients after surgery. And depending on the study, 15 to 68 percent of the men notice that their penis has become shorter after the operation, and in 16 percent penis curvatures are also the result of the operation.
"The frequent occurrence of sexual problems after surgery is all the more serious because many men with prostate cancer still undergo unnecessary surgery," Dr. Derakhshani emphasizes. Thus, according to the recommendation of the guidelines, it may often be sufficient for men who have low-risk prostate cancer to monitor the tumor closely (active surveillance). Should treatment nevertheless become necessary, the focus must be increasingly directed toward achieving optimal cure rates with minimal side effects, according to the Cologne urologist. "It is therefore our duty to make patients aware of equally effective but gentler treatment methods such as brachytherapy (internal radiation) in advance of therapy."