Definition sexual rehabilitation
Sexual rehabilitation is a process to restore sexual function that is often affected by prostate cancer treatments, which are surgery, either open or robotic radical prostatectomy, radiation therapy, brachytherapy or androgen deprivation therapy (ADT).
Sexual changes and outcomes
The sexual dysfunctions that may occur after these treatments include erectile dysfunction, loss of ejaculation, shortened penis and climacturia (passing of urine during orgasm). Loss of libido occurs particularly with ADT.
The outcome of sexual function after treatment depends on the age of the patient, the level of sexual function present before treatment and in the case of surgery, the sparing of the nerve bundles (better outcome if both sides are spared). Even if the erection nerves are spared, nerve paralysis (neuropraxia) may delay return of natural erectile function. Neuropraxia often occurs after surgery, hopefully a temporary situation.
Surgery tends to result in immediate loss of erections, whereas radiation and hormone deprivation treatments may result in a delayed loss of erections, up to 6 months after treatment. Sexual rehabilitation addresses these sexual dysfunctions, especially erectile dysfunction, that men may experience as a result of treatment for prostate cancer. It is an important part of the holistic care of men undergoing treatment.
There is evidence that the earlier the erectile dysfunction is treated, the better the chance of a return of erections. If natural erectile function returns after treatment, the quality of the erections may not be as good as in the past. Erections may take up to 3 years to recover, but usually an indication of the outcome is seen at 18 to 24 months.
Penile injections: erections can be induced within 2 to 3 weeks of surgery with penile injection therapy using alprostadil (Caverject Impulse™) or compounded alprostadil, phentolamine and papaverine known as Trimix. The penis is initially injected with a low dose of alprostadil, about 2.5 to 5 mcg once or twice a week. The early and regular “exercising” of the penis to erection has been shown to expedite the return of erections (but only when the erection nerves have been saved). This exercising regime can be with your partner or by yourself.
Penile injection treatment has been safely used for many years but sometimes its use is painful due to a “chemical post-injection pain”. Care must be taken with the amount injected to avoid a prolonged erection known as priapism and there is a risk of scarring occurring in the penile tissues.
This “exercising” regime allows oxygenation of the erection tissues thus minimising the risk of deterioration of these tissues due to lack of use and low oxygen (hypoxia) levels. If there appears to be an improvement in natural erections whilst on injection therapy, oral treatment can be tried about every 3 months.