Prostate Powerhouse: Mastering Sexual Health amidst Prostate Challenges

Last Updated on July 7, 2024 by Max

Introduction

In men’s health, an often-underestimated powerhouse plays a pivotal role in our well-being: the prostate. Overlooked? Quite often. Underappreciated? You bet. Yet, its impact on our lives, particularly our sexual health, is profound.

In this enlightening journey, we delve into the intricate labyrinth of prostate health and its undeniable impact on sexual vitality. The goal? To empower you with knowledge, to navigate the complexities of prostate health, and to master your sexual well-being even amidst prostate challenges. This article is your roadmap, offering insights, actionable advice, and the latest research.

So, gentlemen, brace yourselves. It’s time to uncover the surprising truths about your prostate and your sexual health. The journey might be intricate, but armed with the right knowledge; you will be better prepared to face any challenges. Welcome to the enlightening world of prostate health and sexuality.        

Prostate Health and Sexuality: An Interconnected Relationship

Prostate health is deeply intertwined with sexual function, as numerous studies and expert opinions have demonstrated. The prostate, a walnut-sized gland beneath a man’s bladder, plays a crucial role in male sexual function. It produces the fluid that carries sperm during ejaculation and aids in urine control. However, various prostate diseases, including prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer, can significantly interfere with sexual function. This connection between prostate health and sexual function has been recognized since 1990 when the American Urological Association declared male sexual dysfunction as a recognized disease entity​.

Benign Prostatic Hyperplasia (BPH)

BPH, also known as an enlarged prostate, affects about half of men ages 51 to 60, with the rate steadily rising with age. As the prostate grows, it can constrict the urethra, causing urination problems, such as a hesitant, interrupted, or weak urine stream, dribbling, a feeling that the bladder doesn’t empty, and more frequent urination, especially at night​1​. An enlarged prostate can also directly impact a man’s sexual ability. Some common sexual side effects include erectile dysfunction (ED), reduced sexual satisfaction, problems maintaining an erection, and decreased libido​​.

The link between BPH and ED

BPH and ED are different conditions, but they can be connected. Although various health problems may cause ED, it can also be made worse by BPH. Some medications used to treat an enlarged prostate can cause ED, but some medicines used to treat ED can help improve symptoms of BPH. For instance, ED medications like vardenafil (Levitra), sildenafil (Viagra), and tadalafil (Cialis) have shown some success in treating enlarged prostates​.

Prostate Cancer and its impact on sexuality

Prostate cancer treatment can significantly impact a man’s sexual function, and these impacts can be divided into three groups: sexual desire, sexuality, and masculinity; erectile function; and ejaculation and orgasm. Various factors such as cancer status, mental well-being, medical conditions, and social circumstances can adversely impact male sexual function. 

Decreased libido, or reduced sexual desire, is another common issue. The physical discomfort caused by prostate conditions and the psychological stress of dealing with such conditions can lead to decreased sexual desire. Furthermore, treatments for prostate diseases, particularly hormonal therapies for prostate cancer, can also decrease libido.

It’s crucial for men to understand the interconnected relationship between prostate health and sexuality. Prostate diseases can significantly impact a man’s sexual function, leading to issues like erectile dysfunction and decreased libido. However, these issues can often be addressed with appropriate treatment and management, and men can lead fulfilling sexual lives. Always consult with a healthcare provider for advice tailored to your individual situation.

Navigating Prostate Disease Treatments: Implications for Sexual Health

Treatment options for BPH and their impact on sexuality

Treatment options for an enlarged prostate may include medications, surgical options, and lifestyle changes. Some medications include doxazosin, terazosin finasteride, dutasteride, and dutasteride-tamsulosin. However, these medications can lead to sexual side effects, including reduced sex drive and problems maintaining and achieving an erection​. If medication doesn’t alleviate the symptoms, surgical options may be considered. Some surgical procedures include TURP (transurethral resection of the prostate), TUIP (transurethral incision of the prostate), TUMT (transurethral microwave thermotherapy), and prostatic urethral lift. However, these surgical procedures, particularly TURP, can result in more sexual side effects, such as ED and ejaculation problems​​.

Interestingly, some studies have suggested that medications typically used to treat ED, such as vardenafil (Levitra), sildenafil (Viagra), and tadalafil (Cialis), may also help alleviate symptoms of an enlarged prostate. However, these medications are not without their own potential side effects and risks, so anyone considering them should consult with their doctor first​​.

Various treatments for prostate diseases, such as surgery, radiation, and hormone therapy, can significantly impact sexual function, including sexual desire, erectile function, and ejaculation and orgasm. Here’s a summary of how these treatments can affect sexual health:

Surgery

The Transurethral Resection of the Prostate (TURP), a standard surgical procedure for treating an enlarged prostate, is the most invasive option and can result in sexual side effects such as erectile dysfunction (ED) and ejaculation problems. Men who have undergone TURP have also reported dry ejaculation, where the semen enters the bladder rather than coming out of the penis during an orgasm​.

Radiation Therapy

Radiation therapy, often used to treat prostate cancer, can cause similar sexual health side effects. The severity and prevalence of these side effects can be greater if the radiation therapy is used as salvage therapy after the primary treatment has failed. However, more research is needed to understand the specific impact of radiation therapy on sexual health​​.

Hormone Therapy

Androgen Deprivation Therapy (ADT) is a standard hormone therapy for prostate cancer. Some clinical trials have shown that adding a second-generation androgen-receptor antagonist, such as enzalutamide, apalutamide, or darolutamide, can delay the time to metastasis and prostate-specific antigen (PSA) progression in prostate cancer​. This therapy can also lead to sexual side effects.

Regarding salvage therapy for recurrent prostate cancer, male sexual dysfunction is a common sequela following treatment, affecting sexual desire, erectile function, ejaculation, and orgasm​​. Current approaches to salvage therapy often include a combination of androgen deprivation therapy (ADT) with agents such as leuprolide acetate or bicalutamide, coupled with radiation therapy after the patient’s incontinence resolves (approximately three to six months after prostatectomy)​​. Adding second-generation androgen-receptor antagonists—such as enzalutamide, apalutamide, and darolutamide—can delay the time to metastasis and prostate-specific antigen (PSA) progression​​. Ongoing clinical trials are exploring new treatments and combinations of treatments for recurrent prostate cancer, hoping to improve survival rates while managing side effects​.

Effects of Enzalutamide (Xtandi), Docetaxel (Taxotere), and Hormone Therapy on Sexual Health

Enzalutamide (Xtandi) and docetaxel (Taxotere) are treatments used in prostate cancer therapy, often in conjunction with androgen deprivation therapy (ADT), which is a form of hormone therapy. The ADT is usually used 6 to 24 months after incontinence resolves from prostatectomy and is combined with radiation therapy. Enzalutamide and similar second-generation androgen receptor antagonists have shown promise in delaying the time to metastasis and PSA progression in castration-resistant prostate cancer. A Duke study involving enzalutamide in addition to ADT followed by salvage radiation showed a three-year PSA-progression-free survival rate of 53%, an improvement over the 45% rate using bicalutamide and radiation alone​.

Regarding Docetaxel (Taxotere), a chemotherapy agent that inhibits microtubule formation, it has been shown to prolong survival in men with metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer. The STARTAR trial investigates moving chemotherapy upfront with ADT, apalutamide, and salvage radiation, to improve the three-year PSA-progression-free survival rate to 75%​​.

However, these treatments (Enzalutamide, Xtandi, Taxotere, and hormone therapy) directly affect male sexual health. As is common with many prostate cancer treatments, they may contribute to sexual side effects such as reduced sex drive, problems maintaining an erection, and problems achieving an erection, but individual responses can vary greatly​.

Restoring Sexual Health After Prostate Disease Treatment

After treatment for prostate diseases such as prostate cancer or benign prostatic hyperplasia (BPH), restoring sexual health can be a complex process. Both the diseases and their treatments can significantly impact sexual function, including problems with sexual desire, erectile function, ejaculation, and orgasm​​.

Pelvic Floor Exercises

To improve urinary incontinence and sometimes to enhance sexual function post-prostate treatment, patients can start pelvic floor exercises. They involve contracting and relaxing the muscles that form part of the pelvic floor.

Medication

Several medications can help manage sexual health issues after prostate disease treatment. For example, medicines used to treat erectile dysfunction (ED), such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), have shown some success in treating symptoms of an enlarged prostate, potentially relieving both prostate and ED symptoms​​. However, it’s important to note that these medications can have side effects and may not be safe for all men, especially those with certain health conditions like heart disease or uncontrolled high blood pressure​​. Some medications used to treat BPH, like doxazosin, terazosin, finasteride, dutasteride, and dutasteride-tamsulosin, can also lead to sexual side effects, including reduced sex drive and problems with erections​​.

Psychotherapy and Sex Therapy

Psychotherapy and sex therapy can be beneficial for managing psychological aspects of sexual health after prostate disease treatment. Mental well-being plays a significant role in sexual function, and therapy can help address concerns about masculinity, sexual desire, and relationship issues that can arise after treatment​​.

Surgical Options

If medications are not sufficient to alleviate symptoms or if the prostate disease is severe, surgical options like TURP (transurethral resection of the prostate), TUIP (transurethral incision of the prostate), TUMT (transurethral microwave thermotherapy), and prostatic urethral lift might be the options. However, these procedures can also result in sexual side effects, such as erectile dysfunction and ejaculation problems​​.

Professional Support

It’s essential to open dialogue with healthcare professionals such as urologists, sex therapists, and mental health professionals who can provide guidance and support during recovery. They can help develop a personalized treatment plan and provide resources for physical, emotional, and relational aspects of sexual health.

Restoring sexual health after prostate disease treatment can be a long journey, and it may require trying different strategies to see what works best for you. A comprehensive and multidisciplinary approach is necessary to manage sexual health after prostate disease effectively.

Penile Rehabilitation After Salvage Therapy

Penile rehabilitation is a strategy used to restore erectile function and the ability to have coital sex after prostate cancer treatment. It usually involves interventions to promote regular erections, aiming to restore the natural part of the penis following nerve damage after surgery or radiation. Rehabilitation strategies can include medications like PDE5 inhibitors (such as Viagra, Cialis, and Levitra), vacuum erection devices, intraurethral suppositories, and penile injections.

While penile rehabilitation may be effective for restoring erectile function, there is a lack of consensus guidelines regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. There also seems to be a lack of effective treatments in other domains of male sexual function, underscoring the importance of psychological and sexual counseling in sexual rehabilitation. A comprehensive multidisciplinary approach is necessary to understand better and optimally assist men and their respective partners for better sexual health and activity​​.

Maintaining Intimacy: Communication and Connection

Open communication with your partner about sexual health changes and challenges is crucial for maintaining intimacy and connection. It’s important to remember that intimacy isn’t only about sexual activity but also emotional closeness, trust, and understanding. Here are some suggestions for maintaining intimacy and connection even when the sexual function is affected:

Open and Honest Communication: Discuss your feelings, concerns, and fears about changes in your sexual health with your partner. It’s essential to express the physical changes you’re experiencing and the emotional impact these changes might have on you. This can help alleviate anxiety and build understanding between you both.

Explore Different Forms of Intimacy: Intimacy is not only about sexual intercourse. There are many other ways to express and experience intimacy, such as cuddling, holding hands, kissing, and sharing quality time. It’s also about emotional closeness and mutual understanding. Exploring these forms of intimacy can help maintain a strong bond with your partner.

Seek Professional Guidance: A sex therapist or a counselor can provide valuable advice and techniques to manage sexual health changes and maintain intimacy. They can offer strategies for communication, emotional support, and alternative sexual practices.

Stay Positive and Patient: Changes in sexual health can be frustrating and challenging. It’s essential to remain patient with yourself and your partner as you navigate these changes. Maintain a positive outlook and remember that it’s a journey that you’re on together.

Maintain Physical Health: Regular exercise, a balanced diet, and adequate sleep can improve your overall health and well-being, which can positively affect your sexual health.

Consider Medical Treatments and Therapies: If sexual health challenges stem from medical issues like erectile dysfunction or an enlarged prostate, discuss with your healthcare provider about potential treatments or therapies. Medications or surgeries may help alleviate some physical symptoms, and therapies like pelvic floor exercises can also be beneficial.

Explore Sensate Focus Exercises: This involves a series of sexual exercises focusing on touch and the giving and receiving of pleasure rather than performance and intercourse. It can help to rebuild intimacy and connection.

Remember that every couple is different, and what works for one may not work for another. The key is to keep the lines of communication open, be patient and understanding with each other, and seek help when you need it. Your relationship can still be satisfying and fulfilling, even if sexual function changes.

Emerging Trends and Breakthroughs

In the field of prostate diseases and their impact on sexual health, ongoing developments, and emerging trends show promise.

Clinical trials at Duke are exploring how aggressively to implement salvage treatment of biochemical recurrence. They are testing new treatments that include androgen deprivation therapy (ADT) coupled with radiation therapy and the addition of second-generation androgen-receptor antagonists such as enzalutamide, apalutamide, and darolutamide. These have been shown to delay metastasis and prostate-specific antigen (PSA) progression in castration-resistant prostate cancer. For instance, Duke’s STREAM trial showed that patients treated with enzalutamide added to ADT had a three-year PSA-progression-free survival rate of 53%, which improved over the 45% rate using bicalutamide and radiation alone​​.

The STARTAR trial (NCT03311555) tests the efficacy of moving chemotherapy up front to prevent time to metastasis. This treatment includes nine months of ADT and apalutamide, salvage radiation, and six cycles of docetaxel. The goal is to improve the three-year PSA-progression-free survival rates from 53% (achieved in a previous trial using enzalutamide and radiation alone) to 75%​.

The NRG GU-002 trial: Features six months of ADT, bicalutamide, and radiation therapy and then compares six cycles with and without docetaxel. These trials aim to prevent recurrence and keep patients’ tumor volume and PSAs low​.

Salvage Prostatectomy: Salvage prostatectomy, an option for patients with recurrent prostate cancer after radiation therapy, has significantly increased survival rates. However, it’s important to note that this procedure carries a significant risk of complications, including urinary incontinence and erectile dysfunction. It is typically considered only when there’s a high probability of localized disease​.

High-Intensity Focused Ultrasound (HIFU): This is a newer technique used to treat prostate cancer. It uses ultrasound waves to heat and destroy cancer cells in the prostate. This technique can reduce the risk of side effects associated with other treatments, such as urinary incontinence and erectile dysfunction​4​.

Proton Therapy: This type of radiation therapy uses protons instead of X-rays to treat cancer. It’s more precise and can minimize damage to healthy tissues and organs around the prostate, potentially reducing side effects such as erectile dysfunction. More than 1.5 million men have undergone proton therapy for prostate cancer worldwide​​.

A study conducted with the Rezum treatment, a minimally invasive water vapor therapy for BPH, showed promising results. In the three-year follow-up of this treatment, 80% of patients have not experienced a biochemical recurrence​​.

While strategies are available for preserving and recovering sexual function, the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy isn’t well defined. Therefore, a comprehensive multidisciplinary approach is often recommended, involving psychological and sexual counseling and medical treatment​​.

Conclusion

In conclusion, maintaining both prostate and sexual health is a multifaceted process that includes understanding the relationship between the prostate and sexual function, recognizing symptoms of prostate-related problems, and being aware of the various treatment options available.

Understanding the Prostate. The prostate is a small gland that plays a crucial role in male reproductive health. Conditions like benign prostatic hyperplasia (BPH) and prostate cancer can significantly impact a man’s life, leading to urinary and sexual problems​​.

Prostate Conditions and Sexual Health. Prostate issues can directly affect sexual health, leading to problems like erectile dysfunction (ED), reduced sexual satisfaction, and decreased libido. Some medications used to treat an enlarged prostate can also cause ED, although ED medications may provide some relief from prostate symptoms​​.

Treatment of Prostate Conditions. Treatments for prostate conditions can range from medications to surgical procedures, depending on the severity of the symptoms and the specific condition. Some medicines may lead to sexual side effects, which should be discussed with healthcare providers​.

Prostate Cancer and Sexual Health. Prostate cancer and its treatments can significantly impact sexual health, and men may experience changes in sexual desire, erectile function, and ejaculation. Various treatment strategies exist to preserve and recover sexual function, and a comprehensive, multidisciplinary approach is often necessary for optimal outcomes​.

Maintaining Intimacy. Open communication with your partner about changes in sexual health is crucial. Intimacy involves emotional closeness, trust, and understanding, and there are many ways to maintain this, even when sexual function is affected.

Proactive steps toward maintaining prostate and sexual health are essential. Regular physical exercise, a balanced diet, and sufficient sleep can positively affect your overall and sexual health. Exploring different forms of intimacy and staying positive and patient can also contribute significantly to maintaining a fulfilling relationship.

Finally, regular check-ups and discussions with healthcare providers must be considered. Early detection of prostate issues can lead to more effective treatments and better outcomes. Regular conversations with your doctor about any changes in urinary or sexual function are essential for maintaining both prostate and sexual health. Remember, your healthcare provider is there to help and guide you through any health concerns you may have.

Resources and Further Reading

For further reading, consider the following resources:

• Websites: Mayo Clinic (www.mayoclinic.org) 
• National Cancer Institute (www.cancer.gov)
• American Cancer Society (www.cancer.org).
• Medical Journals: 
• “The New England Journal of Medicine,”
• “The Journal of Clinical Oncology,” 
• “The Lancet Oncology”.
• ZERO Prostate Cancer for resources related to managing a prostate cancer diagnosis.

Please consult with a healthcare professional for personalized advice.