Sexual Activity After Prostate Surgery

Surgery for the removal of the prostate is a common course of treatment for prostate cancer. Common side effects with surgery include urinary incontinence (leakage) and erectile dysfunction, both of which can have an impact on resuming sexual activity. Erectile dysfunction can make it difficult for an individual to initiate and experience fulfilling sexual activity, while incontinence can have an impact on an individual’s confidence and comfort while engaging in sexual activity after prostate surgery. 

Urinary incontinence occurs post-surgery because people with penises have two urinary sphincters (muscles that open and close to allow urine to pass). One of the two urinary sphincters is located in the prostate. While surgeons try to be careful when removing the prostate tissue, the goal is to remove cancerous tissue, so often this sphincter is affected. The other sphincter is located in the pelvic floor muscles, which are most often unaffected by surgery. With training (strengthening and coordination), the muscles around this sphincter can be strengthened to help with continence post-surgery. 

Erectile dysfunction also occurs because of tissue removal during surgery. Nerves that are responsible for erections run from the spinal cord to the penis alongside the prostate. These nerves are also closely connected to the blood vessels that also allow for erections to occur. Depending on how the cancer presents, as well as other factors, the surgeon may attempt a “nerve sparing” procedure rather than a “non-nerve sparing” procedure. While the chances of being able to regain the ability to have an erection are higher with a nerve sparing procedure, some individuals who have the non-nerve sparing procedure are able to achieve an erection with rehabilitation and time. 

Pelvic health physiotherapy can help with both urinary incontinence and erectile dysfunction. Strengthening the pelvic floor muscles helps with urinary incontinence by making the urinary sphincter in the pelvic floor muscles stronger and better able to prevent leakage. Pelvic floor strengthening (“Kegels”) can also help with erectile function as strengthening exercises help increase blood flow to the area, which is needed by nerves as they recover. Like when training any other muscle group in the body, we want to ensure that the muscle can relax fully, as well as contract fully, so working with a pelvic health physiotherapist can help you to ensure that you are performing the exercises properly, as well as help to decrease any additional tension held in the muscles. 

Your pelvic health physiotherapist can also provide education and instructions on how to use a vacuum penis pump to aid in erection recovery. Prior to surgery, while sleeping, individuals would have multiple erections per night. These nocturnal erections help keep the penis tissues elastic so they can stretch easily when an erection occurs. During recovery post-surgery, nocturnal erections are likely not occurring. The regular use of a vacuum penis pump can help to ensure that the tissues are able to expand during an erection to help optimize sexual activity after prostate surgery. 

Research is also starting to show that pelvic health physiotherapy prior to surgery results in improved outcomes during post-surgical rehabilitations, which is all the more reason to ensure that you have a pelvic health physiotherapist on your health care team when undergoing prostate surgery.

 

Sources

  1. https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0546-5

  2. https://www.researchgate.net/publication/341400589_Pelvic_Floor_Muscle_Training_and_Erectile_Dysfunction_in_Radical_Prostatectomy_A_Randomized_Controlled_Trial_Investigating_a_Non-Invasive_Addition_to_Penile_Rehabilitation

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