  
|  |
|
|
|
Reviewed by Dr John Dean, specialist in sexual medicine
|
As with erectile dysfunction (ED) in general,
when it occurs in association with cancer or other serious
illness there is usually a mixture of physical and psychological
causes.
Quite probably there will be anxiety about
the cancer and what the future holds, and that anxiety can
often contribute towards the development of ED. Revealing
these anxieties and discussing them is part of treating cancer and the ED.
 |
 |
| Anxiety about cancer can be a major
factor in causing ED. |
|
|
The two types of cancer most
likely to be associated with ED are:
-
prostate cancer
-
cancer of the lower bowel (rectum).
It is more common for the treatments for these
cancers to cause ED than the cancer itself.
Prostate cancer
The prostate gland is located
underneath the bladder and it produces a
fluid that is part of semen.
Running through the
middle of the prostate is the urine channel from the
bladder. This means prostate disease often disturbs
bladder behaviour.
Prostate cancer is now the
commonest cancer in men and its frequency is increasing.
Partly this is because men are living
longer, and prostate cancer has always been more
common in older men.
There
are many types of prostate cancer treatment. The type used depends largely on the stage of the disease.
Radical prostatectomy
A potentially curative treatment, radical prostatectomy is
an operation to
remove the prostate gland by surgery.
However, this carries a
fairly high risk of disturbing the nerves that go to
the penis and therefore can cause ED.
It's difficult to say the percentage of
men who suffer ED after the operation because the range
of results published in the medical literature
varies widely – from as low as 10 per cent to as high as
90 per cent.
The risk of developing ED is reduced
when nerve-sparing procedures are used. This is where
the surgeon makes a special effort to identify the
nerve bundles to the penis as they pass alongside
the prostate.
Even with the surgeon’s best efforts, it
is not always possible to avoid nerve damage.
ED treatments are
potentially effective in men who have had a radical
prostatectomy - although they may not all be equally
so.
Oral therapy (ie tablets) seems to be less effective in men who
have had non-nerve sparing surgery.
Trial and error
might be required to find the best treatment for an
individual.
Transurethral resection of prostate
Some men with poor health or more
advanced cancer will have less destructive surgery, called
transurethral resection of prostate (TURP).
The aim is to relieve bladder symptoms and improve
urinary flow rate, rather than 'cure' the
cancer by removing the prostate gland completely.
In this surgery,
the nerves are rarely affected and standard ED therapies
work quite well. (Note that TURP is also a common and effective treatment to reduce the size of non-cancerous enlargement of the prostate gland. So-called benign enlargement of the prostate gland is common in men from middle age onwards.)
Non-surgical treatments for prostate cancer
Some
non-surgical treatments for prostate cancer can also
cause ED and loss of sexual desire.
Leuprorelin and
goserelin are injections used to suppress prostate
cancer growth by interfering with testosterone
production. Casodex is a tablet that blocks the
effects of testosterone in various tissues.
All have
the potential to cause ED and loss of sexual desire,
although this is less likely with Casodex.
Bowel cancer
Cancer of the bowel is another common cancer.
If diagnosed early, it can have a very good
outcome.
The bowel is very long. It is usually
possible to remove the section that contains the cancer,
and then join the ends of the bowel back together
again. This avoids the need for a ‘bag’, or
‘stoma’, on the tummy wall.
The main exception is when
the bowel cancer arises in the lowest part – within
a few centimetres of the anus. If this is the case, there may not be sufficient healthy bowel
below the cancer to allow the surgeon to join
together the cut ends. A stoma is then necessary.
Bowel cancer in such a low position means it is usually
impossible for the surgeon to avoid damaging some of
the nerves in this region - and these will include the
nerves to the penis. Erectile dysfunction can
therefore be a consequence.
However, as with prostate
cancer, treatments for ED may work
and the most effective one has to be chosen on an
individual basis.
General issues
Although there are hundreds of different cancers, and there have been great leaps forward in
treating many of them, for most
people the ‘Big C’ is nearly always viewed with
alarm.
Once a precise diagnosis is reached and the exact
outlook is worked out, many people find things are not quite so bad as they first
appeared. Even so, there is no denying the impact the disease has on the individual and their family.
It's common for people with cancer to find their life revolves around
medical investigations and treatment to the extent that
everything else becomes secondary.
Studies have
found
that after a diagnosis of cancer, issues such as sexual function
get little or no attention - either from the individual themselves or from
the medical and nursing personnel involved with their
treatment.
It’s not that everyone believes sex
isn’t important to someone with cancer, it’s just that it
gets overlooked among the detail of everything else that’s
going on.
Cancer can be a
frightening illness until it is fully understood what
effect it will have on your life. During this
initial period of anxiety, there may well be very little
desire for sex.
Other people may respond differently,
though, and find the intimacy of sex a comfort during
this difficult time.
It's likely that
once all the facts are known and treatment is under way,
a desire for sex will come - although this doesn’t
necessarily mean it will be easy to resume a
sexual relationship.
Relationship issues
Any serious illness can cause anxiety and
uncertainty.
As far as sex is concerned, there could be a
fear that:
-
sex could cause physical injuries
-
sex could cause the illness to break out again
-
the
cancer could be contagious or sexually transmitted.
These
kinds of worries are usually completely without foundation,
but they can make a sexual relationship come to a
standstill.
It's vital for couples in this situation to
talk to each other, and to a doctor, about their concerns.
Usually it will be enough just to be reassured that all is
well, but sometimes the couple will benefit from being
referred to a doctor or therapist specialising in
psychosexual medicine.
Can it sometimes be dangerous to have sex
when you have cancer?
Almost
never. Unless the cancer affects the genital area, there
is usually no reason why the individual shouldn't have sex, and
even then it usually won't be a problem.
While it’s true that
such a general statement needs to be qualified with the
caveat to always check with your doctor first, there are
very, very few people for whom sex would present any
possible difficulties with their health.
Cancer and fertility
It's important people are kept well
informed about their illness and its consequences in the
short and the long term, including the possible impact it
will have on their sex life or fertility.
In recent years
some people undergoing cancer treatment have elected to
freeze some of their eggs or sperm as an insurance against
the difficulties with conceiving that might result from
cancer treatment.
This is an area that gives rise to much
debate, particularly on its ethical aspects, but it is
likely to become an increasingly common
practice.
Support
There are many
excellent support organisations for people with cancer.
Apart from useful practical advice on the many
aspects of living with cancer, it can be a great help to
share a problem with others who have gone, or are going,
through the same experience.
Some of the major support
groups include:
-
Cancer BACUP: http://www.cancerbacup.org.uk
-
Cancer Research UK: http://www.cancerresearchuk.org
-
The Prostate Cancer Charity: http://www.prostate-cancer.org.uk, helpline 0845
300 8383.
The GP and nurses in primary care and the staff of the palliative care team are all
there to help, too.
Although the issue of sexuality can be
overlooked in cancer, it may only require an initial word to
the doctor or nurse for it to be recognised and then
treated well.
|
|
Based on a text by Christine Webber, psychotherapist and Dr David Delvin, GP and family planning specialist
|
Last updated 01.07.2004
|
 |
|
|
 |
| |      |
|
