In today’s podcast, Dr. Leslie Schover discusses her article, “Sexual Healing in Patients with Prostate Cancer on Hormone Therapy," from the 2015 ASCO Educational Book.
ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.
This podcast is part of series featuring articles from the 2015 ASCO Educational Book. Produced annually, the Educational Book is a collection of articles written by ASCO Annual Meeting faculty and leaders from ASCO's other meetings. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology, and serves as an enduring resource long after the meeting concludes.
In today's podcast, Dr. Leslie Schover discusses her article, “Sexual Healing in Patients with Prostate Cancer on Hormone Therapy.” Dr. Schover is a Professor of Behavioral Science with a dual appointment in the Department of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center. In this podcast, Dr. Schover discusses some of the sexual problems that can be caused by prostate cancer treatment, as well as options available to help a man and his partner compensate for those side effects. ASCO would like to thank Dr. Schover for discussing this topic.
Dr. Schover: Hello. My name is Dr. Leslie Schover, from the University of Texas MD Anderson Cancer Center. I'll be sharing some of the key points from my 2015 Educational Book article titled “Sexual Healing in Patients with Prostate Cancer on Hormone Therapy,” and talking about the implications for patients. Men with prostate cancer have a high rate of sexual problems because of their age, other illnesses like heart disease or diabetes, and often because they have damage from their initial surgery or radiation for prostate cancer. Androgen deprivation therapy, also known as hormone therapy, adds to the problems because it decreases a man's levels of the hormone testosterone. Testosterone helps trigger sexual desire in the brain. With low testosterone, most men also have trouble with erections, which may lead to shrinking of tissue in the penis that normally fills with blood when a man is sexually excited.
Men are more bothered about the damage to sexuality if they had a good sex life when they were diagnosed with prostate cancer and have a sexual partner who still wants to stay active. Sexual counseling can help a man, or both partners in a couple, learn how to compensate for hormone therapy's effects. You may need more intense sexual stimulation, both mental –like fantasies or videos—and physical –more hand caressing or oral sex. Sex therapy also teaches ways to improve sexual communication and to avoid feeling anxious or getting distracted by negative thoughts during sex. Some men also try a medical treatment to restore better erections. Men who have sex with men have some special issues, including a greater sense of loss about having dry orgasms, with little or no semen coming out. Some also need very rigid erections if they prefer to be the partner who penetrates for anal intercourse.
Almost all men on hormone therapy for prostate cancer have sexual problems. Even men who only took hormones for a few months during radiation therapy may have permanently decreased desire and erections. Intermittent androgen deprivation, i.e., going on hormone therapy but taking a break from it when PSA is very low, allows erections and desire to recover during periods off treatment. Unfortunately, it can take a few months for testosterone to recover, and the more times a man goes on and off hormones, the less likely that his sex life will improve during his hormone vacations.
The oncology team needs to give a message of hope. Men often feel like less of a man on hormone therapy. However, manhood depends on life experiences, not on hormone levels or erections. Men can take care of a partner by giving her sexual pleasure through manual or oral caressing. A man's own sexual pleasure may improve if he can give up worries about performing sexually and focus instead on sharing closeness and pleasure with a partner. Vibrators can help if it takes a long time to reach orgasm. Some men feel it's worthwhile to use a medical or surgical treatment to improve their erections, even if desire is not strong.
Remember that gay men may have special concerns about being attractive to partners or needing to change their preferred sexual practices. It's not possible to restore semen at orgasm, but it is important to know that a dry orgasm can still be satisfying. For men who leak urine during sex, a special restricting ring around the base of the penis can help you stay dry. If your oncologist, nurse, or social worker doesn't ask how you're doing with your sex life, don't be shy about bringing up your questions or concerns. Sexual health is one important part of quality of life, and you deserve some help to make your sex life better. Please view my article online at asco.org/edbook for a more in-depth discussion of this topic. Thank you.
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