Sexual rehabilitation after male-specific cancer
A Mediclinic urologist and a psychologist discuss some of the complexities of sexual rehabilitation after male-specific cancer.
The treatment of any cancer is dependent on the stage of the cancer, says Dr Kabo Kenneth Ijane, a urologist at Mediclinic Muelmed. For example, with testicular cancer, if only one testis is removed there will be no effect on erectile function. However, if chemotherapy is needed, erectile function is often affected.
But it’s not only the external sexual features that are integral to a man’s sexual health and sexuality. The nerves connecting to the penis are attached to the prostate gland’s outer layer, which means prostate disease and the treatment thereof can negatively impact on erectile function.
‘All prostate cancer treatments affect erectile function one way or the other,’ says Dr Ijane. ‘For example, some treatments for prostate cancer include blocking the secretion and use of testosterone by the body, which essentially creates a state of medical castration.’
With modern prostatectomies, some surgeons practise nerve-sparing techniques to limit erectile dysfunction, but the nerves regulating penile erection are always traumatised to some extent*, even if they are preserved during surgery.
Dr Ijane cautions that sexual function before treatment will also determine whether sexual function is regained after cancer treatment. Post-operative treatment may include medication or medical devices to help restore erectile function.
If possible, sexual rehabilitation should be started even before treatment.
‘The patient and the treating doctors must have a clear and upfront discussion on the goals of treatment, expectations and general outcomes of any treatment before it is started,’ he cautions. ‘This will ideally involve the sexual partner(s)’.
Unfortunately, in advanced disease, the prospect of regaining erectile function is minimal – and this is where counselling on an ongoing basis is indicated. ‘Sexuality is as much a mental issue as it is a physical one,’ affirms Dr Ijane.
‘Since sexuality is such a big part of who we are, it is no surprise that a threat to sexual functioning would be concerning to anyone,’ adds Danie Breedt, a psychologist at Charis Psychological Services near Mediclinic Meulmed. Danie helps patients with physical disability regain their sense of self after a disease or accident.
‘The counselling process focuses on educating people on what sexuality really entails, and coming up with a plan that can work for each person individually. Challenging myths and opinions about sexuality is essential to laying the foundation for intimate relationships,’ says Danie.
‘There are numerous options to overcoming the perceived barriers: all that is needed is knowledge, communication and an open mind.’