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The New Us: Sexual Rehabilitation and Regained Intimacy

The New Us: Sexual Rehabilitation and Regained Intimacy

Facing the negative impact of cancer therapy on sexual life: It is well established that the treatment of many cancers show inevitably negative consequences on the sexuality of both partners. This is frequently found in male patients of prostate, bladder, rectum and testicular cancers as well as female patients with breast, uterus, vaginal and ovarian cancers. It is the responsibility of the counselling physicians to prepare the couple gently on the possible negative consequences in the various sexual domains by the treatments in question and to give them at the same time a positive outlook on available treatment options to overcome these negative consequences.

Prevention and treatment of sexual disturbances after cancer treatment:

  • Males: Especially, the pelvic surgical procedures aiming at curative treatment of prostate, bladder or rectal cancer are burdened with a high rate of both erectile and ejaculatory/ orgasmic problems affecting between 20-90% depending on the procedure performed. PDE 5 inhibitors are the first line treatment of choice to overcome the erectile problems in men and for those in whom oral treatment fails, a transurethral or intracavernous application of PGE 1 (Alprostadil) may finally offer a reasonable solution. About 20-30% of all men after radical prostatectomy have climacturia, i.e. an involuntary loss of urine during sexual intercourse/orgasm, which may become a huge problem for both partners but can relatively, easily avoided by application of a small constriction bandage on the penile base. In men, after testicular cancer treatment, hypogonadism may occur as a consequence and should be diagnosed timely and managed by a regular assessment of the hormonal parameters. Loss of emission/ ejaculation after extended retroperitoneal lymphadenectomies may be successfully managed with oral drug treatment with imipramine or midodrine or even with external ejaculation provoking devices such as Ferticare┬« or Viberect┬«
  • Women: Many women suffer from lubrication disorders after genital cancer surgery, causing intolerable pain during vaginal intercourse. Neutral lubricants or even topical oestrogen creams where possible are easy measures to overcome this problem. Potential hormonal deficits must be considered and, if possible, replaced either by local or systemic hormonal substitution therapy, provided the underlying cancer does not preclude these options. Finally, narrowed vagina as a consequence of surgery or radiation therapy may be amenable to regular, mechanical widening procedures or in exceptional cases, also to plastic surgery.
Conference: WAS Singapore 2015