Helping Men with Cancer Restore Sexual Health
Up to 90% of men treated for prostate cancer and nearly half of all men treated for cancer experience erectile dysfunction or other sexual health challenges, yet these issues are frequently omitted from clinical discussions. According to Theresa Callard-Moore, PhD, LISW, a psychotherapist at the Cleveland Clinic, the lack of communication often leaves patients to suffer in silence, potentially deterring some from pursuing necessary cancer therapies due to fears regarding their future quality of life.
Did You Know? Patients often do not need to wait for a full recovery to address sexual health, as improvements in function typically occur one to two years after the completion of cancer treatment.
Why sexual health remains a hidden clinical issue
The barrier to addressing sexual dysfunction is often rooted in a combination of social stigma and clinical time constraints. Dr. Callard-Moore notes that many patients were not provided with comprehensive sex education, making it difficult to initiate vulnerable conversations about their bodies and pleasure. Furthermore, medical providers may avoid the topic due to the pressure of time or a lack of specialized knowledge regarding sexual health interventions.
Expert Insight: The systemic silence surrounding sexual side effects suggests that the current cancer care model may be prioritizing survival at the expense of long-term intimacy. By failing to integrate these discussions into standard care, providers miss opportunities to mitigate the psychological distress that often accompanies physical dysfunction.
Strategies for improving communication
To bridge this gap, Dr. Callard-Moore encourages healthcare providers to adopt the PLISSIT model, which emphasizes giving patients explicit permission to discuss their concerns. By asking open-ended questions about sexual health, clinicians can create a safe environment for patients to disclose issues. This approach allows providers to refer patients to sex therapists or pelvic floor physical therapists, who can offer tailored support for concerns ranging from incontinence to erectile dysfunction.
Treatment options for sexual function
Medical interventions for sexual dysfunction after cancer treatment are varied and often effective. Nerve-sparing surgical techniques are utilized during procedures, such as bladder cancer surgery, to help preserve erectile function. For patients experiencing erectile dysfunction, treatments include:
- Oral medications like sildenafil and tadalafil, which are effective in approximately 60% of cases.
- Medical-grade penile vacuum pumps that use a band to maintain an erection.
- Prescription penile injection therapy, which introduces a vasodilator to the base of the penis.
- Penile implants, which may be considered as a permanent surgical alternative when other methods fail.
What may happen next
As academic medical centers prioritize a culture of acceptance, more oncology and urology departments may begin to integrate sex therapy into the standard survivorship care plan. Future clinical approaches could see providers raising these topics at multiple stages—from initial diagnosis to post-treatment recovery—to ensure patients are aware of their options. This proactive communication may help reduce the anxiety that leads to the “fight or flight” response, which itself can further exacerbate sexual dysfunction.
Frequently Asked Questions
What is the PLISSIT model?
It is a communication tool used by providers to initiate conversations about sexual health. It centers on giving patients the permission to discuss their concerns in a safe space.
Are penile injections the same as platelet-rich plasma (PRP) injections?
No. Prescription penile injection therapy involves using a vasodilator to aid in erections, whereas PRP injections have not been scientifically proven effective for this purpose.
Can men still experience pleasure if they have erectile dysfunction?
Yes. According to Dr. Callard-Moore, men can still have an orgasm without an erection, and there are many pleasure-centered approaches that do not rely on erectile function.
Have you discussed your long-term quality of life goals with your care team?