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Sexuality and Reproductive Issues (PDQ®): Supportive care - Health Professional Information [NCI] - Treatment of Sexual Problems in People With Cancer

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Providers can help educate couples by offering practical suggestions to overcome changes in responsiveness to sexual stimulation. Couples should allow plenty of time for sexual expression with sufficient foreplay to develop the fullest possible sexual arousal. For some couples, early morning may be a good restful time for sexual expression. Conditions that facilitate sexual pleasure should be explored and may include relaxation, dreams, fantasy, deep breathing, and recalling positive experiences with the partner.

Erection problems are the most common sexual dysfunction for which men seek help after cancer treatment. Many men with erectile dysfunction are able to have an orgasm with oral or manual stimulation; many partners are satisfied and orgasmic with noncoital stimulation. If the desire for intercourse remains, there are several treatment options available for erectile dysfunction, depending on the cause and degree of dysfunction. Only a small percentage of men with erection problems seek help.[7,8]

With the advent of sildenafil (Viagra), a phosphodiesterase-5 (PDE-5) inhibitor used to treat erection problems,[9] the percentage of men who seek treatment for erection problems has increased. Despite the publicity about the effectiveness of sildenafil, the drug works best in men with the mildest forms of erectile dysfunction. Many men will be unable to achieve adequate erections by taking this drug alone. The use of sildenafil enables about 72% of men with nerve-sparing prostatectomy and 15% of men with non–nerve-sparing prostatectomy to achieve erections sufficient for vaginal intercourse.

Radical prostatectomy can result in nerve injury, in addition to vascular and smooth muscle damage. Injury and prolonged flaccidity of the penis can result in hypo-oxygenation of the penile tissue, further complicating structural integrity and compromising future erectile function.[10] The process of healing after surgery takes approximately 3 to 6 months, and full recovery can be expected at 1 year postsurgery. However, during this time, it is important for men to continue to have erections to keep the tissue healthy with adequate blood flow and to improve their future ability to have adequate erections. Therefore, early penile rehabilitation is recommended.[11]

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