Overcoming Prostate Cancer: Overcoming Issues with Intimacy with Dr. Jeffrey Albaughhttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=90It can be very hard to return to your “normal” life after undergoing prostate cancer treatment, and learning to cope with many of the side effects can be challenging and stressful. Along with urinary and bowel discomforts, a man’s sexual health can also be impacted by treatment. Jeffrey Albaugh, PhD, answers your questions about sexual health concerns after undergoing prostate cancer treatment, including erectile dysfunction, fertility issues and pain management. Your participation and early questions are welcomed.Copyright 2014 NorthShore University HealthSystemPost at 10:47 AMAngela: Welcome! Today’s chat: Overcoming Prostate Cancer: Overcoming Issues with Intimacy will begin shortly. Please start submitting your questions and Jeffrey Albaugh, PhD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our, <a href=" /community/blogs/blog.aspx?blog=3&post=132"> recent blog post about Common Sexual Health Concerns for Men and Women. </a>http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9010:47 AMPost at 11:09 AMGregory: I will be undergoing surgery for my prostate cancer by the end of the year. What expectations should I have on how this surgery will affect my sex life?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): This is a great question. There are several things that typically change after prostate removal. The prostate is part of the reproductive and sexual systems of your body, so changes should be expected in several ways. Most of the ejaculate comes from the prostate and the prostate serves to mix and help ejaculate to move down the urethra and out of the body. Men who have their prostate removed, typically do not ejaculate and if they do ejaculate anything it is a small volume from one small remaining gland and/or they will ejaculate a small volume of urine. In addition, the majority of men will struggle with erectile dysfunction initially after the surgery. This may resolve in some men, but many men will need treatment for erectile dysfunction after prostate removal. Lastly, the penis may disappear into the body a little. This is called penile shrinkage and sometimes will resolve over time. You may not experience all these changes. Thanks for your question.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:09 AMPost at 11:13 AMKevin: Since undergoing surgery, I’ve had problems maintaining an erection and having an orgasm. Viagra seems to help some. Are there any other options?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Hi Kevin! Most men are able to climax after prostate removal, but some men struggle with this issue. The Viagra is designed to mostly help with blood flow to the penis and giving you harder erections, but this may also help with feeling and ability to orgasm/climax. Most men with ED can climax without the erection. Oral agents rely on the nerves for erections and those nerves are traumatized after surgery, so the failure rates on oral agents in the first few months after surgery, can be very high, but as nerves recover (which can take an average of 2 years), your response to the oral agents may possibly improve. There are several other local therapies such as the vacuum constriction device, the intraurethral suppository and the penile injections. All treatments have risks and benefits and you have to decide if you want to try each one or not after learning all the details about it. Every treatment can have side effects and not every treatment may be for you in particular.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:13 AMPost at 11:22 AMDr. Jeffrey Albaugh: Prostate cancer is the most common non-skin cancer in men. Fortunately, prostate cancer is typically caught early through screening and often can be successfully cured. Some prostate cancers do not require immediate treatment, but rather active survellience to watch for progression. There is life after prostate cancer, but prostate cancer treatment may have negative effects on the quality of a man's life related to side effects. The most common long term side effect of any prostate cancer treatment, is sexual dysfunction. The most common treatments for prostate cancer are prostatectomy (removal of the prostate) or radiation therapy with external beam, seed implants or proton therapy. I have seen thousands of men over the to help them deal with the side effects of prostate cancer treatment.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:22 AMPost at 11:22 AManoynomous: My sex life just hasn’t been the same since I was treated for my prostate cancer. My wife of 32 years hasn’t been as supportive of me as I had hoped. What support groups are available? How can I bring this topic up to her without making things worse?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Excellent question. Many men have found that their sex life has changed significantly after prostate cancer treatment. The things that used to happen so easily and naturally are not working and that can be frustrating. There is hope. It does help to have a partner who can work closely with you and involving the partner in your treatment of sexual dysfunction is very important. I encourage every patient to bring their partner with them to the visits in my clinic so they are an active part of treatment and understand exactly what is going on. Us TOO International has support group chapters all over the country and in the Chicagoland area. I will be speaking at the Chapter here at Glenbrook Hospital on Tuesday, September 11th at 7PM (follow the signs to the meeting rooms). My new book explores communication with your partner and even has a chapter for partners. It is called Reclaiming Sex & Intimacy after Prostate Cancer Treatment: A Guide for Men & their Partners.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:22 AMPost at 11:31 AMDr. Jeffrey Albaugh: As humans, we don't communicate well around sexual issues or having sex. When we have no problems with sex, we tend to be non-verbal or use groans and moans to communicate during sex. If you have sexual dysfunction, it is critical to begin communicating with your partner about sex and intimacy. This is often best done outside the bedroom or the typical scene of your sex with your partner. You can begin by saying how much you love your partner and want to please them and you would like to discuss these things with your partner. Everyone wants to be pleased and this can open up communication. I highly encourage patients to bring partners to my clinic for the visits and we can engage them in the treatment as well. This can be critical to success with treatment. If you have partner, they need to be a part of the process of moving towards healing.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:31 AMPost at 11:31 AMKurt: After my surgery I have lost my urinary control. It’s embarrassing and I am not sure what I can do to improve it. Any tips?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Thanks for your question Kurt. This is the second most common long term side effect and yes there are things you can definitely do: Have you been doing pelvic floor exercises (sometimes called Kegels)? It is important to do these consistently and correctly. I train men all the time on how to do them correctly in the office. I find most men do not do them correctly unless trained to not use the abdomen, thighs, or buttocks and to simply contract and relax the rectal sphincter. I have a very effective simple way to assess the ability to do this correctly and to teach them to do it correctly. I describe this in more detail in my book in a chapter about this. You can also get a prescription from you provider to see a pelvic floor physical therapist, which can be helpful. I find that once men understand how to do it, they can do it correctly and will do them consistently each day. Research shows they are an effective treatment for mild to moderate stress urinary incontinence.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:31 AMPost at 11:41 AMDr. Jeffrey Albaugh: I typically meet with patients for about 1 hour in the first session to address intimacy, sex and/or incontinence issues. I am board certified in urology as an advanced practice clinical nurse specialist (that is why I have prescriptive privileges) and my PhD is in sexual health research. I have been working with patients with sexual issues for over 20 years and have spoken to patients and trained professionals around the world. I am the Director of Sexual Health. I realize these are very private issues and my goal is to make patients and partners as comfortable as possible to discuss theses issues so we can help them overcome the problems. There is no need to suffer in silence with a sexual issue. At our clinic we treat both male and female sexual dysfunction including erectile dysfunction & premature ejaculation in men; pain during sex, vaginal dryness, inability to orgasm and lack of desire in women to name a few issues. We strive to treat the patient rather than the diseasehttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:41 AMPost at 11:41 AMMarc: I’ve heard that proton therapy can have the least serious effects on sexual health. Is this true? What does this treatment option entail?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Hi Marc! There is very little research directly comparing sexual outcomes of proton therapy versus other radiation therapy or surgery. The most common long term side effect of proton therapy is sexual dysfunction, so it is still an issue. The goal of proton therapy is to deliver the radiation without impacting any tissue on the way in or out or through. This requires a lot of experience so you want to go somewhere where they do it all the time and have alot of experience with it since it has to be extremely precise. It is a form of radiation therapy, but very different in the way it is delivered. The goal of good proton beam therapy is to leave surrounding tissue uneffected, but the nerves for erections literally lay on the back of the prostate, so it is possible they may not be effected, but it is also possible they may be effected.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:41 AMPost at 11:47 AMFrank: I underwent treatment nearly six months ago and am still having extreme pain in my testicles and rectum. It is often very painful to go to the bathroom. Is there something I should be doing to help relieve the pain? Will certain exercises help?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Thanks for your question Frank. You need to work closely with your provider to explore options to help with the pain. Sometimes a warm or cold pack may be helpful when carefully applied and sometimes pain medications such as anti-inflammatory medications are needed and sometimes pelvic floor physical therapy is an option. The pain will typically diminish over time, but sometimes patients still have pain after 6 months. I would highly recommend you ask your provider about a prescription to see a pelvic floor physical therapist if the pain persists as you may be holding tension in the pelvic floor related to these problems. Sometimes we use pelvic floor exercises with a focus on pelvic floor relaxation to help with the problem and a pelvic floor PT specialist can work on all of that with you.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:47 AMPost at 11:51 AMAngela: Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:51 AMPost at 11:53 AMNathan: I’ve started to hear a lot about how your sexual life can be affected by prostate cancer. I was just recently diagnosed and am wondering what other changes can I anticipate this disease will have on my life in the short and long-term?<br/><br/>Dr. Jeffrey Albaugh (NorthShore): Prostate cancer is often slow growing and if treated early can be cured, but depending on treatment some side effects may occur. Some men will choose to active survellience (watching progression of prostate cancer very carefully and treating it when and if necessary). The most common negative effect of this approach is some anxiety about leaving the prostate cancer untreated initially. I think any cancer diagnosis can effect a man's psyche. Surgery has inherent risks and the most common long term effects are usually sexual side effects and/or bladder issues. Radiation can cause sexual side effects and urinary issues and sometimes bowel and skin issues. Each treatment has some short and long term side effects to consider and every man needs to carefully way out all risks and benefits to make an informed decision about treatment. Support groups are important and also seeking information from both urology surgeons and radiation therapists. It also helps to talk to urology nurses.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9011:53 AMPost at 12:01 PMAngela: Thank you for participating in our online chat today. An online transcript will be available shortly.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=9012:01 PM