Meeting the treatment expectations of men who have been left impotent and incontinent after prostate removal for cancer requires a careful understanding of their priorities. Understanding patients allows us to embark on a step-by-step approach to address each problem. I was taught by one of my mentors (and my experience has confirmed) that it is often difficult to treat a man’s impotence if he is still leaking urine, especially when this occurs during arousal and sexual activity. We call this climacturia, and most men are never told that it will happen after their prostate is removed.
Nearly all men after prostate surgery have experienced some leakage during arousal. Fortunately for most men, as they regain control of urination, fewer men continue to have leakage during sex. For obvious reasons, many couples are bothered by actual urine leakage, but climacturia is also associated with shame and embarrassment. This can lead to men and couples avoiding being intimate, prevention of good erections, and frustration in a relationship.
Being aware of a few simple practices has the potential to reduce how much this type of incontinence can affect intimacy:
- Keep an open mind and be creative
- Remember to do your Kegel exercises
- Empty your bladder before engaging in sexual activity
- Have hand/paper towels nearby
- Consider using a condom to catch drips
- Experiment with different positions
Where do we go when this doesn’t solve or settle the issue?
- Have a discussion with a urologist
- Ask about seeing a physical therapist specialized in male incontinence/pelvic muscle rehabilitation
- In select cases, we might consider minimally invasive surgical procedures, such as a urethral sling designed specifically for men
In the past, we would consider doing surgery at the same time as a penile implant if this was required, but currently I think it is in a man’s best interest to approach each problem (even though connected) one at a time. This doesn’t mean men cannot use medications like Viagra, penile injections or vacuum erection pumps in the meantime. One of the other reasons to delay surgery, gets back to my initial statement that impotence often doesn’t improve until we have adequately controlled urine leakage. Occasionally, men are surprised that when they are finally dry during sex, they feel more ‘in the mood’, are more likely to pursue intimacy and have better erections or respond better to the therapies– and that, of course, is a great thing!
Keeping an open mind, knowing your options, and speaking with a trusted urologist can make all the difference for men and couples experiencing climacturia.
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