Sexual Health Information for

Men with Cancer

Sym

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Man

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Table of Contents

The Male Reproductive System

5 Managing Erection ProblemsVacuum Erection Devices . . . . . . . . . . . . . . . . . . . 9

Oral Medicine for Erections. . . . . . . . . . . . . . . . . 12 Penile Injections . . . . . . . . . . . . . . . . . . . . . . . . . 15 InflatablePenileProsthesis. . . . . . . . . . . . . . . . . 19 EnjoyingSexWithoutaFirmErection . . . . . . . . 23 ExternalPenileProsthesis . . . . . . . . . . . . . . . . . 25 Questionstodiscusswithyourpartner . . . . . . . . 27 Whatoptionsareyouwillingtotry? . . . . . . . . . . 28

29 Managing of Incontinence and Leaking UrineHowtodopelvicfloorexercises . . . . . . . . . . . . . 30

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3

The Male Reproductive System

Thisinformationwillhelpyouunderstandhowthemalereproductivesystemworks(beforetreatment)andsomeofthewordsyourdoctororhealthcareprovidermightuse.

Aman’sgenitals(thepenisandscrotum)areoutsidethebody.Thescrotumcontainsthetesticles,whichmakespermandtestosterone.Whenamanejaculates,spermtravelsthroughatube(vasdeferens)totheprostategland.White,milkyfluidcalledsemenisaddedandittravelsdowntheurethraandoutthepenis.

Whenamanhasavasectomy,thevasdeferensiscutandtied.

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What is testosterone?Testosteroneisahormonethataffectssexdriveandinterestinsex.Thetesticlesmakespermandtestosterone.Sometestosteroneisalsomadebytheadrenalglands.

Testosterone normally decreases as men get older. Testosteronecanalsodecreaseforashorttimeifamanisdepressed,stressed,sick,orgetshurt.

Testosteronereplacementisatreatmentforlowtestosterone.Ifyou’vehadtesticularcancerandhadoneorbothtesticlesremoved,askyourdoctorabouttestosteronereplacement.

Will cancer treatment affect my testosterone? Somecancertreatmentsstopthebodyfrommakingtestosterone.Forexample,androgendeprivationtherapylikeEligard®,Casodex®,orhavingthetesticlesremovedcandothis.Ifyouhavequestionsabouttestosteronereplacement,talktoyourdoctororhealthcareprovider.

Youdon’tneedtestosteronetohavesex,butitdoeshelpyougetaroused,haveanerection,andhaveanorgasm.Menwithouttestosteronecanstillhavesex,butitcanbechallengingwithalowsexdrive.Whentestosteroneisdecreased,manymenaren’tasinterestedinsex.

Sometimesmenstopbeingsexualandsometimestheyevenstopbeingaffectionate.Thiscanhappenbecausetheycan’thavesexorbecausethey’velosttheirsexualdesire.Ifthishappenstoyou,rememberyourpartnermightstillbeinterestedinsexand/orbeingaffectionatelikehuggingorcuddling.Yourpartnermightnotsayanythingaboutthisbecauseheorshedoesn’twanttoputpressureon you.

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Somecouplesaren’taffectediftheydon’thavesex.It’simportanttotalkaboutsexorotherwaystobeintimatesoyouknowhowyourpartnerfeels.Yourpartnermightwanttotalkaboutwaystobesexualorheorshemightbeokaywithnothavingsex.

Therearewaystoimproveyoursexlifeandbeintimatebylearningmoreaboutimprovingyoursexualdesireanderections.

Managing Erection Problems

What is an erection? Whenamanhasanerectionbloodflowstothepenis,whichmakesithard.Manymenhaveerectionproblems(erectiledysfunction,impotence)astheygetolder.

Someoftheseproblemsinclude:• troublegettinganerection• thepenisisn’tashardasitusedtobewithanerection• erectionsdon’tlastaslongastheyusedto

Mencanstillhaveorgasms,eveniftheydon’thaveanerection.Duringsexualtouchingorstimulation,amancanstillhaveanorgasm,evenifthepenisisn’thardenoughforintercourse.It’snormalformentohavedifficultywitherections on occasion. Erectile dysfunction gets more common as men get older.

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What happens during an erection?Theprostateglandhasabundleofnervesaroundit.Whenamangetsturnedon(isaroused)orinterestedinsex,orthepenisisstimulated,amessageissenttothesenervesthatmakesbloodflowtothepenis.Thetissueofthepenisislikeasponge,whichcanabsorbblood.Whenthisspongytissuefillswithblood,thepenisgetshard.

Whenmenhavepelvicsurgeryorpelvicradiation,thesenervesareoftendamaged.Aftersurgery,thenervesmightbebruisedorinflamed.Thesenervescanheal,butit’saslowprocessthatcantakeupto2years.Ifthenervesarecut,theywon’tgrowbacktogetherandthedamageislikelypermanent.

Mencanstillenjoyhavingtheirpenisorgenitalareastimulatedandtheycanstillhaveanorgasm,eveniftheydon’tgetanerection.Cancertreatmentsdon’tdamagethenervesthatcontrolorgasmsorfeelingsinthepelvicareaandpenis.

What causes erection problems?Erectionproblemscanbecausedby:

• bloodvesselproblems• nerveproblems• heartdisease• diabetes• smoking• cancertreatmentsinvolvingthepelvis,suchaspelvic

radiationtherapy,orpelvicsurgery• depression,anxiety,orstress• drinkingtoomuchalcohol

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Chemotherapycanalsoaffecttheabilitytohaveanerectionbecauseitcanaffectsexualdesire.Ifthishappens,sexualtouchingmightbeneededbeforeanerectioncanhappen.Ifyou’rehavingtroublewithyourinterestinsexorerectilefunction,thinkabouterectionsinadifferentway—asaresponsetosexualtouch.Erectionsmayhappenwithsexualtouchinginsteadofontheirownwhenyouthinkaboutorfeeltheurgetohavesex.(Formoreinformation,seethe Low Sexual Desirebooklet).

How does an orgasm happen?Whensomenervesarestimulated,itgivesthebodyafeelingofpleasure.Forexample,whenthepenisistouchedinasexualway,amanfeelspleasure.

Manypeoplethinkejaculationandorgasmarethesamething—theyaren’t.Sometimesaftersurgeryorpelvicradiation,someofthenervesaredamagedandsomeofthenervesaren’t.Evenifnervesaredamaged,amancanhaveanorgasmwithouthavinganerection.Thisisbecausethenervesthathelpamanfeelpleasurearedifferentthanthenervesthatcauseanerection.

Iftakingpartinsexualactivities,likestimulatingthepeniswithahand,andyourpenisisn’thard,it’sagoodideatousealubricant.Ifyoudon’t,thefrictioncanbepainfulandyoumightnotenjoyitasmuch.

Iftheprostatehasbeenremoved,amancanstillhaveanorgasm,buthewon’tejaculate.Thisiscalledadryorgasm.Somemensaythatthequalityoftheorgasmisdifferent,butmanymensayit’sjustasenjoyable.

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What is ejaculation?Menejaculatewhentheyorgasm,whichcausesfluidtocomeoutofthepenis.

Ifmenhavehadtreatmentforprostatecancer,theytypicallynolongerejaculatesemen.Theglandthatmakestheliquidpartofsemenisremovedduringsurgery,andisdamagedduring radiation.

Anorgasmisdifferentthanejaculation.Formostmen,thesehappenatthesametime,butamancanhaveanorgasmwithoutejaculating,whichiscalledadryorgasm.Ifamanisunabletoejaculatesemen,thenitmeansheisinfertile.

If I have trouble with erections, are there treatments?Therearemanywaystotreaterectiledysfunctionincluding:

A. Vacuum Erection Devices

B. Oral Medicine for Erections

C.Penile Injections

D. PenileProsthesis

E. SexWithoutaFirmErection

F.ExternalPenileProtheses

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Vacuum Erection DevicesA

Vacuumdevicesarecylinder-shaped,externalpumpsputoverasoftpenistomakeithard.

How does a vacuum erection device work?Youusealubricanttocreateasealbetweenthecylinderandtheskin.Whenyoustartpumping,theairinthecylinderisremoved.Thiscreatesavacuumaroundtheoutsideofthepenis.Thepressurepullsbloodintothepenis,whichmakesitswellandgethard.

Oncethepenisishard,putarubberretainingringonthepenisbeforeyoutakeoffthepump.Thisisnotharmful.Youcanleavetheringonforupto30minutes,butnolonger.

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What if I want an erection longer than 30 minutes? Ifyouwanttohaveanerectionforlongerthan30minutes,youneedtotaketheringoffforafewminutessothebloodflowsnormally.Afterafewminutes,usethepumpagaintomakethepenishardandputtheretainingringbackonfor30minutes,butnolonger.

Will the erection look normal?• Theskinofthepenismaylookdarkerorblueand

mightfeelcool.• Theerectpenismightmovemorefromsidetoside

thannormal.• Thepenismayhangerectfromthebodyinsteadof

standinguperect.Sometimesthismakesthepenisslipoutduringintercourse.Youandyourpartnermightneedtoadjustthewayyouthrustduringsex,ortrydifferentpositions.

• Somemengetafirmererectionifthedeviceisusedafterforeplaythatmightstimulateapartialerection.

• Itwon'tchangehowtheskinonthepenisfeels,ortheabilitytofeelanorgasm.

• Manymenfindthattheringclosesofftheurinarytube,whichmeansthatnofluidcomesoutduringanorgasm.Ifthishappens,itwilllikelydripoutwhenthering is removed after sex.

Are there side effects when the vacuum device is used? Whenyouuseavacuumdevice,youmightgetmildbruisingonthepenis.

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Where can I buy a vacuum device? It’sagoodideatobuyamedicalqualitydevice.Youcanbuythemonline.CallPsychosocial&RehabilitationOncologyinCalgaryat403-355-3207tolearnmoreaboutusingvacuumdevices.Youcanattendateachingsessionwithstaffinthisdepartmentandalsoaccessthedevicefromthere.

Tips for Using a Vacuum Device• It’simportanttohavesupportfromyourpartnerif

youchoosethisoption.It’salsoagoodideatohaveforeplaywithyourpartnerbeforeandafteryouusethevacuumdevice.

• Practiceusingthedeviceforafewweeksbeforeyouuseitforsexualactivity.Ifyouhavequestions,callthemanufacturer—there’susuallyanadviceline.

• Youcanbuymanydifferenttypesofrings.Trydifferentonestofindoutwhatyoulike,whatyou’recomfortablewith,andwhatsizeisrightforyou.

• Thinkaboutaskingyourpartnertohelpyouusethedevice.

• Beforeintercourse,warmthepeniswithawarmclothorhandmassage.

• Talkaboutandmakesureyourpartnerunderstandsthatyou‘restillattractedtohimorher,eventhoughyouneedthedevicetogetanerection.

• Trysomeforeplayonyourpartnerafteryouusethedeviceandbeforeyoustartintercourse,sothatsexualexcitementstayshigh.

• Somepartnersfeelcomfortabletouchingthemselveswhileyouusethedevicetostaysexuallyexcited.

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Oral Medicine for ErectionsB

Therearetypesofmedicinetakenbymouthforerectionproblems,whichinclude:

• Viagra® • Cialis®• Levitra® • Staxyn®

How does medicine taken by mouth work for erections?

Amantakesapillbeforehewantstohaveanerectionforsex.Thepillsworkbyincreasingachemicalthathelpsbloodflowtothepenis.Ittakesatleast30minutestowork.Mostmedicationslastupto4hours,exceptCialis®whichhasboththedailydoseversionandalsoalongeractingpillthatcanlastfor48hours.

Thesetypesofmedicinehavenoeffectonsexualdesireorinterestsotheerectionwillnotjusthappenonitsown.Afterthepillistaken,themanneedstogetsexuallyexcited(mentally)andstartforeplay(suchastouching)togetanerection.Thesetypesofmedicineworkforabout7outof10men.

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Checkwithyourdoctororpharmacistbeforeyoutakeanytypeoferectionmedicine.Don’ttakeerectionmedicineifyoutake:

• nitratemedicine(suchasnitroglycerin)forheartdisease

• alpha-blockerstolowerbloodpressureandtreatenlargedprostateglands

Will oral medicine work for me? • Ifyou’vehadothertypesofcancerthanprostateand

somedegreeoferectiledysfunction,pillsmighthelp.Youmightneedtotakethemlong-term(orforweeksormonths),untilyoucangetanerectionagainonyourown.Confidencecanplayabigpartwitherectilefunction.Ifyoudon’tbelieveyou’llgetanerection,youmightnotgetone.Sometimestakingerectionmedicinehelpsmakeyoumoreconfidentandisonlyneededshort-term.

• Oralmedicineforerectionsusuallyworksbestformilderectionproblems.Talktoyourhealthcareproviderifyouhaveanyquestionsabouterectionproblems.

• Ifyou’vehadyourprostateremoved,thesetypesofpillsmightnotworkforyouinthefirstyearaftersurgery.Theymayworkforyouifyoursurgerywasanerve-sparingprocedure.Thepillsmayworkbetterafteraman’snaturalerectionshavehadtimetorecover—about12to24monthsaftersurgery.

• Ifyou’vehadradiationforprostatecancer,thepillsmighthelpatfirst,butmaynotworklong-term.

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What are the side effects of erection medicine? Sideeffectsmayinclude:

• headaches• flushingintheface• upsetstomach• yourvisiongoingblueforashorttime(Viagra®only)• youreyesbeingsensitivetolight• nasal congestion

Don’teatheavy,high-fatmealswhenyoutakethistypeofmedicinebecauseitmaynotworkaswell.Ifyouhaveanyquestionsaboutthemedicine,talktoyourdoctororpharmacist.

Where can I get erection medicine? Youneedaprescriptionfromyourfamilydoctororoncologist.Thesetypesofmedicinearenotusuallycoveredbymostbenefitplans.Talktoyourinsurancecompanytofindoutaboutyourcoverage.

Tips for Taking Erection Medicine

• Trythemedicineafewtimesbecauseitdoesn’talwaysworkwellthefirsttime.

• Ifyou’vehadpelvicsurgery,askyourdoctorhowlongyouhavetowaitbeforeyoutrythistypeofmedicine.

• Tellyourpartneryou’retakingerectionmedicineandthatit’ssafeforyoutouse.Don’ttrytohideit.

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Penile InjectionsC

Amancangetanerectionwhenmedicineisinjectedintotheshaftofthepeniswithaveryfineneedle.Thismedicineisonlyprescribedbyspecialists(usuallyurologists).Notallmencanusethesetypesofmedicine.Talktoyourdoctortoseeifthey’rerightforyou.Thesetypesofmedicineinclude:

• prostaglandinE1likeCaverject®orEdex®(mostcommon)

• phentolamine

• papaverine

Ifyou’vehadprostatecancer,bladdercancer,colorectalcancer,orsurgeryorradiationtothepelvis,thistreatmentmightbethebestoptionforyou.Injectionscanworkevenifyou’vehadtheprostateremovedandthenervesthatcauseerectionsaredamaged.Ifyou’vehadsurgery,usuallyjust a smalldoseofmedicinewillgiveyouafirmerection.Ifyou’vehadradiation,youmightneedahigherdosesincesomeofthebloodvesselsmaybedamaged.

How do the injections work? Amaninjectsthemedicineintohispenisabout 10to15minutesbeforehewantstohaveanerection.Themedicinemakesthepenisswell(withoutphysicalstimulation)bycausingbloodtoflowtothearea. Withforeplayorwhenamanisexcitedaboutsex,theerectionwilllikelygetharder.Theerectionusuallyhappenswithin10to15minutesoftheinjectionandwilllast30 to 60 minutes.

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Theerectionmaynotgodowncompletely,evenafteran orgasm. If the erection lasts longer than 2 hours after the injection, call your doctor right away. If you can’treachyourdoctor,gotoanurgentcarecentreoremergency room.

Theideaofinjectingmedicineintothepenismightnotsoundappealing,butmostmensaythepainisn’ttoobad. Yourdoctorwillteachyouhowtodotheinjectionandthefirstonewillbegivenatthedoctor’soffice.It’sveryimportanttodotheinjectionthewayyourdoctortaughtyou—onthesideofthepenis,towardsthebottom.Theneedleisputrightintothepenisata90°angle.

Onlyuseinjectionneedles1timeandthenthrowthemaway.Youcanbuyneedledisposalcontainersatadrugstoreoruseanoldbleachbottletostorethem.

https://edpostprostatehelp.wordpress.com/treatment-options/penile-injection/

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Ifyou’rehavingtroubleinjectingyourself,thinkaboutaskingyourpartnertolearnhowtodotheinjectionfromyourdoctor.Youcanbuypenileauto-injectors,whichmightmakeiteasier.Ifyouareinterestedinthis,talktoyourdoctororhealthcareprovider.

Themedicinemustbestoredinthefridge,whichmakesithardtouseifyou’retravelling.

What are the side effects of the injection? Themostcommonsideeffectsoftheinjectionare:

• achinginthepenis(feelslikepinsandneedles)• aburningfeelinginthepenis• bleedingattheinjectionsite,whichcancausea

bruise—topreventthis,pressfirmlyontheinjectionsitefor5minutesaftertheinjection

Long-termeffectsarerare.About3to10menoutof100developscarringonthepenis.Mildscarringmightfeellikesmalllumps,butseverescarringmightmakethepeniscurvewithanerection.

What if my erection lasts longer than 60 minutes? Anerectionwillrarelylastforlongerthan4hours,butwhenitdoes,it'scalledpriapism. If your erection lasts longer than2hoursafteryou’vehadsex,seeadoctorrightaway.Thismighthappenifthedoseofmedicineistoohighforyou. Don’t increase your dose of medicine unless your doctortellsyouto.Don’tinjectmorethan1timeaday.It’sbesttowait48hoursbetweeninjections.

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Where do I get the medicine? Youneedaprescriptionforthemedicineandyoualsoneedahealthcareprovider,suchasaurologisttoteachyouhowto inject it. You need a referral from your family doctor or oncologisttoseeaurologist.Thesetypesofmedicinearenotusuallycoveredbymostbenefitplans.Talktoyourinsurancecompanytofindoutaboutyourcoverage.

Tips for using the injection

• It’simportanttohavesupportfromyourpartnerifyouchoosethisoption.It’salsoagoodideatohaveforeplaywithyourpartnerafteryougivetheinjection.

• Iftheinjectiondoesn’tworkwellthefirsttime,waitatleast48hoursandtryagain.

• Alwaysusethedoseofmedicinethatyourdoctortells you to.

• Mendon’tusuallysaytheneedleistoopainful,butsometimestheerectionitselfmaybepainful.Ifyouhavepainusingtheinjectionsandit’swithinthefirst6monthsaftersurgery,youmaywanttowaitafewmonthstotrytheinjectionagain.Itwilllikelyhurtlessthelongeritissinceyouhadyoursurgery.

• Talkaboutandmakesureyourpartnerunderstandsthatyou‘restillattractedtohimorher,eventhoughyouneedtheinjectiontogetanerection.

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What if I’ve tried different types of medicine and they don’t work?Ifyou’vetrieddifferenttypesofmedicinetohelpwitherectionproblemsandtheyhaven’tworkedwellforyou,thereareotheroptionsincluding:

• inflatablepenileprosthesis(IPP)• sexwithoutafirmerection• penispump/vacuumerectiondevicewithrubber

retaining ring

Inflatable Penile Prosthesis (IPP)D

AnIPPisapumpsystemimplantedintothepenis.Surgeryisneededtoputthepumpsystemin.IPPsareinflatedsothey’reerectforsex,anddeflatedsothey’resofttherestofthetime.

Thereare2companiesthatmanufacturetheseimplants.Theycomeinself-contained,2-pieceor3-pieceversions.Themorecomplextheimplant,thefirmerandlargertheerectionwhenit’sinflated,andthesofterandmorenaturalthepenisiswhenitisn’tinflated.However,themorepartstheimplanthas,themorelikelyitistobreakdown.

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Togetanerection,amanpressesonasmallpumpthatmovesfluidintothecylindersinthepenis.Thepenisdoesn’tdeflateafterorgasmuntilareleasevalveispushed.Youcan’ttellifsomeonehasapenileprosthesis,unlessyouseethesmallscaronthebottomofthepenis.

How does the IPP work? AllIPPsaresimilar.Theyallhave2cylindersandapumpsystemthatareputinthepenisandthesurroundingarea.Whenthey’reempty,thepenislooksandfeelssoftandhangsdown.Whenthey’refilledwithfluid(salineorsaltwaterthatstaysinthepumpsystem),thepenisgetsbiggerandhard.

Therearedifferentkindsofpumpsystems,buttheyallworkthesameway—fluidispumpedintothedevicetomakethepenishard.TheIPPmakesanerectionthat’sjustlikeanatural erection.

http://www.soc.ucsb.edu/sexinfo/article/erectile-dysfunction-causes-symptoms-treatment

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Manymensaythesizeoftheerectionisshorterthanwhat’snormalforthem.Thisdoesn’tusuallymattertotheperson’spartneranditdoesn’tusuallyaffectapartner’sorgasmwithintercourse.

Ifthisisaconcernforyouandyourpartner,trydifferentsexpositions.Forheterosexualcouples,trywiththewomanontopasitincreasesfrictionagainsttheclitorisandmakesiteasiertohaveanorgasm.Forsamesexcouples,it’ssafetotrydifferentpositionstostimulatethepartner’sprostate.

What can I expect with an IPP?• Whentheprosthesisisn’tinflated,thesoftpenisisa

littlefullerthannormal,butitlooksthesame.• Itdoesn’tchangehowtheskinofthepenisfeelsora

man'sabilitytohaveanorgasm.• Amanstillejaculatesandpassesurinethesameway.• Onceaprosthesisisputin,amanwillneverbeable

togetanerectionwithoutinflatingit.• Iftheimplantisremoved,themanwon’teverbeable

tohavenaturalerections.

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Who can get penile prostheses? IPPsareusedforhealthissuesthataffecterectionproblemswhentherearenoothertreatmentoptions.Onceaprosthesishasbeenputin,amancan’thaveanerectionwithoutit.Thismeansitwon’tworkformenwithstress-relatederectionproblems.It’sbesttogetcounsellingforthesetypesofproblemsorjustgiveittime.

Ifamanhashadaradicalprostatectomyforprostatecancer,heneedstowaitatleast2yearsbeforehavingsurgerytogetanIPP.Thisistoseeiftheabilitytohaveanerection will recover.

What are the side effects of the implant? • Implantsworkwellabout9timesoutof10.About1in

100menhavemechanicalproblemswiththeIPP(forexample,partofthedevicespringsatinyleak).Theseproblemscanoftenbefixed.

• Menrarelygetaninfectioninthefirstfewdaysaftersurgery(about2outof100men).Ifthishappens,theIPPhastoberemoveduntilitheals.

• It’sbesttochooseasurgeonwhohaslotsofexperienceputtinginIPPs.

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Enjoying Sex Without a Firm ErectionE

Manycoupleskeephavingsex,evenifthemancan’tgetafirmerection.Peoplecanstillhaveorgasmswithcaressing,oralsex,orothertypesofstimulation.

Thinkabouttryingasextoy,suchasavibrator.Avibratorworkswellifyou’retiredorifyougettiredusingyourhandstostimulateyourpartner.Youcanalsoliefacingyourpartnerandrubyourgenitalsagainsteachotheroruseavibratorbetweenyou.Makesuretouseagoodlubricanttomakeitfeelgoodanddecreasepainfromfriction.

Tips for Using an IPP • It’simportanttohavesupportfromyourpartnerif

youchoosethisoption.It’salsoagoodideatohaveforeplaywithyourpartnerbeforeandafteryouusetheIPP.

• TellyourpartneryouhaveanIPP.Don’ttrytohideit.• Don’tusetheIPPuntilyou’rehealedfromyour

surgery.Yoursurgeonwilltellyouwhenit’sokaytohavesex.

• ThinkaboutgettingyourpartnertoinflatetheIPPaspartofforeplay.Beforepenetration,warmthepeniswithawarmwashclothorhandmassagewithalubricant.

• Talkaboutandmakesureyourpartnerunderstandsthatyou‘restillattractedtohimorher,eventhoughyouneedthedevicetogetanerection.

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Manypeoplethinkthatsexwithpenetrationistheonlywaystohavesex.But,mostcouplesusetouchingandcaressingaspartoftheirroutine.Whencouplescan’thaveintercoursebecauseoferectionproblems,manygiveuponsex,butotherscontinuetohavesexinotherways.Thinkabouttryingsomethingnew. Thereisnoriskwhenlearningtoenjoysexwithoutafirmerection.Somepeoplemayfeelthisoptiongoesagainsttheirreligiousbeliefsorvalues.Ifthisisaconcernforyou,talktoyourhealthcareprovider.

Where can I buy sex toys? Youcanbuysextoysatsexpositiveadultstoresoronlinesuchas:alittlemoreinteresting.com,pinkcherry.ca,oramazon.ca.

Tips for Having Sex without a Firm Erection• Trydifferentwaystocaresseachotherthatyou

haven’ttriedbefore.Trythingsmorethanonceiftheydon’tworkwellthefirsttime.

• Makesureyouunderstandyourpartner’sbody,andwhereandhowtheyliketobetouched.Mostwomenliketohavetheclitoristouchedandcaressed.Talktoyourpartneraboutwhatyoulike.Beopentotryingnewkindsoftouch.

• Ifyouoryourpartnerhasahardtimereachingorgasm,thinkaboutusingavibratorwhenyouhavesex.

• Addinnewwaystoincreaseyourexcitementlikethinkingaboutasexualfantasyorreadinganeroticstorytoeachother.

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Researchshowsthatmanypeoplefindusingexternalprosthesesforintercourseverysatisfying.Thisoptionmightnotberightforeveryone.

Todothis,adildoandpelvicharnessareused,whichyoucanbuyatadultsexstoresoronline.Thedildositsintheharnessjustlikeanerectpenis.Thepelvicharnessholdsthedildoon,rightabovethesoftpenis.Thecouplecanthenhavepenetrativeintercourse.

• Usealubricantwhenstimulatingthepenisbyhandorwithavibrator.

• Thinkaboutmasturbating(onyourownorwithyourpartner).Thiscanhelpyouknowhowyoulikebeingtouchedbest.Sometimes,thiscanchangeaftersurgeryorcancertreatment.Talkabouthowyouliketobetouchedwithyourpartner.Also,anythingthatincreasesthebloodflowtothepenishelpskeepthetissuehealthy,includingmasturbation.

External Penile ProsthesisF

http://www.lovelifeandintimacy.com/

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Getintoapositionjustlikeyouwouldforregularintercourse.Thrustjustlikeyouwouldforpenetrativesex. Yourpartnercangetpleasuredirectlyfromthistypeofintercourse,butyou’llneedtobestimulatedwithyourpartner’shandtofeelpleasureinthepenis.

Ifthesoftpenisiscaressedwiththepartner’slubricatedhand,themancanhaveanorgasm.Havingthepenisstimulatedandthepelvicmovementswithintercoursecanmakeitpleasurableforthemanwearingtheprosthesis.Manymensaythisfeelsjustlikeregularsex.

How does this type of sex work? Withtherightstimulationandthemusclememoryofpelvicmovementsduringsex,apersoncanactuallymakethebrainthinkit’shavingpenis-in-vaginasexorpenetrativeintercourse.

Therearenoriskswiththistypeofintercourse,butsomepeoplemayfeelthisoptiongoesagainsttheirvaluesoreventheirreligiousbeliefs.Ifyouhavequestionsorconcerns,talktoyourhealthcareprovider.

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•

Possible questions/topics you can discuss with your partner:

• Howdowefeelaboutusingorexploringerectileaidsand/orsextoys?

• WhatshouldwedowhenyougetarousedandIdon’t?• Areyoucomfortablewithoneofusreachingorgasm

eveniftheotherdoesnot?• IsitokayifIbringyoutoorgasmthroughtouchingor

oralcaressingevenifIdonothaveafullerection?• Whatkindsoftouchingdoyoumostenjoynow?• ThesearethekindsoftouchthatImostenjoy

now……..

Tips for Having Sex with an External Penile Prosthesis

• Talkabouttheseideaswithyourpartneraheadoftime.Makesuretotalkaboutyourcomfortlevelandworriesyoumighthave.

• Makesureyouandyourpartnerarebothwillingtoexploreanewwayofbeingsexual.

• Gotothesextoystoretogetherorgoonlinetogethertobuytheseproducts.

• Useawater-basedlubricantforstimulatingasoftpenis.

• Trydifferentpositionsforsextofindwhat’smostcomfortableforyouandyourpartner.

• Beopentotryingnewthings.Evenifyoudecideyoudon’twanttotrythemagain,you’vebondedwitheachotherovertryingsomethingnew.

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What options are you willing to try?

OptionHow willing are you to try it? (Circle one)

How willing is your partner? (Circle one)

Why?

Non-penetrative sexual activity (touching, oral sex)

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Experiment with sex toys

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Oral medications

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Vacuum erection device

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Penile injections

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Inflatable penile prosthesis

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

External penile prosthesis with harness

1=willing to try2=unsure3=not willing to try

1=willing to try2=unsure3=not willing to try

Other

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Managing Incontinence and Leaking of Urine

What is urinary incontinence?Urinaryincontinenceistheaccidentalreleaseofurine.It’scommonforpeopletolosesomebladdercontrolaftertreatmentsforcancerofthepelvis,suchasradiationorsurgery.Thiscanbeembarrassinganddisruptdailyactivities.Evenifyouhavegoodbladdercontrolduringtheday,youmightstillhaveincontinencewhenyousneeze,cough,orlaugh(stressincontinence).What causes stress incontinence?Stressincontinencehappenswhenthemusclethatholdsthebladder’soutletclosedisn’tstrongenoughtoholdbacktheurine.

How is incontinence treated? Therearetreatmentsforincontinenceandwaystohelpyoumanageitathome.

How long does incontinence last?Afterpelvicsurgery(e.g.,forprostatecancer),manymenhaveincontinenceforatleast3months.It’susuallybetterafter6months.Incontinenceusuallygetsworselaterinthedaybecausethemusclesinthepelvicfloorgettired.

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What is pelvic floor physiotherapy?Exercisesyoucandotostrengthenyourpelvicfloor.Whenthemusclesinthepelvicflooraretightened,itshouldfeellikeyou’retighteningthesamemusclesyouusetostoptheflowofurineorpassgas.Itfeelslikeyou’reliftingthescrotumupandinward.Whenthemusclesarerelaxed,itshouldfeellikewhenyourelaxtopassurine.Pelvicfloormusclestrengthisanimportantpartofbladdercontrol.Strongpelvicmusclescanhelpdecreaseincontinence,helpthebladderholdurinewhenyoufeeltheurge,andmakehardererections.Ifyoudopelvicfloorexercisesregularly,incontinencemaygetbetterafteracoupleofmonths.Ifsymptomsdon’tgetbetter,seeyourdoctor.Forinformationonfindingaphysiotherapistnearyou,visit:physiotherapyalberta.ca.

How to do pelvic floor exercises:

1. Emptyyourbladderandgetintoasittingposition.2. Tightenyourpelvicfloormusclesasstronglyasyou

can,thenletgo.Itshouldfeellikeyou’reliftingorpullingthatareaup.Don’ttightenthemusclesinyourstomachorbuttocksanddon’tholdyourbreathwhileyoudothetightening.

3. Holdthetighteningfor3seconds,5seconds,or10 seconds. Hold it only as long as you can fully holdit.It’sbettertodoafewreallygoodtighteningexercises,thanmanythataren’tfullytightened.

4. Repeatthis10times.Themoreyoupractice,themoremusclestrengthyou’llbuildup.Ifyoukeepdoingtheexercises,eventuallyyou’llbeabletoholdfor 10 seconds.

5. Trytopracticetheseexercisesduringtheday.Youcandotheexerciseswhilesitting,standing,lyingdown,orwalking.Yourmuscleswillgetstrongerifyoudotheexercises3to5timeseveryday.

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How do I manage incontinence and sex?Somecouplesstrugglewithurineleakingduringsex.Theseideasmighthelp:

• Layatoweloutonthebedbeforesex—ifurineleaks,thetowelwillabsorbit.

• Keepawarm,wetclothnearyouforeasycleanupifneeded.

• Rememberthaturinedoesn’thaveanygermsinit,soitisn’tharmfulifitleakswhilehavingsex.

• Tryhavingsexintheshowerorbath.• Useanerectionring(likethekindusedwithavacuum

erectiondevice)tohelppreventleaking.• Evenwhenmenhavegoodcontrolofthebladders

duringtheday,theymightstillleakurinewhentheybecomearousedorhaveanorgasm.

What if my incontinence isn’t getting better? Somemenwithseverestressincontinencemightneedsurgery.Yourdoctormightwantyoutowaituntilafteryourcancertreatmentstohavesurgery.Manydoctorsrecommendwaitingatleast1yearbeforehavingsurgeryforincontinence.Yourdoctorwilltellyouwhatsurgeryisbestforyou.

Thedifferenttypesofsurgeryforincontinenceinclude:• artificialsphincter• urethralbulking• bulbourethralsling:aslingisputundertheurethrato

supportitandisattachedtomuscleorthepubicbone• electrical stimulation

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SymptomManagement|SexualHealthInfoforMen|Prov|2016|B0082

DevelopedbyDr.L.Walker&Dr.J.RobinsonandapprovedbymembersofOASIS(OncologyandSexuailty,IntimacyandSurvivorship)

Cancer Patient Education