Chapter 27: Living with and beyond cancer
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Interventions
Pharmacological treatments
There are different pharmacological interventions that can support men with sexual dysfunction after a full patient assessment has been carried out. For erectile dysfunction, phosphodiesterase type 5 inhibitors such as vardenafil, sildenafil, avanafil and tadalafil can be prescribed. If these medications prove to be ineffective, alprostadil is commonly used and administered either by intracavernosal or intraurethral routes. These medicines work by relaxing the blood vessels in the penis, allowing blood to flow into it, causing an erection (Sexual Advice Association [254]). They need to be prescribed by a trained healthcare professional with experience in men's sexual health who can teach the man to self‐administer. The patient will need to be assessed regularly for side‐effects and the efficacy of the selected treatment.
Non‐pharmacological interventions
Early erectile dysfunction rehabilitation usually involves a combination of treatments used to improve blood flow to the penis and reduce cavernous tissue damage, thereby preventing penile atrophy. This may help improve long‐term erectile function and enable an earlier return of assisted or unassisted erections sufficient for intercourse (Macmillan Cancer Support [161]). Vacuum erection devices can achieve this and are often used in combination with pharmacological treatments after radical prostatectomy and other radical pelvic surgeries. Men should be given the opportunity to be assessed by a specialist and be taught how to use these devices safely.
Websites
Cancer.Net
Sexuality and cancer treatment: women.
COSRT
The College of Sexual and Relationship Therapists (COSRT), the UK's leading organization for therapists specializing in sexual and relationship issues.
London Cancer Alliance
Sexual Consequences of Cancer Treatment: Management Pathway.
HNA Prompt Sheet: Sexual Consequences for Women
Menopause Matters UK
The Royal College of Obstetricians and Gynaecologists UK
The Sexual Advice Association
A charitable organization that aims to help improve the sexual health and well‐being of men and women and raise awareness of the extent to which sexual problems affect the general population.
Patient resources
Macmillan Cancer Support
Side effects and symptoms:
Macmillan Learn Zone: Sexual relationships and cancer:
Relationships and sex:
http://www.macmillan.org.uk/information‐and‐support/coping/relationships/your‐sex‐life‐and‐sexuality
Fertility in women:
Breast Cancer Care
Your body, intimacy and sex:
Fertility and breast cancer treatment: