The Basics: How An Erection Occurs
At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.
Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis .
Figure 1: Anatomy of the penis
The penis is made up of three cylindrical bodies, the corpus spongiosum which contains the urethra and includes the glans of the penisand two corpora cavernosa , that extend from within the body out to the end of the penis to support erection. Blood enters the corpora cavernosa through the central arteries.
Erection After Prostate Cancer Treatment
Following prostate cancer treatment of any kind, it is a possibility that you will no longer be able to have an erection. If you are unable to have an erection following treatment, this condition may last only for a short time or could be permanent.
All of the currently available, potentially curative treatment options for prostate cancer can result in temporary or permanent erectile dysfunction , though many men who undergo treatment for prostate cancer see little or no ill effects to their erectile function. Radiation therapy, prostate surgery, cryotherapy, hormone therapy, and others can all result in ED.
Unfortunately, there is no definitive way to determine which men will have ED following treatment. In general, men with vascular conditions, diabetes, obesity, or pre-existing erectile problems are at greater risk for ED.
Studies that have sought to determine the chance of men having ED following prostatectomy, radiation, and other prostate cancer treatments have resulted in widely varying numbers. Some studies seem to show that only a small percentage of men have long-standing issues with ED, while others have shown much higher numbers.
For men who have undergone prostatectomy, long-term ED has been seen in up to 67% percent of men, but some studies have shown that using medications such as Viagra may help to achieve erectile functioning.
Penile Rehabilitation How It Works
Prostate removal can interfere with the function of the cavernosal nerves due to their very close proximity to the prostate, as well as the arterial blood supply into the penis as some of it travels through the penis. This effect is less in younger, fitter men with robust erections who have had nerve-preserving surgery and maximal when the nerves cannot be preserved because of the proximity of prostate cancer and in older patients.
The concept of penile rehabilitation stems from the theory that if penile blood flow and erections can be encouraged soon after surgery, the recovery of erections will be faster and more complete. Even so, it can take up to 3 years for recovery to be complete. The initial research into penile rehabilitation was with injection therapy and found that men who regularly used it had a much higher rate of potency 6 months after surgery than those that did not: 67% versus 20%.
In the modern era, penile rehabilitation is done with PDE5is . It typically starts 4 weeks after surgery, and appears to be as effective as injection therapy 64% of patients who took Viagra being potent at 18 months after surgery compared to 24% of men who did not.
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Advantages And Disadvantages Of Surgery
What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.
- If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
- The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
- Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
- If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
- Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.
Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of surgery do you recommend for me and why?
- What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
- How many of these operations have you done and how many do you do each year?
- Can I see the results of radical prostatectomies youve carried out?
- What pain relief will I get after the operation?
- How and when will we know whether the operation has removed all of the cancer?
- How often will my PSA level be checked?
- What is the chance of needing further treatment after surgery?
- What is the risk of having urinary problems or erection problems and what support can you offer me?
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What Typically Increases The Risk Of Complications From Prostate Cancer Surgery
Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.
Radiation is a very effective treatment for prostate cancer, but it doesnt work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment a procedure called salvage prostatectomy is potentially curative.
Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures which is a narrowing of the urethra that blocks urine flow or injury to adjacent structures like the rectum.
Prostatectomy Surgery & Your Sex Life: The Basics
Your prostate gland plays a key role in your sexual and urinary function. If your prostate is surgically removed, youll likely experience changes to your ability to have sex.
Several different methods are used to remove part or all of the prostate gland. The type of technique thats used for your prostatectomy may have an effect on your sex life and sexual performance after surgery.
Because your prostate plays a key role in producing and secreting semen, you may not be able to ejaculate normally after its surgically removed.
Its normal to experience erectile dysfunction after prostate surgery. Although most men regain the ability to get an erection in the months and years after surgery, some develop persistent erectile dysfunction that doesnt improve over time.
Medications like sildenafil , tadalafil and others can often help to improve your sexual performance after prostate removal.
When these arent effective, other treatments, such as injectable medications or penile prosthesis, may help you to enjoy a healthy sex life.
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Can You Live Without A Prostate
You can live without a prostate, though there are some side-effects.
The prostate is removed to prevent the spread of prostate cancer, while it might also be removed because it has enlarged through normal ageing and is putting pressure on the uretha .
A prostatectomy is the removal of all or part of a prostate, with the most common procedure being the transurethral resection of the prostate .
Laser prostatectomies are also performed which is the least invasive type of removal.
What Are The Side Effects
The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .
Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.
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What Can I As A Partner Expect
One of the effects of prostate cancer treatment is erectile dysfunction or impotence. This means that your partner may not be able to have erections that are hard enough for him to have sex with you or that he may not be interested in sex because of the medicine he is taking to treat his prostate cancer. This affects not only the man, but you, too, as his intimate partner. If you are the partner of a man with erectile dysfunction, it can be difficult to cope with changes in your sexual relationship. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in him staying away from intimate situations where he may feel under pressure to make love. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. This may not have anything to do with his feelings for you, but is a result of his cancer treatment. Erectile dysfunction can be difficult for both of you. You may want to reassure your partner that:
- Sex is not as important as long as he is healthy and that he is no less of a man to you
- You will work through it with him
- You understand his feelings
- He is important to you
It may help if you explain to your partner how important nonsexual touching and intimacy such as kissing and cuddling is to you.
How To Return To An Active Sex Life After Prostate Cancer Treatment
No matter the cancer, treatments often cause side effects that affect patients quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patients sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.
Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery, says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta. The degree of dysfunction depends on many factors, including the patients overall health, co-existing medical problems, as well as the patients level of sexual function and ability before treatment.
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What Is A Common Misconception You Find In Patients Regarding Complications That Might Occur After Prostate Cancer Surgery
I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, I have a 75 percent chance of returning to my baseline function. It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because as is usually the case the devils in the details.
The Side Effects Of Anti
Most men tolerate anti-androgen therapy well.
- Hot flashes
- Weight gain
- Bone density loss
- Irritability or mood swings
- Enlargement of breasts
- Starting patients on Vitamin D and calcium, providing consultation with our endocrinology team about preserving bone health, and getting baseline bone density scans when indicated
- Encouraging men to commit to active physical therapy and aerobic exercise to limit weight gain, preserve muscle composition, and even retain urinary function and control it better
- Recommending medications to help with hot flashes and mood changes that can arise during hormone therapy
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What Changes Do I Need To Make To My Diet
Discuss your post-surgery diet with your doctor as you will probably want to avoid or at least minimize issues such as constipation. The lack of exercise, the medication, even the stress, might affect your bowel functions. Your diet will be focused on eating more vegetables, fruits, grains and avoiding meat, especially the red one, pasta, alcohol, fast-food, sugar and processed desserts.
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Your Emotions And Sex
Your prostate cancer and its treatment wonât just affect your body. Theyâll also have a serious impact on your emotions. Stress and anxiety can trigger your body to make adrenaline, which gets in the way of having sex. The more you worry, the worse the struggle. If youâre in a relationship, your partner will be going through many of the same feelings.
One of the most important things you can do is to talk to your partner. Have an honest conversation about your fears and expectations when it comes to sex. Don’t assume they know how you feel. Being open with each other will help you both feel supported and help you work together to make any adjustments that you may need to stay intimate.
Talking with a mental health professional — either one-on-one or with your partner — can be a powerful way to help manage your emotions. A therapist can also prescribe medications that may ease stress and anxiety. A professional sex therapist can help you and your partner find ways to improve your sex life. It may also be helpful to join a support group where you can talk with others who share your experience.
Prostate Cancer Foundation: “Erectile Dysfunction.”
UCLA Urology: “Prostate Cancer: Dealing with Erectile Dysfunction.”
Albaugh, J. Reclaiming Sex & Intimacy After Prostate Cancer: A Guide for Men and Their Partners. Anthony J. Jannetti, Inc., 2012.
Harvard Prostate Knowledge: “Achieving orgasm after radical prostatectomy.”
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Can Impotence Occur After Prostate Surgery
Consider your options
If youre undergoing prostate surgery, you may be concerned about how it will affect your sexual function. Erectile dysfunction is the inability to become sexually aroused and have an erection.
The condition has many complex causes. It can be caused by a physical problem, an emotional issue, or both. Regardless of the cause, ED can affect both you and your partner.
Many body systems play a role in sexual arousal. These include:
- the brain
Can I Lower The Risk Of Prostate Cancer Progressing Or Coming Back
If you have prostate cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. While there are some things you can do that might be helpful, more research is needed to know for sure.
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Recovering From Prostate Surgery
To treat prostate cancer, doctors perform tens of thousands of surgeries each year. In recent years, one procedure — called a radical prostatectomy — has become a fine art, says J. Brantley Thrasher, MD, a professor of urologic surgery at the University of Kansas Medical Center in Kansas City. While side effects like incontinence and impotence are still major concerns, most patients respond well to the surgery, Thrasher says.
In fact, many men respond almost too well. “They feel so good after the surgery that they start to push themselves too hard,” he says. One of his recent patients went on a two-mile jog — while still wearing a catheter. “I told him he needed to slow down and rest for a while.”
If you have a radical prostatectomy in your future, you’ll want to know what to expect. Here’s a closer look at this procedure. As you’ll see, your life won’t necessarily take a turn for the worse after prostate surgery. In fact, it just might get better.
Why do surgeons perform radical prostatectomies?
According to the Food and Drug Administration, radical prostatectomy is considered to be the most definitive treatment for many men with prostate cancer, a disease that kills about 30,000 American men each year. Depending on their age and the stage of their cancer, however, some men do well with a less invasive treatment.
How should I prepare for surgery?
What happens during a radical prostatectomy?
What will happen during recovery in the hospital?
Providing Your Medical History
At first, the doctor will probably ask you about your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer from depression? Are you under a lot of stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner?
As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when youve had erectile dysfunction. Your doctor may conduct a written or verbal screening test.
If the cause is clear a recent operation for prostate cancer, for example the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.