Where Does This Leave You
Increasing availability of these previously expensive drugs is a tremendous help for men who have undergone radical prostate surgery. Despite the uncertainty regarding penile rehabilitation, there is no doubt that real-time erections often improve while on Viagra and so straightforward access to these drugs is essential for a speedy return to a functioning sex life after cancer, for those who want it.
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Alastair Lamb and Altan Omer have nothing to disclose.
Altan E. Omer MD FEBU is a Pelvic Uro-Oncology and Robotic Surgery Fellow at the Churchill Hospital, Oxford.
Surgery For Prostate Cancer And Ed
Prostate cancer tends to be a slow-growing cancer. Surgery may be a good option if your doctor believes the cancer is contained in the prostate gland. Surgery is also dependent on age, overall health, and other factors.
A radical prostatectomy involves the removal of the prostate gland. The prostate gland is a donut-shaped gland that surrounds the urethra just below the bladder. The urethra carries urine and semen out from the body through the penis.
There are some risks associated with surgery. Two small bundles of nerves on either side of the prostate are vulnerable to injury during the operation. A type of operation called nerve sparing surgery may be possible. This depends on the size and location of the cancer.
Surgery may require removal of some nerves if theres a chance the cancer has invaded one or both sets of nerves. If both sets of nerves are removed, you may not be able to achieve an erection without the assistance of medical devices.
I Don’t Have Erections After Surgery Am I Impotent For Life
Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.
If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing. You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.
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Why Therapy Can Be Better Than Medication
Its so important to differentiate whether youre suffering from a physical or psychological problem. Why? Because medications given for an ED diagnosis have side effects, and theyre not cheap. AND I truly believe that you should save the ED meds for when youre much older and have a higher rate of actual, physical ED.
If youre going to have to take medication for the rest of your life, you might as well wait. Why start a medication that you have to take every single time before sex when youre young and under the age of 60 or 70?
I see men taking all kinds of supplements and mysterious chemicals that they order off the internet because theyre sick of sexual dysfunction and think that theres something up with their body. Trust me, theres a better way to overcome impotence.
The truth is, if you can get an erection in the morning when you wake up, if you can get an erection when you masturbate to porn, and if you can get an erection on your own when your partner is not around, you dont have erectile dysfunction!
What you have is a challenge with sexual desire, performance anxiety, or psychological factors .
And that, my friends, you are more likely to solve by going to a therapist, a counselor, a sex coach like myself, than any amount of medication is actually going to do for you.
If You’re A Gay Or Bisexual Man
To be the active partner during anal sex you normally need a strong erection, so erection problems can be a particular issue. You could try using a constriction ring around your penis together with another treatment like PDE5 inhibitor tablets, to help keep your erection hard enough for anal sex.
If you are receiving anal sex, a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find that their experience of sex changes if they have their prostate removed .
If you receive anal sex, then bowel problems or sensitivity in the anus may be an issue after radiotherapy. Its best to wait until your symptoms have settled before trying anal play or sex. If youve had permanent seed brachytherapy there is a risk in the first few months that your partner might be exposed to some radiation during sex. Talk to your doctor or nurse for further advice.
With all sexual changes you may be able to find ways to work through this.
Watch Martin’s story below for one gay man’s experience.
Watch other men’s personal stories about sex after prostate cancer.
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Its Complicated: Enlarged Prostate And Sex
BPH and sexual function
Prostate enlargement, also known as benign prostatic hyperplasia , and erectile dysfunction are separate problems. Both increase with age, but one causes problems in the bathroom and the other in the bedroom. However, the two are somewhat linked.
BPH happens when your prostate becomes enlarged, but cancer isnt the cause. A mans prostate continues growing throughout most of his adult life. This is why many older men are affected by the condition.
ED is the inability to get or maintain an erection. It can be caused by physical conditions such as:
It can also be caused by psychological issues.
These two conditions dont necessarily seem linked, but certain treatments that relieve BPH can cause ED and other sexual side effects. On the other hand, treating ED can improve enlarged prostate symptoms.
- inability to empty the bladder
- a weak urine stream
A surgery called transurethral resection of the prostate can help relieve these symptoms. Men who have this procedure often experience sexual side effects after surgery.
Between 50 and 75 percent of men experience retrograde ejaculation after TURP, according to Harvard Medical School. This means that semen released during orgasm enters the bladder rather than exiting the penis. Retrograde ejaculation is sometimes called dry orgasm. Its not harmful but can affect male fertility.
If Youre The Giving Partner
Cleanliness and safety are a must, even for the giver.
Cut and file your nails smooth to help avoid scratching or tearing the delicate skin in and around the anus.
Wash your hands thoroughly, even if youre planning to use a condom over your finger to penetrate your partner. For extra comfort, stuff cotton balls inside the condom or glove.
You can also get the party started in the shower together, which serves as foreplay and gets you both all nice and clean for the big show.
Youll probably need to try a few different moves and experiment with speed and pressure to find what feels best.
Here are some techniques to try, whether youre using fingers or toys.
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Causes Of Erectile Dysfunction
The bodys endocrine system is responsible for the production of hormones that regulate sexual function, reproduction, metabolism, and a lot more. Diabetes is a type of endocrine disease, and it could lead to erectile dysfunction.
Diabetes impacts the bodys ability to use insulin. Diabetes comes with a lot of complications, which include nerve damages, restricted blood flow, and hormonal imbalance. All these could contribute to a mans inability to get an erection.
Several neurological conditions could increase the risk of having erectile dysfunction. These conditions prevent the brain from properly communicating with the reproductive system.
This could lead to problems with erection. Some of the neurological disorders associated with erectile dysfunction include
- Parkinsons disease
- Multiple sclerosis
- Alzheimers disease
Also, if you have undergone prostate surgery, you could have nerve damage, which would lead to erectile dysfunction. Long-distance cyclers can also experience temporary ED this is because of the consistent pressure on the buttocks and genitals.
Certain conditions affect the heart and prevent it from pumping blood appropriately. This could lead to erectile dysfunction because when there is inadequate blood flow to the penis, an erection cannot be achieved.
Lifestyle factors and emotional disorders
Physical And Psychological Effects Of Prostate Biopsy And Cancer Diagnosis
The incorporation of prostate-specific antigen measurement and the transrectal ultrasound biopsy probe into standard urologic practice had a dramatic impact on the incidence of prostate cancer in the United States and resulted in a trend toward earlier-stage disease at presentation. No longer were men presenting with late-stage disease or undergoing painful perineal biopsies. The biopsy no longer required an anesthetic or a hospitalization. Within a 7-year period , the annual number of cases diagnosed doubled. Most cases are now detected by PSA elevation, rather than by digital rectal examination.
Though generally well-tolerated when done under a local anesthetic, the TRUS biopsy is not without side effects or complications. In a prospective study of 211 men undergoing prostate biopsies, intraoperative pain was considered severe in 20% of the biopsy events. Preoperative anxiety was reported in 64% of biopsy events and was predictive of intraoperative pain. Anxiety continued post-biopsy and peaked before result disclosure. ED attributed to anxiety in anticipation of biopsy was reported in 7% of cases. The ED incidence doubled to 15% at days 7 and 30 after the biopsy, well after the anxiety associated with the biopsy resolved.
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Percentage Of Men Obtaining Full Erections 2 Years After Open Prostatectomy
As one can see, the chance of regaining potency diminishes with age and with the number of nerves damaged. Even though it is usually technically possible to spare the nerves, sometimes the nerves themselves are cancerous and must be removed since the primary goal of the surgeon is to remove the prostate cancer. If the cancer has not reached the nerves controlling erection, the da Vinci Robot has the visual capabilities and the precision necessary to spare these nerves in most cases, thus it is possible that using the robot may add to the chances of being potent after surgery. However, there is no way to guarantee this due to variability in patient anatomy and condition. It is important to realize that some men never regain the ability to maintain an erection after robotic prostatectomy.
As mentioned above, medical therapy may aid in return to erections, but this has not as of yet been fully substantiated. Usage of sildenafil and newer erectile medications may potentially increase the potency percentages in the table above but this has not been proven. A recently presented study found that daily doses of 50mg or 100mg sildenafil for 9 months increased full erections by 7 fold when compared with a group who did not receive any medication.
Does Viagra And Cialis Work After Prostate Removal
During recovery, medications like Viagra and Cialis will help. Viagra can restore impotence and contributes to more pleasurable sex life.
A study published in the Journal of Urology reported that 53% from a total of 80 men who underwent radical prostatectomy had their erection function restored after taking Viagra.
But is Viagra an addictive drug?
Many men experienced a high rate of improvement in their sexual performance due to medications such as Viagra, Cialis, or Levitra. If you have been wondering whether these medications are addictive, you should know that the active ingredient in Viagra, sildenafil, is not an addictive substance.
These medications work by increasing the blood flow to the penis and facilitate the erection process. Addiction is brain-triggered, but Viagra does not target the nervous processes in the brain. That is why it is considered a safe option for those who want to faster recover their sexual potency after prostate cancer treatment.
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The Three Parts Of Male Orgasm
Kacker starts by pointing out a common misconception that erections are necessary for male orgasm. They arent. Men can have experience orgasm without an erection. The converse is also true, of course: men can have an erection without having an orgasm.
When discussing orgasm and radical prostatectomy, its useful to think of the male orgasm as having three separate parts, says Dr. Kacker.
First, secretions from the testicles, the prostate, and the seminal vesiclessmall, slender glands near the prostateflow into the urethra, the tube-like structure that carries semen through the penis and out the body. The emission of those fluids creates a feeling of fullness and a sensation of inevitability.
Second, theres ejaculation, which is accompanied by contractions of the pelvic floor muscles, the group of muscles used to hold in intestinal gas and urine.
And third is the mental componentall of the processing the brain does of incoming sensory signals from penis and pelvis that contribute to the mental experience of build up and release.
S Men Can Take To Improve Or Recover Orgasms
This doesnt mean that some men dont have difficulty experiencing orgasm after radical prostatectomy. The missing sensation of fullness and the lack of ejaculate are big changes. But there are some things you can do to correct the problem, according to Dr. Kacker.
Men can achieve an orgasm on their own with manual stimulation or with a partner through manual or oral stimulation. Just remember that an erection is not needed. Using a vibrator on the head of penis is often helpful. Vibration can stimulate the nerves in the penis and increase the signals being sent to the brain.
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Isnt Viagra Very Expensive
Viagra is indeed rather expensive. A box of four 100mg tablets will cost the NHS or you £23.50 per box. However, since December 2017 in the US, and amazingly since June 2013 in the UK, it has been legal for other drug manufacturers to make generic sildenafil and so, with a private prescription you can now pick up a box of 4 x 100mg sildenafil citratetables for as little as 79p, a thirty-fold price reduction. Its almost as cheap as paracetamol! The NHS is slowly waking up to this but still official NHS guidance only permits one packet of four tables per month for those who meet strict erectile dysfunction criteria. We hope this will change soon, given that 11 boxes could be purchased for the £8.80 standard NHS prescription charge! Furthermore, Cialis also came off patent in December 2018 in the US and we can therefore expect generic tadalafil, which currently costs £54.99 for a box of 28 x 2.5mg cialis is generally taken daily due to its longer half-life to come down to similar prices.
Surgical Treatments For Bph
While many doctors claim to treat prostate enlargement with surgery, such claims are almost always related to improving urinary function. Since the prostate surrounds the urethra, symptoms of BPH almost always involve urinary function. If a man has severe urinary issues or blockage, surgery may help.
Some doctors recommend removing the prostate to resolve the urinary issues in severe cases. The prostatectomy will likely resolve the urinary issues, but the surgerys side effects will surely deteriorate the mans quality of life.
Surgery should never be the first choice to relieve problems associated with BPH. Any urologist recommending surgery as a first-line treatment for BPH is not providing patients with the best advice. Every surgery has side effects. Some can be minor and others life-altering. Many solutions can make BPH more tolerable without destroying a mans quality of life.
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Surgery Effect On Ejaculation
Surgery can affect ejaculation in different ways. For example, if surgery removes the prostate and seminal vesicles, a man can no longer make semen. Surgery might also damage the nerves that come from the spine and control emission . Note that these are not the same nerve bundles that pass next to the prostate and control erections . The surgeries that cause ejaculation problems are discussed in more detail here.
If you are concerned about erectile function, its important to understand what erectile dysfunction really is. Failing to have an erection one night after youve had several drinks or even for a week or more during a time of intense emotional stress is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesnt get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, its time to talk to your doctor.
Can You Get Erections After Prostate Cancer Treatment
If you have ever wondered whether you’ll be able to have an erection after prostate cancer treatment, you are not alone. Many men who are facing a prostate cancer diagnosis, or who have undergone prostate cancer treatment, are worried about whether or not they will be able to have an erection after prostate cancer.
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Changes To Orgasm And Ejaculation
After prostate cancer treatment you will still have feeling in your penis and you should still be able to have an orgasm, but this may feel different from before. Some men lose the ability to orgasm, especially if they’re on hormone therapy.
If you’ve had radical prostatectomy, you will no longer ejaculate when you orgasm. This is because the prostate and seminal vesicles, which make some of the fluid in semen, are both removed during the operation. Instead you may have a dry orgasm – where you feel the sensation of orgasm but don’t ejaculate. Occasionally, you might release a small amount of liquid from the tip of your penis during orgasm, which may be fluid from glands lining the urethra.
If you’ve had radiotherapy, brachytherapy, high intensity focused ultrasound or hormone therapy, you may produce less semen during and after treatment. With radiotherapy, brachytherapy and HIFU you may also notice a small amount of blood in the semen. This usually isn’t a problem but tell your doctor or nurse if this happens. Some men on hormone therapy say their orgasms feel less intense.
Some men leak urine when they orgasm, or feel pain. Others find they don’t last as long during sex and reach orgasm quite quickly.