How Are Enlarged Prostate And Erectile Dysfunction Related
Many men wonder if BPH can cause erectile dysfunction. The short answer? Not really. While the prostate is an important organ for male sexual function, BPH is more of a urination issue than a sexual one. The prostate goes through two major growth spurts during a mans lifetime: one during puberty and another around 50 or 60 years of age. It is estimated that more than half of men will have some form of BPH in their 50s , which is why we see so many older men complaining of LUTS.
Usually, an enlarged prostate isnt a problem unless symptoms become burdensome and treatment is needed. Thats where concerns about erectile dysfunction come in. To treat BPH, your options are medications to relax the prostate or stop it from getting bigger, and surgery. and similar medications are part of a class of drugs called alpha-blockers, which cause the blood vessels of the prostate to constrict, relaxing muscles in the prostate so urination can occur more easily. One side effect of these drugs is less blood to flow into the penis during an erection though, and that could be a problem. Another drug, , is an anti-testosterone drug that stops the prostate from growing. However, lower testosterone levels in the body may cause ED as well. Lastly, surgical procedures can also cause ED due to damage to structures around the penis, which I will go into detail below.
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.
The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
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Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
Talk About How You Feel
First off, it is essential to evaluate how you feel.
It is vital to talk about it if you want to improve.
Most men prefer not to talk about this with a professional, and they avoid the topic with their partners.
However, this position will only make things worse with your partner and cause anxiety to you.
After talking it out with a professional, you will see how easy it is.
They are trained to answer your questions and give you recommendations and a variety of options.
Sometimes men are anxious about erections after surgery because they read so much about it.
Their anxiety plays against them, turning a weaker erection function into a complete failure.
Thus, one of the first aspects to consider is your mindset, feelings, and emotions.
Therapy can help a lot if youre struggling.
It is sometimes appropriate to incorporate your partner in the talking, but it is not always required.
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What To Expect From Prostate Surgery
Before understanding how prostate surgery can affect your sex life and sexual activity, its important to understand what prostate surgery is in the first place. Otherwise known as a prostatectomy, prostate surgery usually involves the removal of part of the prostate gland or the entire gland. Simple prostatectomy refers to the removal of just the inner part of the prostate gland. This surgery is usually a treatment for an enlarged prostate. Radical prostatectomy involves the removal of the entire prostate gland, and this surgery is a form of prostate cancer treatment .
Your healthcare team may recommend some form of prostate removal if you have problems emptying your bladder , frequent urinary tract infections, frequent prostate bleeding, bladder stones with prostate enlargement, very slow urination, or kidney damage .
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Caring For Your Incision
The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.
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Why Is Rehabilitation Important
Whether you are single, or in a relationship, you should have the opportunity to discuss penile rehabilitation with your doctor or specialist nurse. Self pleasuring is important for many people and this can play a part in rehabilitation. This might help to give you confidence and to become aware of the changes that your treatment might have caused.
It might still be worth talking to your doctor even if you are not sexually active, or dont plan to be. This is because penile rehabilitation has benefits in terms of keeping the penis healthy.
Ideally, rehabilitation should start soon after your prostate cancer treatment, or in some situations before treatment. For example, you should start rehabilitation within 3 to 6 months of starting hormone therapy or radiotherapy. Or within the first 3 months of surgery to remove the prostate gland.
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.
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Orgasm After Prostatectomy Is It Possible
You can expect to enjoy sex and orgasm after prostate surgery.
Many men are surprised to find that they even experience pleasurable orgasm without an erection. Keep in mind that your sexual pleasure does not depend on penetration.
Dr. David Samadi says restoring an enjoyable sex life after prostate cancer surgery is in part dependent on prostate cancer treatment and choice.When men and their partners know what to expect, they can accelerate recovery, experiment, and work together. Sex-related activities should be resumed as soon as you are ready but keep in mind some changes are temporary, and some might be permanent, but the bottom line is that all of the problems can be overcome.
Patients that recover from robotic prostatectomy can expect one significant change regarding orgasm, the orgasm without ejaculation. It will feel different but the pleasure part will still be there.
Note that the male orgasm has 3 main components:
Even though the first 2 parts of the orgasm are affected by the radical prostatectomy, the third one that involves brain stimulation and generates the sensation of pleasure still remains.
Who Needs A Prostatectomy
As men age, the likelihood of medical problems associated with the prostate increases. Medicines, lifestyle modifications, and a proper diet can help with many conditions, but oftentimes issues with the prostate require more extensive medical intervention.
Less severe conditions are more likely to be treatable without the need for surgical work. Some prostate conditions that can generally be treated without prostatectomy include:
- Benign prostatic hyperplasia .
Other prostate conditions, though, do necessitate the removal of the prostate gland and/or other tissues. Although some patients might opt for a prostatectomy for more minor reasons like inability to empty the bladder or bladder stone, by far the most common reason for prostatectomy is cancer.
Here is everything you need to know about prostatectomy and prostate cancer.
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Long Term Side Effects Of External Radiotherapy
You might have long term side effects after having external radiotherapy for prostate cancer, such as erection problems . Tell your doctor or nurse if you have any of these problems, they can help you with them.
Most side effects gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that they begin months or years later.
Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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Inflammation Of The Back Passage
Inflammation of the back passage is a long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Bleeding is usually slight but can be more severe for some people. Talk to your radiographer or nurse if you have proctitis. They might suggest you use treatments such as steroid suppositories for a short time. This might reduce the inflammation.
How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.
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Can An Enlarged Prostate Cause Erectile Dysfunction
benign prostatic hyperplasia . BPH rectile Dysfunction An enlarged prostate may have a number of effects on a person’s health, including their sex life.
a frequent need to urinate a feeling of not emptying the bladder intense urges to urinate a weak urine stream problems starting or stopping urinationProstate issues can also cause sexual problems. The extent of any sexual problem varies according to the condition of the prostate. Some common sexual side effects include:
- erectile dysfunction
Cialis ,Many men will develop an enlarged prostate as they age, because the gland does not stop growing throughout their lifetime. As men age they should get regular prostate screenings to check for prostate cancer. Several medications, lifestyle changes, and surgical options are available to help reduce the effects of living with an enlarged prostate. With proper treatment, men can usually maintain a regular sex life.
What Changes Can You Expect
- Ejaculation will cease:Without a prostate gland or seminal vesicles, you will no longer experience ejaculation. Even though your orgasm may feel different, it will still be pleasurable.
- Leaking urine during sex:This is possible but does not happen to all men. Its harmless and temporary.
- Performance anxiety:Dont underestimate the emotional roller coaster of prostate cancer surgery and recovery. Its normal to worry about sex after prostate cancer. Being open and honest with your partner will help.
Keep in mind that your overall health, age, and present ED status are all factors in your recovery to sex after prostate surgery.
Less commonly, the prostate cancer tumor may bulge to one or both sides of the prostate gland, making nerve-sparing surgery extremely difficult or impossible.
Dr. Samadi will help you understand your exact prostate cancer status and the position and size of your tumor. In some cases, a nerve graft can be performed to regenerate the penile nerves for sex after prostate surgery.
- Changes in mood and libido:The psychological impact of surgery can be significant this will leave you tired and irritable, not in the mood for sex so you will need to move towards intimacy slowly and your desire will return back to normal.
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Surgery To Remove The Prostate
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
You are still able to have an orgasm, but it will be a dry orgasm. Some men say that a dry orgasm without semen feels normal. But other men find that their orgasm is less intense and pleasurable. The loss of a visible ejaculation can be significant for some men and their partners. Some men say that it feels different but they have managed to find ways to adjust to this.
If you are used to having anal sex and you are the receiving partner, surgery to remove the prostate gland can change this experience. Some men can find the penis rubbing against the prostate gland pleasurable. So if the prostate gland is no longer there, anal sex might feel different. You could look at different ways of enjoying sex and being intimate. Counselling and sex therapy might help.
Treating Ed After Prostate Surgery
There are a few treatment strategies that may help you regain the ability to have an erection following prostate surgery, as long as you have at least one nerve bundle intact.
Some doctors may recommend a treatment strategy known as penile rehabilitation or penis rehab. Many health experts believe that the sooner youre able to get an erection after surgery, the more likely youll be able to gain better control of this side effect over time. Most doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal . The goal of penile rehabilitation is to preserve as much erectile function as possible through the use of medications and/or devices .
For some people, PR may involve the use of prescription medications. Oral medications known as PDE5 inhibitors are common treatments for erectile dysfunction. The most common one is sildenafil . Other PDE5 inhibitors include tadalafil , vardenafil , and avanafil .
In some cases, a specific type of device may be helpful in restoring normal erections. Known as vacuum therapy , this kind of treatment uses a vacuum pump to draw blood into the penis. Because a vacuum pump can lead to erections regardless of nerve disturbance, VT may be an important part of PR to help restore erections .
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