Pde5 Inhibitors: Viagra Levitra And Cialis
Approved by the FDA in 1998, sildenafil revolutionized the way we think about and treat erectile dysfunction, largely because it is so easy to use and effective. Since then the FDA has approved three closely related drugs, vardenafil , avanafil and tadalafil .
All four drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, its important to realize that none of these drugs is an aphrodisiac. Youve got to feel sexually stimulated in order for them to work.
The main differences between the drugs have to do with timing: how quickly they begin to work, and how long their effects last . Levitra may start working slightly faster than Viagra although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who dont respond to Viagra. And while some doctors are skeptical about this claim, theres no harm in trying Levitra or Cialis if Viagra doesnt work for you.
Cialis has also been approved to treat men with both erectile dysfunction and BPH. The dose is lower, usually 5 milligrams per day.
What Are Some Treatment Options For Prostate Cancer And Their Effects For Erectile Dysfunction
Today, there are multiple treatment options when it comes to prostate cancer including GAINSWaves innovative shockwave therapy treatment. It is important to know treatment options and the possible risks affiliated with surgery or radiation treatment. Therefore, it is important to consult with your physician.
Erectile Dysfunction Or Impotence Post
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Impotence is simply described as the inability to achieve or maintain an erection suitable for sexual intercourse. Impotence affects 20 million American men or about 10% of the entire male population and 35% of the men over the age of 60. An erection is created when the penis fills with blood much like a tire fills with air. Blood is pumped into the penis and not allowed out, and the more blood that is pumped in, the firmer the erection. The reasons for lack of erections are either the lack of appropriate filling of the penis or inappropriate emptying.
For men who have had radical prostatectomy for prostate cancer, the nerves that control the flow of blood into and out of the penis may be cut or removed. These nerves do not control the sensation to the penis, nor are they responsible for the orgasm that occurs with sexual intercourse. Only the firmness of the penis is affected.
If nerve sparing was attempted during your procedure, the return of erections could take as long as 6 to 18 months. Partial erections may return earlier and may be a sign of subsequent complete return of function, although not a guarantee. Partial recovery is actually quite common and lends itself to some other options for treatment.
Medical Treatment
Injection Therapy
Urethral Suppositories
MUSE was released in early 1997 and more experience will be gained over the first few years that it is available to the public through their physicians.
Vacuum Devices
What Is New?
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Cavernous Nerve Interposition Grafting
Studies have shown that microsurgical end-to-side grafting of the sural nerve of the leg or the femoral nerve to the cavernous bodies could achieve effective results in patients whove had prostate surgery.
This surgical technique helps to restore the nerve connection to the erectile tissues and cause an erection. With the help of medication, as high as 50% of patients following prostate surgery gains satisfactory erection for normal sexual activity
The article is a part of our series on What is Erectile Dysfunction: A Complete Guide
References
John P MulhalCavernous Nerve Stimulation and Interposition Grafting: A Critical Assessment and Future Perspectives,Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477600/
Ilan Gruenwald,Boaz Appel,Noam D. Kitrey and Yoram VardiShockwave treatment of erectile dysfunction,Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607492/
Changes In Penis Size
Some men notice that their penis is shorter after surgery . Some men notice other changes such as a curve in their penis or a narrower area. We don’t know for certain why these changes happen, but it could be because of low oxygen levels in the penis, caused by not having erections. Other treatments such as hormone therapy with radiotherapy may also cause changes to the size of your penis.
Encouraging blood flow to the penis after surgery may help prevent this. In particular, using a vacuum pump, either on its own or with PDE5 inhibitor tablets could help maintain your penis size and improve erections.
Keeping your penis active after surgery
Although you may not be ready or recovered enough for sex, you can still start treatment for erection problems in the weeks immediately after surgery. It could be taking a low-dose PDE5 tablet once a day or using a vacuum pump, or sometimes both together. The treatment along with masturbation encourages blood flow to the penis. This can help keep your penis healthy. You may hear this called penile rehabilitation. Think of it in the same way as having physiotherapy if you had injured your arm or leg. Starting treatment soon after surgery may help improve your chance of getting and keeping an erection. But it may not work for every man.
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Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
What Is The Prostate Gland
About the size of a walnut, your prostate gland is located just below your bladder. It wraps around the tube that carries semen and urine through your penis and out of your body. The prostate makes seminal fluid, which is part of semen. Normal functioning of the prostate gland depends on testosterone and androgen, which are hormones made by the testicles.
Libido is the desire to have sex. A low libido may be caused by low levels of testosterone. It may also be caused by:
- Weight gain, especially around the waist
- Sleep problems, such as sleep apnea
- Medications, such as opioids, steroids and those prescribed for high blood pressure and depression
- Hormone imbalances, such as a high level of cortisol
- Your psychological/emotional state, such as depression, anxiety, grief, fear and insecurity. In some cases, distress is caused by the cancer diagnosis itself, or by the treatment you receive, doubts about your feelings of manliness or ability to perform sexually, or worries about your relationships or what the future holds so your state of mind can play a big part in ED. Finding an effective ED treatment or talking with your peers or partner may help. If your negative feelings don’t go away or get worse it may be helpful to see a counselor or psychiatrist who specializes in sexual issues.
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How To Manage Erectile Dysfunction During And After Prostate Cancer Treatment
The ultimate goal of both surgery and radiation therapy for prostate cancer is to remove as much of the cancer as possible while maintaining a patients desired quality of life.
Remember: your ideal treatment plan should be unique to your situation. Thats why its so important to get a second opinion and consult with an expert team of medical professionals including urology, radiation oncology, and other specialists.
If you want to learn more about potential treatment options for erectile dysfunction, or just have a lot of questions youd like answered, click here for resources from EDCure.org.
If youre looking for a doctor and want to discuss your options for treatment as well as possible side effects you can expect, feel free to use our free doctor finder tool below:
Does An Enlarged Prostate Affect A Man Sexually
An enlarged prostate can cause sexual problems in men, such as:
- Erectile dysfunction
- Reduced sex drive
Sudden onset of erectile dysfunction may be a sign of prostate cancer and needs medical evaluation. Erectile dysfunctions may also occur after the therapy for prostate cancer including surgery, radiotherapy, and hormonal therapy.
Sexual problems, such as erectile dysfunction or ejaculation problems, may occur in men with noncancerous enlargement of the prostate . Sexual dysfunction in BPH usually results from the treatment rather than the disease. Medications for BPH, such as the antitestosterone drug and finasteride , have been associated with erectile dysfunction in 3.7% of men who use it. Finasteride is also linked with diminished libido in 3.3% men. Other medications for BPH, such as terazosin , tamsulosin , and doxazosin , can improve BPH symptoms with a lower risk of sexual side effects.
Surgical procedures for BPH, such as the transurethral resection of the prostate , are often used when medications fail. Erectile dysfunction can occur because of TURP in a small percentage of men.
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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.
Can I Prevent Ed After Prostate Surgery
These days, many prostatectomies use nerve-sparing techniques to reduce injury to the tissue and prevent ED, though it still can happen. There are also several interventions for men after prostate surgery to help regain erectile function and prevent ED. Research shows that after surgery, 20% 25% of men regain their erectile function, but it may take several years.
To increase the chances of penile recovery and to prevent ED, several interventions after surgery may be offered. One option is called penile rehabilitation which uses medications to help improve blood flow into the penis. This may include the use of drugs like Viagra or Muse taken at night before bedtime. However, current research on the benefits of this intervention is limited. Still, its recommended that men be encouraged to proceed with normal sexual habits after healing, as it may help prevent long-term issues, and to use medications to increase blood flow and improve erections.
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Getting Treatment And Support
Speak to your GP or doctor or nurse at the hospital.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether it’s for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit.
Talking about sex
It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. It can also help you feel more positive and more in control.
You can ask about sexual problems at any stage – before, during or after your prostate cancer treatment. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they don’t then you may need to bring it up yourself.
Not everyone is used to talking about sex. You might need to bring it up more than once, or with a different person in your team. You can also ask to be referred to an expert in sexual problems or an ED clinic – they will be used to talking about sexual problems.
Our sexual support service
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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What Can I Do Rehabilitation And Aids
Studies suggest that starting a program to promote erections about six weeks after surgery can help some men recover sexual function. Different methods are available, depending on your particular case, your level of motivation and the judgment of your surgeon. These penile rehabilitation programs focus on increasing blood flow to the area to encourage healing and help men have regular erections that are hard enough for penetration. Having two to three erections a week, even if there is no sexual activity, helps keep the tissues in the penis healthy.
There are different options to treat ED, and they may or may not be part of a rehabilitation program:
- Oral medication: sildenafil/Viagara®, tadalafil/Cialis® or vardenafil/Levitra MUSE
- Vacuum erection devices
- Penile self-injection with a prostaglandin: alprostadil/Caverjet/Edex
Talk to your provider in Roswell Park’s Genitourinary Center about the options available to you.
What You Can Do Now
Sexual side effects from prostate cancer treatment are often temporary, especially if your doctor used nerve-sparing surgery. While your body recovers, you can try a few things to maintain your sex life:
- Let your doctor know about any sexual problems youre having right away. Although it can be hard to talk about sex, being open and honest will help you get the treatment you need.
- See a therapist. Couples therapy can help you and your partner understand and deal with sexual issues.
- Take care of yourself by exercising, eating a well-balanced diet, reducing stress, and getting enough sleep. Looking and feeling your best will give your self-esteem and mood a boost.
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Q: Does Prostate Removal Surgery Cause Erectile Dysfunction
A:Yes. Erectile dysfunction can and often does occur after a radical prostatectomy the complete removal of the prostate gland. Thats because the operation can sometimes injure tiny nerves, muscles and blood vessels involved in getting an erection.
If you develop ED after undergoing surgery, the problem isnt necessarily permanent. Many men regain full sexual function over time, usually within a year, though for some it can take a few years.
If problems continue, medicines and devices can help. Your doctor may also prescribe medicines and devices during recovery to help bring back erection.
You are more likely to develop ED following surgery for prostate cancer if:
- You are 60 or older
- You had some evidence of erectile dysfunction before surgery
- You are in poor health
Its important to also point out that there are different types of treatments for prostate cancer and many men who are diagnosed dont need to be treated right away. If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. Watchful waiting involves monitoring changes in your symptoms and tumors.
Each treatment option for prostate cancer has different benefits and risks. Talk to your doctor about what option is best for you.
For more information about Mount Sinai South Nassaus Center for Prostate Health, .
Sex After Prostate Cancer Treatment
Prostate cancer is the most common non-cutaneous cancer in men. Treatment for prostate cancer most commonly involves surgery to remove the prostate or radiation therapy to the prostate gland. Erectile dysfunction is often a consequence of these curative measures but effective therapy is fortunately available.
The first step in treating erectile dysfunction following prostate cancer treatment is to avoid the problem all together. Surgeon experience can play a major role in preserving sexual function following prostate cancer surgery. Surgeons with expertise in nerve sparing techniques can preserve the nerves responsible for erectile function. In expert hands, up to 60% of men can regain their baseline sexual function following prostate cancer surgery. So, my first suggestion to men worried about their erectile function after prostate cancer surgery is to choose their surgeon wisely.
The second stop in treating erectile dysfunction following prostate cancer treatment is to optimize health. This means that men need to have their ED risk factors identified and treated in order to improve their general health which will translate into better sexual function. By treating risk factors such as obesity, high blood pressure, elevated cholesterol, anxiety and tobacco abuse men can actually improve their baseline erectile function as well as their potential response to ED treatments.
The bottom line: do not give up on your sex life after prostate cancer treatment.
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