What Is The Connection Between Erectile Dysfunction And The Prostate
As men age, physical problems related to erectile dysfunction and the prostate become intertwined. Erectile dysfunction, the inability of the penis to become or remain erect, is one of several symptoms associated with an enlarged prostate. Also, erectile dysfunction is a possible side effect of several of the treatments for prostate cancer.
Symptoms associated with an enlarged prostate include a blocked urethra and changes in bladder function. These symptoms can also affect a mans ability to achieve a full erection. Necessary blood flow to the penis may be inhibited by an enlarged prostate and lead to impotence.
Prostate cancer treatments are the most common causes of issues related to erectile dysfunction and the prostate. The first possible treatment involves the extraction of the entire prostate gland via a surgical procedure. A second, less invasive course of prostate cancer eradication involves radiation treatment. Cryosurgery is another alternative that works by freezing the cancerous tissue. Finally, hormone therapy is also a viable option for remedying prostate cancer.
What Is A Transperineal Biopsy
This is where the doctor inserts the biopsy needle into the prostate through the skin between the testicles and the back passage . In the past, hospitals would only offer a transperineal biopsy if other health problems meant you couldnt have a TRUS biopsy. But many hospitals have stopped doing TRUS biopsies and now only do transperineal biopsies.
A transperineal biopsy is normally done under general anaesthetic, so you will be asleep and wont feel anything. A general anaesthetic can cause side effects your doctor or nurse should explain these before you have your biopsy. Some hospitals now do transperineal biopsies using a local anaesthetic, which numbs the prostate and the area around it, or a spinal anaesthetic, where you cant feel anything in your lower body.
The doctor will put an ultrasound probe into your back passage, using a gel to make this easier. An image of the prostate will appear on a screen, which will help the doctor to guide the biopsy needle.
If youve had an MRI scan, the doctor may just take a few samples from the area of the prostate that looked unusual on the scan images. This is known as a targeted biopsy.
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Urinary Symptoms Linked To Sexual Dysfunction
In this study, published in the current issue of Mayo Clinic Proceedings, researchers studied 2,115 men between the ages of 40 and 79. The men completed questionnaires about their sexual function and urinary tract symptoms every two years.
Researchers found that each of the indicators of sexual function was inversely related to the severity of urinary tract symptoms reported by the men. As the men’s urinary symptoms increased, their level of sexual function decreased.
After adjusting for age, urinary tract symptoms resulting from an enlarged prostate that were most strongly associated with sexual dysfunction were:
- A feeling of urgency
- Needing to get up multiple times at night to urinate
- A weak urine stream
These symptoms were associated with:
- Difficulty getting or maintaining an erection
- The way men felt about problems with sexual drive, erection, and ejaculation
- Sexual satisfaction problems
However, the association with men’s urinary tract symptoms and sexual dysfunction diminished with advancing age. No association between these symptoms and most sexual problems were found in men over age 70.
Researchers say that because both of these conditions are common in aging man, it may be very difficult to see if a true association exists outside of an age-related one.
SOURCES: Chung, W. Mayo Clinic Proceedings, June 2004 vol 79: pp 745-749. News release, Ascribe Newswire.
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Luts And Sexual Function
LUTS associated with BPH are often accompanied by sexual dysfunction, including erectile dysfunction and ejaculatory problems. Interest in sexual intercourse declines with severity of LUTS. Men with more severe LUTS have significantly lower libido, greater difficulty maintaining an erection, and lower levels of sexual satisfaction than men with less severe LUTS. OLeary showed that, in men with LUTS, the severity of urinary symptoms appears to exert the greatest influence on the degree of sexual dysfunction. Burger and colleagues found evidence of a correlation between sexual desire, erectile reliability, and sexual satisfaction and the degree of baseline symptoms. According to the U.S. National Health and Social Life Survey, both premature ejaculation difficulties and ED are associated with LUTS. Frankel and colleagues reported that men with storage-related complications from LUTS, particularly incontinence, had approximately twice the probability of experiencing sexual dysfunction, especially impotence, as men without such complications. It is unclear whether the sexual dysfunction that occurs with LUTS is due to sleep disturbance, anxiety, or a physiologic effect. The impact of ED the emotional distress that often accompanies it must be differentiated from LUTS, highlighting the need for several different diagnostic tools when evaluating a patient.
What Is The Prostate Gland
The prostate is a small gland , the size, shape and color of a chestnut. Located below the bladder and surrounding the urethra, the prostate produces a fluid that is stored within the gland and ejected towards the urethra during ejaculation. So, the prostate plays an essential role exclusively in ejaculation and reproduction. However, prostatic diseases are common and may cause severe sexual problems.
More specifically, 1 out of 2 men will present prostatitis, 1 out of 6 prostate cancer and 1 out of 3 benign prostate hyperplasia.
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How Does The Treatment For Bph Cause Erectile Dysfunction
Alpha-blockers
Alpha-blockers including alfuzosin, doxazosin, tamsulosin and silodosin relax smooth muscles, especially in the bladder neck and prostate which can improve urine flow. However, while they can be helpful in relieving BPH symptoms, in some patients they may also cause unwanted side effects such as impotence , dry orgasm , and a decrease in the production of seminal fluids.
5-alpha reductase inhibitors
Research has shown that men who take these drugs for an enlarged prostate could be at higher risk for sexual problems, especially erectile dysfunction , low libido, and trouble ejaculating.
5-alpha-reductase inhibitors represent a type of drug that is used to treat both BPH and androgenic alopecia . Two examples of 5-alpha-reductase inhibitors are dutasteride and finasteride. These drugs are considered safe and effective for these two conditions, but they could have sexual side effects.
In a study published in 2016 by the Journal of Sexual Medicine, Chinese researchers analysed seventeen studies on 5-alpha reductase inhibitors and sexual function. The study included almost 17,500 men with an average age of 60 years. About 55% of men were treated with 5-alpha-reductase inhibitors while the rest received placebo.
Another study performed by the researchers from the Boston University School of Medicine showed that ED associated with long term use of finasteride for the treatment of BPH appears to worsen.
The Elephant In The Room
Lets get to the point. Yes, BPH can affect your sex life.
It can cause a reduced sexual drive, there can be a reduction in sexual satisfaction, and thirdly, it can cause ED or erectile dysfunction. Erectile dysfunction is defined as the inability to attain and maintain an erection for intercourse at least 25% of the time.
Some drugs used to treat BPH can lead to ED. They can also reduce sperm count, lower sperm movement and sperm volume.
At the same time, certain ED treatments like Viagra, Cialis, and Levitra can improve BPH and reduce those urinary symptoms.
Yes, its complicated.
To continue, specifically, Proscar, an anti-testosterone drug prescribed for BPH has been linked to ED in 3.7% of men using it, with 3.3% having diminished libido, whereas alpha-blockers like Flomax can improve the symptoms of BPH with a lower risk of sexual side effects.
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Other Diagnostic Tests And Procedures
Other diagnostic tests , such as uroflowmetry and cystourethroscopy, have been used in patients with LUTS. However, their reliability varies considerably, making it difficult to base a diagnosis solely on the results of these techniques. However, they can be used in conjunction with digital rectal examination to estimate prostate volume, although prostate size does not have a significant bearing on the degree of obstruction or symptoms. Postvoid residual volume also has a high degree of intrinsic variability, which limits the value of this test.
Impact Of Erectile Dysfunction On Qol
Preservation of sexual function should be considered in the management of patients with symptomatic BPE. With increase in elderly population, it is expected that more men will experience ED and symptomatic BPE. There was positive correlation between the severity of ED and prostate size in this study, and patients with severe ED had higher mean prostate size of 122.94 g. This further supports the need to screen patients with symptomatic BPE for ED. Sexual and urinary functions have a direct impact on QoL. This present study shows that QoL has a weak negative correlation with ED and a weak positive correlation with prostate size . This is because patients impression on quality of life varies. While a patient with a huge prostate and severe ED may be satisfied with the symptoms, another patient with milder form may feel terrible with his symptoms .
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Treatment Of Enlarged Prostate And Ed
While an enlarged prostate can cause ED, there are treatment options available to you to facilitate normal sexual function. Luckily many forms of enlarged prostate-associated erectile dysfunction are treatable, and by tackling the underlying problem of an enlarged prostate, many men can restore or greatly improve their sexual performance.
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Can Prostatitis Affect Your Sex Life
Problems affecting this small gland can affect your sex life. For example, BPH and even prostate cancer treatment such as radiation therapy can contribute to sexual problems. So, what about this disease then?
Prostatitis has a significant impact on a mans health and quality of life. The disease can affect the urinary tract, but also your sexual performance.
A growing body of evidence confirms that prostatitis can cause erectile dysfunction , a common sexual problem where a man cannot achieve or maintain an erection for pleasurable intercourse.
Below you can learn more about prostatitis erectile dysfunction.
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Why Does Erectile Dysfunction Happen
Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:
- narrowing of the blood vessels going to the penis commonly associated with high blood pressure , high cholesterol or diabetes
- hormonal problems
Psychological causes of ED include:
- anxiety
- depression
- relationship problems
Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.
If this is the case, it is likely the underlying cause of erectile dysfunction is psychological . If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.
Erectile dysfunction can also be a side-effect of using certain medicines.
Read more about the causes of erectile dysfunction
Overcoming Intimacy Issues While Dealing With Prostate Problems
Old-fashioned beliefs suggested erectile dysfunction to be psychological in origin. While anxiety and stress are factors that can cause ED, scientific advances now provide proof that in a majority of cases, it is traced back to physical conditions which interrupt nerve functioning and restrict blood flow.1 Diabetes, arthrosclerosis, cardiovascular conditions, as well as some types of prostate disease and their treatments are responsible for most cases of ED.3 This article will focus on how prostate diseases have impacted erections and sexual activity.
Erection is a matter of synchronous body function, which fills the penile tissue with blood, allowing it to swell and stand erect. This process requires an orchestrated mechanism, lead by blood vessels, endocrine system, and the nervous system, and obviously, any interference can affect the quality of an erection.2 Nitric oxide promotes vasodilatation while neurotransmitters such as norepinephrine and acetylcholine increase the production of chemicals such as guanosine monophosphate, prostaglandins, and polypeptides which initiate the erection process by shifting chemical gradients in the muscles and capillaries of the corpora cavernosa, which runs along the shaft, causing inflation and swelling of the penis.1
Prostate Cancer
Sudden and frequent erectile problems can be a symptom associated with prostate cancer, so a prostate-specific antigen, PSA test, accompanied by a rectal exam is performed to assess the situation.
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Prevalence Of Erectile Dysfunction
On the contrary, the prevalence of ED in this study is higher than the finding obtained in a population-based multinational study in regions of the UK , Netherland , France , Korea linking ED and LUTS due to BPE in 4800 men aged 40 to70 years. The study observed a prevalence of 21.1%. The difference in this observation may be due to the fact that larger group of patients with LUTS due to BPE were enrolled compared to the 117 patients with symptomatic BPE enrolled in this study . However, the consistent observation is that ED and symptomatic BPE were significantly associated with increasing age .
Talk With Cleveland Urology Associates
With all of these conflicting and complicated circumstances, it is always best to consult with your doctor if you are experiencing BPH especially with sexual side effects.
Trust Cleveland Urology Associates to determine which treatment will be best for all of the symptoms you are experiencing.
As always, if you have any further questions or would like to schedule an appointment, please call or request an appointment online today.
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Is Drinking A Lot Of Water Good For Your Prostate
If you have BPH or prostatitis, make an effort to reduce your caffeine intake by cutting back on coffee, soda or energy drinks. Avoiding caffeine can make a big difference in your urinary health. Another important drink for you prostate is water. Stay hydrated, and do not try to drink less to reduce your urine.
What Are The Symptoms Of Bph
The symptoms of BPH tend to be urinary in nature. If you are struggling going number one in the bathroom, you may want to get checked for BPH. Youll often see BPH referred to as LUTS, which stands for lower urinary tract symptoms.
Symptoms can include:
- Incomplete emptying of bladder
- Needing to go excessively at night
Its interesting to note that there may be a correlation between the severity of BPH symptoms and the risk of other sexual dysfunctions. For example, men with severe trouble going to the bathroom often also find they have reduced sex drive, inability to keep an erection, and lowered sexual satisfaction.One review found that most men who sought treatment for either BPH or ED were actually diagnosed with both conditions.
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What Is Free Psa
The routine PSA test measures total PSA in your blood. But there are two types of PSA. Bound PSA is attached to a protein. Free PSA is not. The free PSA test breaks the results down and provides your doctor with a ratio. Men with prostate cancer tend to have lower levels of free PSA than men who dont have prostate cancer.
Its a simple blood test, but theres no consensus among doctors on the ideal ratio of free to bound PSA. The free PSA test is valuable in that it gathers more information, which can help in the biopsy decision.
On its own, the free PSA test cant confirm or rule out a prostate cancer diagnosis.
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How Enlarged Prostate Impacts Sexual Function
An enlarged prostate is also called benign prostatic hyperplasia . Its an issue where your prostate, while not cancerous, is enlarged giving you the typical urination symptoms.
Things like:
- Dribble after your done
- Feeling of not getting it all out
Any of these has the ability to reduce confidence when it comes to sexual performance. However, most of the problems would be fear and psychological worry about potential pain which are very real issues.
There are a number of potential remedies for reducing and improving BPH. Sexual activity is one of the many home remedies for an enlarged gland.
However, if remedies dont work, prostate reduction surgery is an option. And here is where potential erectile issues show up. The surgery leaves scar tissue . In certain scenarios this tissue causes increased difficulty in getting an erection.
Assessing Your Cardiovascular Health
Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease .
Your GP may:
- reducing stress
As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease .
Read more about preventing cardiovascular disease
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