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Enlarged Prostate Treatment And Your Sex Life
Getting older? If youre a man, the size of your prostate might become a concern.
Prostate growth is a natural part of aging. For most men, this typically walnut-sized gland starts getting bigger around age 40. About 90% of men over age 80 have an enlarged prostate.
The medical term is benign prostatic hyperplasia , and scientists arent exactly sure why it happens. The most important word is benign. The growth isnt a sign of anything wrong. Its not a tumor and its not related to prostate cancer, although it is possible to have both conditions at the same time.
Still, an enlarged prostate can create some problems due to anatomy. The urethra, which carries urine and semen out of the body, goes right through the prostate gland. And with BPH, tissue grows inward, putting pressure on the urethra, making urination difficult.
Lower urinary tract symptoms include problems with weak urine flow, an urgent need to urinate, and nocturia .
Its usually the urinary bother that makes men seek treatment. Unfortunately, treatments can have sexual side effects, like erectile dysfunction and trouble with ejaculation.
Not all men have these complications, but you should know the possibilities before you move forward. Your urologist can tell you more about your personal situation.
Lets look at the sexual side effects of BPH treatment in more detail.
How might enlarged prostate treatments affect my sex life?
Can the sexual side effects of BPH treatment be managed?
Increased Adrenergic Response May Cause Ed And Luts/bph
Both urinary function and erection can be affected by changes in the smooth muscle tonus caused by increased adrenergic response. Unilateral sympathectomy in rats led to homolateral increase in prostate . Transgenic rats that are spontaneously hypertensive due to greater adrenergic tonus presented urodynamic characteristics similar to those of males with LUTS . Furthermore, the rats presented a deficient erectile response to electrical stimulus of the cavernous nerve .
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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.
Presence Of Nitrergic Innervation In The Prostate And Cavernous Bodies
Some authors demonstrated there is intense nitrergic innervation in the prostate glandular epithelium, fibromuscular stroma and blood vessels of normal gland this innervation is diminished in BPH. On the other hand, the importance of nitric oxide in maintaining erectile function is well known .
Lee and colleagues studied a population of 372 men from Taiwan and found that polymorphism of eNOS gene G894T is more frequent in males presenting ED and LUTS/BPH . Such polymorphism was described in exon 7 of the eNOS gene, which encodes the enzymes that produces endothelial nitric oxide. This polymorphism causes a change in the amino acid sequence, resulting in altered activity of the enzyme and reduced production of nitric oxide . This finding shows that there may even be a genetic origin for the association between ED and BPH/LUTS.
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How Should Cialis Be Taken
Take Cialis exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you.
Some men can only take a low dose of Cialis or may have to take it less often, because of medical conditions or medicines they take.
Do not change your dose or the way you take Cialis without talking to your healthcare provider. Your healthcare provider may lower or raise your dose, depending on how your body reacts to Cialis and your health condition.
Cialis may be taken with or without meals.
If you take too much Cialis, call your healthcare provider or emergency room right away.
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How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
Treatment Options For Symptomatic Bph
Symptoms related to BPH, particularly LUTS, can be managed by waiting for spontaneous improvement of symptoms, by medical therapies, or by various surgical procedures. The choice of treatment depends on the severity and annoyance of the patients symptoms, his expectations of treatment, and his acceptance of the risks of treatment.
One of the factors most frequently considered by patients contemplating a particular therapy for BPH is the effect of that therapy on sexuality. An inability to ejaculate or a significant decrease in ejaculate volume is significantly associated with deterioration in QOL. The selective 1-blockers cause few sexual side effects as a result, they are associated with a higher QOL. Physicians should inquire about sexual function as part of each patients pretreatment evaluation and, where appropriate, manage BPH and ED simultaneously.
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How Does The Treatment For Bph Cause Erectile Dysfunction
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.
What Causes Prostate Enlargement
Multiple factors cause prostate enlargement. Documented causes include specific medications, some of which are commonly used for prostate problems, as well dietary issues, disease processes, and hormonal imbalances.
Nutritional and dietary issues are known to be common causes of BPH. A diet heavily laden with animal fat is one of the most significant causes. Foods known to have high levels of animal fat include red meat and dairy products.
Aside from BPH, a diet high in animal fats is also known for causing cardiac problems and diabetes. Increasing epidemiological evidence suggests that these foods significantly increase the risk of developing BPH.
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Medications For Prostate Enlargement
Typical medications used to treat prostate issues are Finasteride , dutasteride , and tamsulosin . Finasteride and dutasteride are 5-alpha reductase inhibitors that reduce the amount of the 5-alpha reductase enzyme in the blood. This enzyme converts testosterone in the blood into estrogen. High levels of estrogen exacerbate prostate growth and can result in BPH.
Men with high estrogen levels also tend to develop breast enlargement . Any man who spends a lot of time at the gym has probably noticed older men with enlarged breasts due to a high estrogen level. Enlarged male breasts are an outward indicator, but BPH is most likely also present inwardly.
Tamsulosin is an alpha-blocker that works by relaxing the prostate and bladder muscles so that urine flows easier.
Each of these drugs has a profile of severe sexual side effects. Alpha-blockers can lead to difficulty ejaculating, and 5-alpha reductase inhibitors can destroy libido as well as alter the sensation of orgasm or interfere with erections. For example, in several studies, Finasteride has been shown to increase the risk for men with BPH to develop erectile dysfunction.
Lifestyle And Diet Root Causes Of Bph And Ed
The root cause of erectile dysfunction, whether it comes as a result of BPH or not, is almost always a blood circulation issue.
To achieve a satisfactory erection, a man must have relatively decent blood circulation throughout his body. The penis becomes erect through a series of neurological and physical processes.
The neurological process occurs in the brain when the man becomes sexually aroused. It initiates physical, sexual arousal, which then triggers the process of inflating the penis with blood to achieve a sufficient erection.
However, if arteries are clogged with plaque deposits, they certainly cannot deliver adequate blood flow to the penis for an erection. Thus, the erection is either weak, subsides quickly, or is non-existent. The most common circulatory issues that cause ED include but are not limited to the following conditions:
- High Blood Pressure
- Excessive alcohol use
- Cardiac Insufficiency.
Any effort to improve symptoms of either BPH or ED must address the circulation issue if there is to be any degree of improvement. Note that BPH is not included on the list above because it usually occurs in a combination of one or more of the other listed items.
Contrary to popular belief, erectile dysfunction is not a benign condition. An erection is wholly dependent on good blood circulation. The penis requires unimpeded blood circulation to produce an erection for sexual activity.
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The 4 Causes Of An Enlarged Prostate
It is normal for a prostate to become enlarged as a man ages. The prostate is approximately the size of a walnut in younger men but can grow to be much larger as they get older. An enlarged prostate can cause no visible symptoms but will eventually impact urinary and erectile functions if not properly treated.
There are many reasons a prostate gets enlarged, and most of them arent cancerous. Here are the most common:
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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.
Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
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Why Choose New York Urology Specialists For Treatment Of Erectile Dysfunction
- All treatment is performed by a board-certified urologist experienced in treating men with symptoms of ED, premature ejaculation, and other sexual problems using medical therapy, minimally invasive therapies, lasers, and surgery.
- We are one of the few practices in the region to offer a full range of options for the treatment of sexual, and erection problems in men.
- We offer diagnostic testing in our office which avoids hospital costs.
- Extensive Experience: Thousands of men have treated successfully using medical therapy, shockwave therapy for ED, penile injections with Trimix, and penile implant surgery.
- Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
- We are one of the few practices in the region to offer a full range of options for the treatment of sexual and erection problems in men.
- We are conveniently located within 30-60 minute commute to men who are seeking ED treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.
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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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.