Achieving Orgasm After Radical Prostatectomy
Men worry about erectile dysfunction after radical prostatectomy, the operation that involves removing the prostate gland as a way to treat prostate cancer. Its a legitimate concern. Men, their spouses and partners, and their surgeons should talk about erectile dysfunction before and after the surgery. Almost all men will experience erectile dysfunction for several months to a year after a radical prostatectomy, although todays nerve-sparing operation has decreased the number of cases when its permanent.
But orgasm after radical prostatectomy? Its often even not on the radar screen. Dr. Ravi Kacker thinks that should change.
Sometimes orgasm gets forgotten because everyone is so focused on erectile dysfunction, says Dr. Kacker, a urologist and fellow in male sexual medicine at Harvard-affiliated BethIsraelDeaconessMedical Center. But for somemaybe mostmen and their partners, achieving orgasm can be as important as erectionsor even more so for having a healthy sex life.
And, says Dr. Kacker, theres good news. Orgasms after radical prostatectomy may feel qualitatively different for most men, but they dont need to be any less pleasurable or satisfying.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
A physician can recommend a number of treatments to address an enlarged prostate. An enlarged prostate will require surgery to relieve the symptoms. In most cases, surgical treatment for an enlargement of the penis is enough. Moreover, a doctor may recommend a course of treatment based on symptoms. A TURP procedure is not painful and requires less recovery time than open surgery. The recovery period will be shorter and less traumatic.
Erection And Your Sex Life
There are three cylindrical bodies that make up the penis. The first one is the corpus spongiosum . It contains the urethra, which includes the head of the penis or glans. The others are the two corpora cavernosa or erectile bodies that extend from the pubic bones to the head of the penis. The structure is a sponge-like tissue and has irregular blood-filled spaces. For a firm erection to occur, this penis anatomy needs to function optimally.
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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.
Can Erection Rehabilitation Be Applied To Improve Erection Recovery Rates
A relatively new strategy in clinical management after radical prostatectomy has arisen from the idea that early induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. There is an interest in using oral PDE5 inhibitors for this purpose, since this therapy is noninvasive, convenient, and highly tolerable. However, while the early, regular use of PDE5 inhibitors or other currently available, on-demand therapies is widely touted after surgery for purposes of erection rehabilitation, such therapy is mainly empiric. Evidence for its success remains limited.
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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 Is Prostatic Massage
To perform a prostatic massage, a practitioner will place a lubricated, gloved finger into your rectum and apply pressure to your prostate gland. The procedure is not normally painful, but some may find it uncomfortable.
Prostatic massage is thought to help men with ED by clearing the prostatic duct. Massage might also interrupt infections and eliminate blocked fluids. A few studies have found that men who get prostate massage for the symptoms of ED experience improvement.
Unfortunately, these studies have been small. Prostatic massage isnt considered a mainstream form of ED treatment. Even still, for some men, this alternative option may be helpful in addition to other forms of treatment.
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Can An Enlarged Prostate Cause Ed
While an enlarged prostate does not cause ED, some BPH treatments may affect the ability to keep an erection, so its important to talk to your doctor to understand possible BPH treatment side effects.
Certain BPH medications may cause decreased sex drive and ED as a side effect.4 For instance, studies have shown a connection between certain anti-testosterone drugs and ED.5 If BPH symptoms continue even after medication therapy, your doctor may suggest a surgical treatment to remove the extra prostate tissue causing your BPH. However, surgical treatment also comes with side effects. A common surgical treatment, transurethral resection of the prostate , has also been shown to cause ED in a small percentage of men.5
You and your doctor may discuss a minimally invasive BPH treatment option, Rezm Water Vapor Therapy. Rezm Therapy treats the cause of BPH by using the natural energy stored in water vapor to remove the extra prostate tissue that is causing urinary issues while preserving sexual function. A five-year clinical study showed that men who had treatment with Rezm Therapy for their BPH did not suffer any procedure-related ED.6 It also showed that the quality of life improved for those men who had Rezm Therapy.6 Learn more about how Rezm Therapy works.
Physical Sources Of Ed
ED takes place when:
There is inadequate blood streams into the penis Several wellness concerns can lower blood circulation right into the penis, such as hardened arteries, heart problem, high blood sugar level as well as smoking.
The penis can not catch blood during an erection If blood does not stay in the penis, a guy can not keep an erection. This concern can take place at any type of age.
Nerve signals from the brain or spinal cord do not get to the penis Specific diseases, injury or surgical procedure in the pelvic location can harm nerves to the penis. Nattokinase Cause Erectile Dysfunction
Diabetic issues can cause small vessel disease or nerve damage to the penis.
Cancer cells treatments near the pelvis can impact the penis performance Surgical procedure and or radiation for cancers cells in the reduced abdomen or hips can create ED. Dealing with prostate, colon-rectal or bladder cancer frequently leaves men with ED. Cancer cells survivors ought to see a Urologist for sex-related wellness issues.
Substance abuse to treat various other health issue can negatively affect erections Individuals must discuss medication adverse effects with their primary care doctors.
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Treatments For Erectile Dysfunction
Once your doctor has determined the underlying cause of your erectile dysfunction, they will recommend a treatment plan. This can include a combination of individual treatments or it can include one treatment.
Treatments are those that address the underlying physical cause of your erectile dysfunction. This list is not exhaustive and itâs important to consult your doctor.
What Is The Importance Of Preserved Erectile Function
In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.
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How Are Prostate Cancer And Erectile Dysfunction Related
If you have issues with your prostate, a general workup can include urine tests, bloodwork, and a physical exam. This exam usually consists of a digital rectal exam , where a doctor will feel your prostate from inside your anal cavity. If the prostate feels smooth and round, thats generally a sign that you probably only have BPH. Otherwise, you may need to undergo further testing, and cancer may be a concern. Men who are diagnosed with prostate cancer worry about many areas of their health. I have heard many of these questions over the years: How bad is it?, What options do I have?, and What are possible complications of treatment?
Currently, the mainstays of treatment for prostate cancer are anti-testosterone therapy, surgery, and radiation therapy. Each of these has pros and cons related to treatment success and long-term effects on the body. However, one of the most common complications for all three of these options is erectile dysfunction. We talked about how anti-testosterone therapy can affect erections when we discussed BPH treatments above. Lets now look at prostate surgery and radiation therapy.
Key Points: Guidance At A Glance7
- Involve the man and his partner in discussions about ED rehabilitation before and after radiotherapy/ADT.
- Assess the man and his partners sexual functions â the partner may also require support.
- Assess other health problems / current medications that may affect sexual function.
- Encourage adoption of exercise programme and lifestyle changes.
- Start the rehabilitation programme early, and no later than 3â6 months after ADT or radiotherapy has commenced.
- Consider combination therapy of PDE5-I tablets and vacuum erection device as first-line treatment.
- Consider including daily low-dose PDE-I tablets in ED rehabilitation programme.
- Consider using the most effective PDE5-I, as judged by treatment trial.
- If initial treatment fails, consider alprostadil pellets, injections or topical alprostadil, followed by penile implant.
- Reassess erectile function regularly after starting a rehabilitation programme.
- Enable access to psychosexual therapy for men and / or couples who do not benefit from biomedical strategies alone and / or experience high levels of distress related to sexual changes.
- Duration of treatment depends on response â avoid strict time limits.
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Effects Of Prostatitis On Sexual Function
Prostatitis is the most common prostatic disease in men younger than 50 years of age and the third most common urologic diagnosis in men older than 50 years of age . The US National Institutes of Health announced a new definition and classification for prostatitis, which has been widely accepted. Patients are divided into four categories by the NIH: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain symptoms , and asymptomatic inflammatory prostatitis. CPPS is the most common presentation, particularly perineal, testicular, penile, and ejaculatory pain. Other genitourinary tract complaints include sexual dysfunction and voiding complaints .
In a multicenter study from China, 1,786 patients with chronic prostatitis participated in a survey using the NIH Chronic Prostatitis Index and five questions taken from the International Index of Erectile Function . The overall prevalence of sexual dysfunction in these patients was 49%, and the prevalence of premature ejaculation and ED accounted for 26% and 15%. The conclusion of this study was that the rate of prevalence of sexual dysfunction in Chinese men with chronic prostatitis is high. In addition, age was associated with the prevalence of sexual dysfunction.
Few studies have reported on the association of CP/CPPS with ED. Nonetheless, CP/CPPS is believed to exert adverse effects on the overall quality of life, and, consequently, to induce ED.
Early Penile Rehabilitation After Surgery
As mentioned before, the recovery time for erections after surgery can be up to 2 years. If a man does not have an erection during this time period, the tissues in his penis may weaken. Once this happens, he will not be able to get an erection naturally. Some experts and doctors recommend different methods to promote erections starting within weeks or months after surgery to help some men recover sexual function. You may hear this called penile rehabilitation, or erectile rehabilitation.
Penile rehabilitation has 2 parts:
Making sure you are getting regular erections that are hard enough for penetration. Its best if you can have an erection 2 to 3 times a week. This will help keep the tissue in your penis healthy.
Using a low-dose pill to help the blood flow around the nerves and help the nerves heal.
Medicines to help produce erections pills such as sildenafil , tadalafil , or vardenafil are typically used in combination with other therapies or devices. Since the drugs might not produce an erection because they need the nerves responsible for erections to be healthy, penile injections or vacuum devices might be offered. See Managing Male Sexual Problems Related to Cancer to learn more.
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Exercise Nattokinase Cause Erectile Dysfunction
Current research studies have actually found that exercise, particularly modest to vigorous cardiovascular activity, can improve erectile dysfunction.
Also less exhausting, normal workout might decrease the risk of erectile dysfunction. Enhancing your level of activity may additionally additionally decrease your danger.
Talk about an exercise plan with your doctor.
How Effective Are Oral Erectile Dysfunction Drugs
- Following surgery, up to 70% of men who have had nerves spared on both sides of the prostate will regain erections with the use of one or more oral drugs for erectile dysfunction. Results are less favorable for men who have had a single nerve spared or no nerves spared.
- Following radiation therapy, overall, 50% to 60% of men regain erections with medication. However, current data are rather limited, especially for patients treated with radioactive seed implants.
- Hormone therapy. Men treated with hormone therapy do not respond well to any erectile dysfunction treatments, but data are limited.
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Prostate Cancer And Erectile Dysfunction
Prostate cancer may lead to erectile dysfunction in two ways, the tumor itself may invade and damage the surrounding tissues leading to erectile dysfunction, or the treatments to remove, treat, or shrink the tumor may lead to temporary or lasting erectile dysfunction.
A quickly developing case of ED may even be a sign of a developing prostate cancer, so abrupt changes in erectile function should always be brought to the attention of your doctor.
If required, surgical removal of the prostate gland due to prostate cancer may lead to the severing of arteries and nerves needed to develop an erection and may lead to ED in some patients. It is estimated that between 25% and 80% of men will regain their sexual function after a radical prostatectomy, but this will depend on the tumor location, nerve-sparing techniques used, the skill of the surgeon, and the patientâs age. It is important to note, that during the period of time that the vessels, nerves, and tissues are healing from surgery you may experience ED, but once everything has had time to recover, erectile function may improve.
Radiation therapy for prostate cancer may also lead to damage of the surrounding tissues and cause erectile dysfunction. Certain hormonal medications are sometimes utilized for the treatment of prostate cancer, such as Leuprolide, Goserelin, Flutamide, or Bicalutamide can also lead to hormonal effects that cause ED in some users.
Address Your Whole Health At Low T Center
Getting quality health care is easy with our team at Low T Center. Were dedicated to making mens health care convenient, accessible, and affordable. Our providers take a holistic approach to mens health. We are here to help you identify potential causes of your symptoms. We also help find treatment solutions to help you feel your best. Make an appointment today to take the first step toward better health and get a comprehensive health assessment!
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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
Bph Medications And Sexual Side Effects
Some drugs used to treat BPH can cause difficulty in maintaining an erection. Men who take alpha-blockers such as doxazosin and terazosin may experience decreased ejaculation. This is because alpha-blockers relax the bladder and prostate muscle cells.
Alpha reductase inhibitors can also cause ED. Additionally, reduced sex drive is a possible side effect of the alpha reductase inhibitors dutasteride and finasteride.
Approximately 3 percent of men taking dutasteride reported experiencing a decreased libido in the first six months. About 6.4 percent of those taking finasteride experienced this within the first year. Roughly 4.5 percent of men taking dutasteride-tamsulosin reported decreased libido in the first six months.
Men who take these medications may also experience lower sperm count, decreased sperm volume, and lower sperm movement. Adverse events typically decrease with continued use.
Medications that treat erectile dysfunction may help improve BPH. The ED drugs below have all been shown to reduce BPH symptoms:
However, they arent currently approved to treat BPH.
These medications inhibit a protein that breaks down a chemical called cyclic guanosine monophosphate , which increases blood flow to the penis. By inhibiting the protein that breaks down cGMP, blood flow to the penis can be increased.
One comparing tadalafil and a placebo showed that men who took 5 milligrams of tadalafil daily had significant improvement in both BPH and ED symptoms.
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