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.
Nerve Damage From Chemotherapy
Some chemo drugs like cisplatin, vincristine, paclitaxel, bortezomib, and thalidomide can damage parts of the nervous system, usually the small nerves of the hands and feet. These drugs have not been found to directly injure the nerve bundles that allow erection. But some people have concerns because the drugs are known to affect nerve tissue, and there are many nerves involved in sexual function.
What Will I Learn By Reading This
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect . Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
What erectile dysfunction is
Why prostate cancer treatment can cause erectile dysfunction
What can be done about erectile dysfunction
How erectile dysfunction may affect your sex life
What your partner can expect
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate relationship.
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Do I Have An Enlarged Prostate
If youre having trouble urinating, you may have an enlarged prostate. Known as benign prostatic hyperplasia , an enlarged prostate commonly affects men as they age.
An overgrowth of cells in the prostate, a walnut-sized organ that is part of the male reproductive system, can cause it to become enlarged. Because the prostate gland surrounds the urethra, an enlarged prostate can constrict the flow of urine through the urethra.
Almost all men will experience an enlarged prostate as they age. Between the ages of 51 and 60, nearly 50% of men develop an enlarged prostate, with the percentage increasing each year. By age 80, 90 percent of men are likely to experience problems urinating because of an enlarged prostate.
Theme : Psychological Ramifications Of Sexual Dysfunction
Some of the men we interviewed reported psychological issues due to the sexual dysfunction that resulted from prostate cancer treatment. This included many reports of depression and anxiety, in addition to some suicidal ideation. One man reported that hed rather have his legs cut off than exist in his current state of sexual dysfunction. Men who might not have used clinical terms like depression or anxiety nevertheless reported the psychologically devastating effects of feeling abnormal, unnatural, and less of a man due to their sexual dysfunction. There was a sense from men and their partners that sexual dysfunction has a great impact on every aspect of life. Like depression, it can change the very lens with which men and their partners view and experience their whole existence. The participants said the following:
Man 14: And that made me very depressed. I was really surprised about that because nowhere in our research prior to my surgery did I run across that a whole lot about how one of the side effects mentally would be depression. And even now I still have some issues with depression, but its been over a year and a half and I think Ive adjusted somewhat because I found that to combat depression I need to stay active, find things that I used to enjoy that I still enjoy and not focus so much on the depression aspect because I had a lot to be pleased about.
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How Is Benign Prostatic Hyperplasia Treated
Patients who have mild symptoms may not require treatment other than continued observation to make sure their condition doesnt get worse. This approach is sometimes called watchful waiting or surveillance. There are a number of treatment options available if your symptoms are severe.
Finasteride and dutasteride work by decreasing the production of the hormone dihydrotestosterone , which affects the growth of the prostate gland. These appear to be most beneficial for men with larger prostates.
Drugs that relax the muscle in the prostate are more commonly used. These include terazosin , doxazosin , tamsulosin , alfuzosin , and silodosin . The most common side effects are lightheadedness, weakness and retrograde ejaculation.
Medications are sometimes combined to help treat symptoms and improve the flow of urine. One such medication is dutasteride and tamsulosin .
Several different types of surgery can be used to remove the prostate tissue that blocks the flow of urine, including:
Minimally invasive treatments
Last reviewed by a Cleveland Clinic medical professional on 03/10/2020.
How Do The Results Impact Penile Tissue
Fibrotic changes lead to shortening and decrease in girth of the penis following surgery. Venous leakage from damaged tissues is also thought to play a role in the development of erectile dysfunction after prostate surgery. Penile rehabilitation with a penis pump helps maintain penile length and girth. It also helps with nerve recovery and overall tissue health for quicker recovery.
The authors of a 2016 clinical study determined that the average loss of penile length after radical prostatectomy was 1.87 cm and 1.82 cm respectively. They further determined that men who use a vacuum erection device that no significant changes in penile length were observed in men using a vacuum erection device after surgery.
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Is A Prostate Massage The Same Thing As Trying For A Prostate Orgasm
Yes. If you massage the prostate in a way that feels good, youre probably going to have an orgasm if you keep at it.
Some doctors recommend prostate massage therapy to help relieve the symptoms of certain conditions, such as painful ejaculation prostatitis.
Yep! Though evidence on the efficacy of prostate massage for certain conditions is somewhat limited, it does appear to have some benefits.
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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Bph And Erectile Dysfunction: Are They Related
Approximately 70% of men with BPH have co-existing erectile dysfunction , according to research presented in The World Journal Of Mens Health. But that doesnt necessarily mean that ED causes BPH or that BPH causes ED. It also doesnt mean that if you have one problem, you must have the other as well. This statistic simply means theres some sort of connection between the two. But what is the relationship? And what does this link mean for your wellness?
If youre suffering from BPH and/or ED, youre likely wondering how this will influence your sexual and urinary health. Wonder no morethe answers are here!
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
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What Have I Learned By Reading This
You learned about:
Why prostate cancer treatment can cause erectile dysfunction
What can be done about erectile dysfunction
How erectile dysfunction may affect your sex life
What your partner can expect
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
Talking About Orgasm Problems Is Important
Men and their partners have become much more open about talking erectile dysfunction, in general and as a consequence of prostate cancer treatment, notes Dr. Kacker.
Whatever you think about all those ads for Viagra and Cialis, they have made it easier to talk about ED and helped remove some of the stigma around the condition.
We should be having the same frank, open discussions about orgasm, says Dr. Kacker. Orgasms can bring a couple together and allow them to maintain sexual intimacy in the difficult period around diagnosis and treatment of prostate cancer.
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How Soon After Prostate Cancer Treatment Can You Be Sexually Active Again
Different Prostate Cancer treatments have various periods before one can resume sexual activity. Its also down to an individuals recovery time, which has to factor in age.
A man who has had a prostatectomy in his eighties will find that it will take him a lot longer to resume any sexual activity than a man in his fifties who has had external beam therapy.
The individuals general health and genetics all play a part in the healing process. With a prostatectomy, studies tend to show that it is at least several months before erectile function returns, but it can be up to a year.
For more limited surgery, such as TURPs, one can expect to be sexually active again within 4 6 weeks if that is the only surgery and treatment. Often it happens in conjunction with other treatments, such as hormone or radiotherapy, which have much longer recovery times.
There are still options that are open to men before that. If a man still feels sexual desire, then sexual activity is still possible.
There are three parts to orgasm, and while the sensation of fullness or ejaculate may no longer be present, the mental part of orgasm which takes place in the brain is just as possible as before surgery. Plus theres absolutely nothing stopping a man from being more focused on his partners sexual pleasure.
The Most Common Prostate Problem Among Men Over Age 50 This Condition Can Cause Embarrassing Urination Issues
While BPH does not increase your risk of getting prostate cancer or having sexual problems, it can affect quality of life, specifically by causing annoying and embarrassing urination problems.
Since prostate enlargement happens gradually, men often think more frequent trips to the bathroom are a natural part of aging, says Dr. Howard LeWine, chief medical editor at Harvard Health Publishing and an assistant professor of medicine at Harvard-affiliated Brigham and Womens Hospital. But a little medication can help relieve symptoms, meaning less urinary urgency and fewer nighttime awakenings to use the bathroom.
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Theme : Importance Of Education/comprehensive Information
The men in our study spoke about the importance of education and comprehensive information before and throughout the process of prostate cancer treatment. Many men who were dissatisfied with their care were upset when they were given misinformation or they felt the information about sexual dysfunction after prostate cancer treatment was not accurate. Although the men who were most unhappy about sexual dysfunction after prostate cancer did not feel well-prepared in terms of their understanding of the impact of prostate cancer treatment on sexual function, the men who had come to terms with their sexual dysfunction felt they had been well-prepared for the sexual side effects of treatment. Men recommended that information be repeated before, during, and after treatment due to challenges in terms of readiness to learn immediately after the cancer diagnosis. They also talked about the challenges of dealing with a stigmatized topic such as sexual dysfunction. The participants said the following:
Man 16: I was fully informed by everybody. All the doctors that were involved fully informed me that these were things that I was up against if they removed my prostate So definitely you definitely must keep everybody informed about whats going onIts really-thats extremely important
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.
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Surgery For Prostate Cancer And Ed
Prostate cancer tends to be a slow-growing cancer. Surgery may be a good option if your doctor believes the cancer is contained in the prostate gland. Surgery is also dependent on age, overall health, and other factors.
A radical prostatectomy involves the removal of the prostate gland. The prostate gland is a donut-shaped gland that surrounds the urethra just below the bladder. The urethra carries urine and semen out from the body through the penis.
There are some risks associated with surgery. Two small bundles of nerves on either side of the prostate are vulnerable to injury during the operation. A type of operation called nerve sparing surgery may be possible. This depends on the size and location of the cancer.
Surgery may require removal of some nerves if theres a chance the cancer has invaded one or both sets of nerves. If both sets of nerves are removed, you may not be able to achieve an erection without the assistance of medical devices.
Does Enlarged Prostate Cause Ed
Of the many symptoms caused by BPH, one of the most common complaints men have when visiting a urologist is Erectile Dysfunction or ED. This is defined as the inability of a man to attain or maintain an erection sufficient for vaginal penetration and satisfactory sexual performance.
BPH does not directly cause ED, but many men with BPH seek medical attention to relieve ED.
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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.
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
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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