What is erectile dysfunction?
Erectile dysfunction or impotence is the inability to develop an erection or sustain it. This is not life threatening in itself but erectile dysfunction can indicate some underlying health condition that may need treatment.
Symptoms of erectile dysfunction:
The symptoms of this include:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
Causes:
Erectile dysfunction can be caused by any physical problems like heart diseases, high blood pressure, high cholesterol, diabetes, metabolic syndromes, sleep disorders, tobacco use, some prescribed medicines, Parkinson’s, tobacco use, treatments for prostate cancer or enlarged prostate among several other causes. Psychological conditions such as stress, anxiety, depression etc can also cause this. In this article erectile dysfunction is discussed in detail in relation to prostate cancer.
Treatment:
The doctor first works to counter the underlying condition that causes or worsens the erectile dysfunction and treats for it. Depending on the cause and severity of the problem, and other health issues the patient may have, the right treatment can be selected.
- Oral medication is a common treatment for erectile dysfunction and it can be in the form of drugs such as Sildenafil, Tadalafil, Vardenafil, Avanafil. All four of these medications aim at enhancing the effects of nitric oxide, a natural produced chemical in the body that increases the blood flow and allows erection.
- Alprostadil, a chemical substance can be either self injected into the penis or placing a tiny suppository in the penile urethra, these methods can sustain an erection for about an hour.
- Penis pump is a hollow tube with a hand powered or battery powered pump that creates a vacuum to increase the blood flow in the penis that can help obtain an erection.
Complications:
Erectile dysfunction can lead to certain complications that can be demoralizing or distressing, it is however important to note that in most cases, it is not a permanent condition and can be countered by using treatment for it or can simply revert to original sexual functioning in time. The following are some of these:
- Stress
- Anxiety
- Embarrassment
- Relationship problems
Prostate cancer and erectile dysfunction:
The prostate is an exocrine gland that is responsible for the urine control and the secretion of fluids which are useful outside the body. It produces a fluid that transports and nourishes the sperm to fuse with the female ovum or egg. Prostate cancer is the cancer in the cells of the prostate gland, prostate cancer by itself does not cause erectile dysfunction, it is the treatment methods that result is this problem.
While prostate cancer is not the cause of erectile dysfunction, the treatment for this disease can lead to this complication. The following are the treatment methods in which erectile dysfunction is a common side effect.
Surgery:
Erectile dysfunction is a common side effect in people that have undergone prostate cancer surgeries. Prostate surgeries involve removing the prostate gland, nearby tissues and even lymph nodes if the cancer has spread beyond the prostate. Radical retropubic prostatectomy and radical perineal prostatectomy are the two types of surgeries depending on how the prostate is approached.
Erectile dysfunction can be noted right after the surgery regardless of if the nerves that control the erection are affected due to surgery. If the nerves are not damaged, one can recover from erectile dysfunction within one to two years of the procedure but if however, there is nerve damage, recovering from erectile dysfunction is unlikely. Even if an erection can be achieved after surgery, there may be little to no ejaculation causing “dry” orgasms.
Vacuum devices for erectile dysfunction drugs can be used to improve the speed of return to normal sexual function, if desired, sperm banking is an available option too. Read more about surgery for prostate cancer here.
Radiation therapy:
Erectile dysfunction is the most common side effect of radiation therapy. Erection problems do not occur immediately after radiation is given to the prostate, but slowly develops with time. Older men are more likely to develop erectile dysfunctions than younger men who are given radiation to treat prostate cancer. The occurrence of erectile dysfunction however decreases with more sophisticated treatments such as brachytherapy, IMRT or 3D conformal radiotherapy. Read more about radiation therapy of prostate cancer here.
Hormone therapy:
Hormone therapy is also referred to as androgen deprivation therapy (ADT) or androgen suppression therapy. It aims at reducing the male hormones, called androgens and restrict their impact on prostate cancer as androgens help the growth of prostate.
When hormone therapy is used, erectile dysfunction and decreased drive can be common for two to four weeks after treatment. This is because the treatment aims at androgen reduction and as a result, testosterone reduction is common. Men with erectile dysfunction do not respond properly to any treatment aimed at curing erectile dysfunction but the data on this is limited. Read more about hormone therapy for prostate cancer here.
Components of erectile function effected:
Four main components of erectile functioning that are affected by the prostate cancer treatments are:
Libido:
Libido or sex drive is commonly affected by hormone therapy or any other treatment methods that decrease the testosterone levels. It is possible to obtain an erection even if one has low libido, but it is more difficult to maintain it if this is the case. When the levels of testosterone restore after a few months after treatment, the drive returns too, it is important not to take undue stress due to this situation.
Mechanical ability:
Mechanical ability is the ability to achieve a firm erection and this is controlled by the nerves and vessels surrounding the prostate and the penis. This is mostly affected by surgery and radiation therapy and in cases where there is nerve damage.
Orgasm:
Orgasm may be difficult to achieve right after treatment, especially if the libido of the patient is affected. This is however a temporary issue and will soon revert back to normal a few months after treatment. No treatment methods and medication may be needed for this.
Ejaculation:
The patient may experience little to no ejaculation after treatment too, especially if the prostate or the seminal vesicles are removed or irradiated (in surgery or radiation therapy respectively).