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Summary

Erectile dysfunction, also termed impotence, refers to the inability to obtain or maintain an erection that is firm enough or lasts long enough to have satisfactory sexual intercourse. 

The problem is almost always treatable. Most men who seek help receive a benefit from treatment. 

Erectile dysfunction impacts self esteem and confidence – and may cause depression. It also has an effect on relationships 

NOTE:  Erectile dysfunction is not a yes or no type of equation after a prostate cancer treatment. Instead, it is a spectrum with many different shades, involving getting an erection (initiating), maintaining an erection, and being able to complete intercourse. It also involves your sexual partner. 

  • Discuss erectile dysfunction with your doctor before agreeing to any treatment for prostate cancer.
  • It is advisable to take your partner with you when you discuss erectile function and the options with your doctor. Couples who discuss the issue together and agree on treatment can achieve emotional and physical success concerning sexual activity faster and more meaningfully than if a man makes the decision on his own.

If you have any symptoms of erectile dysfunction after treatment, do not wait for your doctor to ask about it. Bring up the subject yourself.

Causes of Erectile Dysfunction

In addition to various treatments for prostate cancer, erectile dysfunction may be caused by other health conditions such as diabetes, hypertension or cardio vascular disease, or the aging process.

The condition tends to be physical, not psychological.  




How An Erection Works

A successful erection involves several parts of the body working together: the brain, blood vessels, nerves, and certain hormones. Sexual stimulation resulting from various erogenous thoughts or stimuli or local genital contact triggers the erectile process. The brain and nerves of the nervous system course in the pelvic region to the genitalia and direct chemical messages that result in penile erection. 

The process importantly involves blood flow to the penis. The erectile tissue and blood vessels supplying the penis open up and allow blood entry to cause engorgement and rigidity of the penis under the control of chemical signals. Depending upon the level of stimulation, the chemical signals determine whether the penis is in its flaccid or erect state.




Treatments For Erectile Dysfunction

Several options are currently available for managing erectile dysfunction following treatment for prostate cancer.

  • Use of medications such as Viagra, Cialis and Levitra. 
    • These drugs help obtain and maintain an erection when a man is sexually stimulated. 
    • The drugs do not always work in the same way each time. Response to the drugs depends on factors such as stimulation, energy, libido, and your partner’s participation in the activity. Erections rarely extend beyond intercourse. 
    • There may be side effects.
  • A vacuum erection device
    • The device is passed over the penis creating a vacuum in the cylinder which results in increased blood flow into the penis. A constricting band or ring is then placed at the base of the penis which traps the blood. The result is that the penis is rigid and can be utilized for intercourse.  
    •  No medication or injection is required. 
    • These devices are particularly effective for couples in a relationship.
  • Pellet implant: the insertion of a drug filled pellet through the tip of the penis. The drug gets absorbed into the penis.  
  • Penile injection: 
    • Medication is injected into the side of the penis through a very fine needle like the ones diabetics use for insulin.  
    • The dose can be adjusted on the spot.  
    • The injection takes about 15 to 30 minutes until a penile erection is achieved. 
    • Depending on the dosage, an erection can last 30 to 60 minutes.  
    •  Side effects can include d some discomfort at the injection site. Over time scar tissue or fibrosis can grow. 
    • For most patients, this technique works when less invasive therapies fail.
  • Penile implant: If the other therapies do not work, or if they are not preferred, an alternative is to do a penile implant – an implant into the penis. 80 to 90% of men who have undergone a penile implant, say they would undergo the procedure again or recommend to a friend. While intrusive, and requiring anesthesia (typically in the hospital overnight), a penile implant is one of the most satisfying and effective treatment options for refractory erectile dysfunction.
    • The technique is like a breast implant: space is cleared in the penile tissue and a device is inserted into the penis through an incision.
    • There are different types of implants. One used most often, and which gives the most natural type of function, is an “inflatable penile implant” style of implant. Rigidity and flaccidity are purely mechanical. They based on the transfer of liquid from reservoirs in the scrotum between the two testicles into the penis.  Inflation takes 1 to one and half hours to perform. 
    • When flaccidity is desired, the liquid goes back to the cylinder and the penis and groin look natural. You wouldn’t know if you didn’t know.
    • When interested in initiating sexual activity, there is a small mechanism inside the scrotum which transfer fluid from the cylinders through a pumping mechanism. The result is a rigid penis.
    • Effectiveness is not dependent on sexual activity.
    • A penile implant is the most consistent and reliable treatment for erectile dysfunction that currently exists.