Overcoming erectile dysfunction with prostate disease

Do you know what erectile dysfunction really is? Not being able to have an erection one night after drinking a few more drinks, or even for a week during a period of intense emotional stress, is not erectile dysfunction.

The inability to get an erection again immediately after an orgasm is not erectile dysfunction either. Almost every man occasionally has trouble getting an erection and most partners understand this.

The erectile dysfunction is the inability to achieve and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis does not get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to achieve an erection. On another occasion, the erection may not be as firm as usual or may end before orgasm. When such difficulties occur regularly, it is time to talk to your doctor.

Erectile dysfunction can have many causes, including certain forms of prostate disease or therapies for the prostate cancer. Fortunately, in many cases, this problem can often be dealt with effectively, for example by taking medication to treat erectile dysfunction.

How an erection occurs

Put quite simply, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires an extraordinary orchestration of the body's mechanisms. Blood vessels, nerves, hormones and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from occurring at all.

Prostate Cancer

Surgery for prostate cancer can sever some of the nerves or arteries necessary for an erection. For men undergoing radical prostatectomy (removal of the prostate gland), estimates of how many men will regain the ability to have an erection vary widely, from 25% to 80%. So-called ’nerve-sparing“ surgical techniques also lead) to erectile dysfunction in up to half or more of all cases. The results depend on variables such as the age of the patient, the skill of the surgeon and the location of the tumour (if a tumour is too close to the nerve bundle, the nerves cannot be spared). Even when the nerves are not permanently compromised, it can take 6 to 18 months for the nerve fibres to recover from the trauma of surgery and restore sexual function.

Radiation treatment (radiotherapy) can also damage erectile tissue. Both external radiation and radiation-emitting seeds implanted in the prostate (brachytherapy) lead to erectile dysfunction in about half of the men receiving these therapies. However, these changes may not occur until two years after treatment.

Erectile dysfunction is sometimes a side effect of certain hormone therapy drugs prescribed for men with cancer that has spread beyond the prostate. Among these hormone-based drugs are leuprolide (Lupron) and goserelin (Zoladex). Others, such as flutamide (Eulexin) and bicalutamide (Casodex) can cause erectile dysfunction to a lesser extent. Prostate cancer itself, in its advanced stages, can also spread to the nerves and arteries necessary for an erection.

Benign prostatic hyperplasia

Men who have thebenign prostatic hyperplasia (BPH), or enlarged prostate, may also experience erectile dysfunction and ejaculatory problems. While BPH itself does not cause these problems, some of the treatments used can. For example, finasteride (Proscar), a testosterone-lowering drug prescribed for BPH, has been linked to erectile dysfunction in 3.7% of men who use it and decreased libido in 3.3%. But alpha blokers such as tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) may improve BPH symptoms with a lower risk of sexual side effects.

Transurethral resection of the prostate, a surgical technique often used when drugs fail, also causes erectile dysfunction in a small percentage of men.

Low testosterone

The levels of testosterone tend to decrease with age. They peak at the beginning of adulthood and then may decrease to 1% per year from about the age of 40. Sometimes a sudden drop occurs due to an injury or illness (such as an infection), chemotherapy or radiotherapy, or certain medications.

The hormone testosterone plays an important role in men's health, but perhaps its most significant role is in fuelling sexual desire. If testosterone levels fall too low, men can experience erectile dysfunction and lacklustre libido.

Prostatitis

The prostatitis is an inflammation of the prostate gland that can be acute (usually caused by a bacterial infection) or chronic (usually not caused by an infectious agent). Symptoms include pain during urination, more frequent urination and possibly discharge from the penis or fever. Severe prostatitis can directly cause erectile dysfunction. In milder forms, the condition may produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to erectile dysfunction.

What tests to do for erectile dysfunction

The doctor will listen to your heart and also take your blood pressure; both high and low blood pressure can impair blood flow. The doctor will check your pulse at several points: at the wrist, ankle and groin. Slow or low pulse in any of these areas can mean that not enough blood is getting to the tissues of the extremities, including the penis.

In addition, the doctor will examine the testicles, penis and chest. Abnormally small testicles and enlarged breasts are sometimes signs of inadequate testosterone. Spots of scar tissue in the penis suggest Peyronie's disease. The doctor may check the prostate gland for signs of infection or cancer by performing a digital rectal examination.

Your control will probably include tests for the cholesterol (to assess the risk of cardiovascular disease) and triglyceride and blood sugar levels (to check for diabetes). The doctor may also request a urine sample because the presence of red or white blood cells could be a sign of an underlying urological problem.

Now that drugs can successfully treat most men with erectile dysfunction, many routine diagnostic tests are only used when the doctor suspects that the patient has an underlying problem that requires additional treatment.

Hormonal tests

Checking testosterone levels was one of the first tests ordered for men with erectile difficulties, but it was before doctors realised that testosterone deficiency was rarely the source of the problem. Now, hormone tests are performed for men whose medical examinations suggest an endocrine problem and for those who have experienced a loss of sexual desire.

The doctor may also want to check blood levels of prolactin (a pituitary hormone that can block the action of testosterone) or thyroid-stimulating hormone (a good indicator of an overactive or hypoactive thyroid gland).

Blood flow examinations

A duplex colour Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage. A newer version, called a penile doppler, can be performed in a doctor's office. If you have tried erectile dysfunction pills, but have not found them helpful, your doctor can inject prostaglandin, a fatty acid that widens blood vessels, into your penis to see if this causes an erection. If so, there is a good chance that you will respond to one or more of the injectable drugs used to treat erectile dysfunction.

Nocturnal tumescence test

If it is unclear whether your erectile difficulties have a psychological or physical cause, your doctor may suggest a nocturnal penile tumescence test. Psychological factors come into play when you are trying to achieve or maintain an erection. But the psyche does not influence nocturnal erections, which occur involuntarily during sleep. Physical causes influence both types of erections.