Dealing With Erectile Dysfunction
By Emily L. Sauber
Erectile dysfunction is when a man is not able to achieve or maintain an erection sufficient for his sexual needs. It's often a side effect of the treatments for prostate cancer.
Some men have chronic, complete erectile dysfunction, called impotence. Others have partial or brief erections. Younger men are more likely to regain sexual potency after treatment than older men. Plus, a man's ability to have an erection before surgery or radiation greatly influences whether he will have erectile function after treatment. Men who were able to maintain strong erections before treatment are also more likely to maintain them after treatment compared with men who had problems before treatment.
The majority of men who have surgery to remove the prostate, called radical prostatectomy, will experience erectile dysfunction. The rates of dysfunction are lower when surgeons can use nerve-sparing techniques. In older studies, around half to 75 percent of men had problems with erectile dysfunction after radiation treatment; these numbers may be declining with newer radiation techniques, according to the American Cancer Society.
Despite the incidence of erectile dysfunction after treatment, doctors and nurses may not always discuss the issue with men after treatment. Men may also feel uncomfortable talking about it with their healthcare team and even with their partners. The discussions should happen, though, because erectile dysfunction is treatable. Keep reading to learn how to start the discussions about your sexual health after prostate cancer treatment and to learn what your options are if you experience impotence after treatment.
Communication: The First Step in Overcoming Erectile Dysfunction
Clinical expert, Deborah Watkins-Bruner, RN, PhD, says the first step in treating erectile dysfunction is talking about it.
"The key message is that if you are willing to bring it up and discuss it with a healthcare professional, there are multiple alternatives to help you. A significant percentage of men will respond to therapies," Watkins-Bruner says. "The problem is that medical professionals tend not to deal well with any sexual dysfunction after treatment. Research has shown this. So it may be your job to take the initiative."
Watkins-Bruner emphasizes that men should tell their doctor about the problem as simply and directly as possible. "You can bring up the topic by saying something like, 'I have a concern. I have not been able to have an erection or have an erection as often.' Or you might say, 'I can have an erection, but it does not maintain itself.'" Watkins-Bruner advises men to state directly what the problem is and to describe it. Once your doctor knows about the problem in detail, he or she can suggest appropriate treatments.
Some men may find it helpful to discuss erectile dysfunction with other men who are also experiencing it. other about this. " Us Too" is a prostate cancer education and support group that has local chapters where men can talk with each other. See www.ustoo.com to find a support group near you.
Treatment for Erectile Dysfunction
Your choices for treatment include pills such as Viagra (sildenafil), the vacuum device, penile injections, and penile prosthesis.
According to Watkins-Bruner, men should "review their alternatives and pick the one that best suits their lifestyle." Oral medications and vacuum devices are a less invasive method of treatment for erectile dysfunction than implants. Regardless of what a man decides, Watkins-Bruner says he should discuss his options at length with his doctor.
Oral medications, such as Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil), are taken in pill form and absorbed into the bloodstream. The drugs work by inhibiting an enzyme found mainly in the penis. The result is increased blood flow to the penis and a fuller erection.
The most common side effects of these pills are headache, facial flushing, and upset stomach. Less common side effects are bluish or blurred vision and sensitivity to light, and a thorough eye exam is recommended before using these drugs. They can also have serious interactions with some other drugs, such as nitrates taken for chest pains. Men with heart problems should check with their cardiologist before using these drugs.
Vacuum devices are tools that help men develop an erection suitable for intercourse. The device works by drawing blood into the penis and keeping it there. To use it, a man inserts his penis into a hollow, plastic tube that is then pressed against the body, creating a seal. A small hand pump creates the vacuum, which draws blood into the penis, causing it to become hard. After a few minutes of pumping, the man places a small, rubber ring around the base of the penis so that the erection can be maintained.
Side effects of vacuum devices include coldness or numbness in the penis after the rubber ring has been removed. Also, the vacuum device may interfere with foreplay.
Penile injections are self-injections. A man or his partner uses a tiny needle to inject medicine directly into the side of the penis. The injections begin to work within 5 to 15 minutes and create an erection. A doctor can teach a man how to inject himself.
Side effects include dizziness or feeling flushed. Prolonged or lengthy erections may also be a problem. Men should seek medical attention if they have an erection lasting longer than four hours.
Penile implants are a type of prosthesis. A surgeon places a device inside the penis. Penile implants are tubes that can mimic the erection process. There are three types of implants. They are the semi-rigid, the inflatable, and the self-contained inflatable.
Implants are the most invasive procedure because they require surgery. As with any surgery, there's a risk for infection. In rare cases, after getting an implant, men experience numbness at the head of the penis or find intercourse uncomfortable. If the implants are removed, men are at an increased risk for erectile dysfunction because the implant permanently changes the internal structure of the penis.
The Emotional Effects of Erectile Dysfunction
Just as open communication is important between a man and his doctor for getting treatment for erectile dysfunction, communication is equally important between a man and his partner. Watkins-Bruner stresses that the "emotional effects of erectile dysfunction on a couple are generally not so difficult if their relationship was healthy to begin with. Being open with your partner about your fears and concerns is the first step in overcoming them.
"What we have found in research is that couples who had a good, open sexual relationship prior to treatment have the best chance of maintaining a good sexual relationship after treatment. The drugs or the implants that we can use don't cure marital woes," she continues. "If there are other problems--if there is some kind of conflict or problem with the relationship--the couple needs to see a counselor. When the only problem is that a man is suddenly having erectile dysfunction after treatment and they have a good relationship to begin with, it's not difficult for talk about it. The ability to deal with these issues flows from that."
Watkins-Bruner believes men may feel frustrated the first time they attempt to engage in intercourse after treatment and fail. "They think because they failed to have an erection on the first try that means they're never going to have one again. That's not the case. Men need to know that just because there are times when they can't have an erection, that doesn't mean they always can't."
Plus, Watkins-Bruner reminds, "not having an erection doesn't preclude giving pleasure to your partner." She notes that there are many other ways for couples to be intimate. And many don't require an erection. "Intimacy is always possible without intercourse, and so is mutual pleasuring. Those who participated in oral stimulation before treatment, for instance, should continue that after treatment." According to Watkins-Bruner, a good therapy outcome is based on patient and partner satisfaction.
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