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Risk factors for ED after a prostatectomy – surgical removal of part or all of the prostate.

Following a prostatectomy, the risk of erectile dysfunction is influenced by factors including: [12] The skill of the urologist or urological surgeon.

The greater their surgical experience and success rate at preserving sexual function, the more likely a given procedure is to conclude with this outcome. Younger men are more likely than older men to keep or regain their erectile abilities. The greater a man’s ability to produce erections before the procedure, the more likely he is to keep or regain it after the procedure. If both bundles of nerves responsible for erections are sufficiently damaged, it may no longer be possible for a man to have spontaneous erections without the aid of devices or medications that assist the bodily process.

(For more information about remedies for ED after having a prostatectomy, see treatment.) Diagnosis of erectile dysfunction. The first step in treating ED is getting a diagnosis of the root cause by visiting a doctor, who will typically begin with questions regarding: [13] The symptoms experienced The length of time symptoms have been present General physical and mental health Levels of alcohol and drug intake Whether any other medication is also being taken. It may also be necessary for a person to answer questions about their sex life.

These may include: Details of current and past sexual relationships Information about sexual orientation Whether the dysfunction occurs all the time, intermittently or only in certain situations Whether ejaculation is possible Libido, i.e.

As narrowed blood vessels are the most common cause of erectile dysfunction, a doctor will usually examine a person’s cardiovascular condition as part of the diagnosis. This may involve testing for high blood pressure, checking for heart irregularities, as well as evaluating their weight or overall level of health. Blood tests may also be ordered to check for underlying medical conditions that may be causing the condition.

In most cases, doctors will be able to suggest and prescribe treatment options. Treatment methods will depend on the underlying cause of the problem, meaning the chosen method will differ from case to case. Common treatment options for erectile dysfunction include: Treatment of underlying conditions. If an underlying condition is causing erectile dysfunction, treating it will generally be the first step towards

resolving

If medications used to treat other conditions are thought to be causing erectile dysfunction, a doctor may be able to prescribe alternatives.

[14] Good to know: Use of prescribed medication should never be discontinued without supervision by a doctor.

A range of lifestyle changes can help treat erectile dysfunction, including: Losing weight Reducing stress Quitting smoking Reducing alcohol and drug intake or giving them up completely Getting regular exercise.

There are a number of exercises that may help to treat ED.

These include: Pelvic floor exercises: Exercises designed to strengthen the pelvic floor muscles, such as Kegel exercises, can be effective in treating or preventing erectile dysfunction. Yoga: Can be effective in reducing stress and anxiety, psychological problems that can cause erectile dysfunction.

Swimming: A good exercise for improving overall health, which can in turn help treat erectile dysfunction.

Counseling, sex therapy and relationship counseling. If stress, anxiety or depression are causing erectile dysfunction, counseling may be an effective treatment. If relationship issues are the cause, some form of sex therapy or relationship counseling may prove successful.

Sensate focus, a type of sex therapy, focuses on building intimacy between partners. It involves totally abstaining

from

The drugs most commonly used to treat ED are called phosphodiesterase-5 (PDE-5) inhibitors.

These medications work by counteracting phosphodiesterase-5 (PDE-5), a chemical naturally occurring in the body, thereby increasing blood flow to the penis during sexual stimulation.

PDE-5 inhibitors are the most commonly prescribed medication for treating erectile dysfunction.

The most common types are: Sildenafil: Brand name, ViagraВ® Tadalafil: Brand name, Cialis Vardenafil: Brand name, Levitra Avanafil: Brand name, Spedra.

These medications work by artificially dilating the blood vessels in the penis, enabling improved blood flow. The effects of tadalafil last for up to 36 hours, while the other three varieties generally last for around 10 hours. Each should be taken 30 to 60 minutes before engaging in sexual activity and will only take effect when one is sexually aroused. [14] A doctor will be able to advise about which type of PDE-5 is most suitable for each person and the health risks and side effects that come with them. Good to know: Following a prostatectomy, if one, rather than both, sets of the nerve bundles responsible for erections has been damaged (a unilateral nerve-sparing prostatectomy), it is possible to use PDE-5 inhibitors to stimulate an erection.

[16] mazzogran price PDE-5 inhibitors are associated with several side-effects including headaches, a runny nose, hot flushes, an upset stomach and light sensitivity.

In some cases, they can cause more severe vision problems: a temporary or permanent blindness which may be a sign of non–arteritic anterior ischemic optic neuropathy (NAION).

This eye condition has been linked to all brands of PDE-5 inhibitors.

Recent research indicates that there is an approximate two-fold increase in the risk of NAION in men over 50 who have recently used PDE-5 inhibitors, compared to those who have not.

[16] However, the overall risk of PDE-5 inhibitors causing NAION is low, with a risk estimate of 2.27 percent in a 30 day period and 3.52 percent in a 12 month period.

[17] PDE-5 inhibitors are not recommended for people who have already been affected by NAION, or who have a family history of retinal degenerative disorders.

These medications are also known to react with nitrate-containing drugs used to treat heart disease, so it is important to discuss possible interactions with the doctor in cases where PDE-5 inhibitors may be taken in combination with other medications, especially heart medications. An efficient medication for assisting erectile function is thought to be alprostadil, a man-made version of prostaglandin E1, a substance naturally made in the body to help produce erections.

Generally, due to the fact that it is a relatively new treatment with limited safety data, alprostadil will only be prescribed if other treatments, including counseling, lifestyle changes and PDE-5 inhibitors, have been ineffective or are unsuitable. It is administered in three main forms: [18] As an injection, directly into the base of the penis As a small pellet, which is placed into the urethra, i.e. the opening on the tip of the penis As a topical cream, applied to the urethra.

Doctors will advise on which form of alprostadil should be used and give instructions on how to properly administer it at home. After application, an erection can usually be achieved in around 15 minutes. Alprostadil has significantly fewer and less severe side effects than most oral medications which can be used to treat erectile dysfunction. It works by widening the blood vessels and increasing the blood flow to the penis, causing an erection. If side effects occur, these are usually non-serious and are limited to prolonged erections, pain and dizziness. [19] Another advantage of Alprostadil is that the dosage can be adjusted to determine the duration of an erection.

A commonly prescribed topical medication for ED is VitarosВ©, a prescription medicine in the form of a cream, containing the active ingredient alprostadil.

[7] Vitaros comes in a single-use container with a plunger, barrel and protective cap, containing either 200 or 300 micrograms of alprostadil in 100 mg of cream. [8] The appropriate dose strength for each person is decided in consultation with their doctor.

Storage and application guidelines for Vitaros© include: [9] Vitaros should be stored in the fridge, but can be taken out before use in order to reach room temperature for ease of application. If it is taken directly out of the fridge, it may need to be warmed up for use by massaging the tube in one’s hands.

Urination after application will result in cream being expelled from the urethra, lessening its erectile effects.

Each tube of Vitaros contains the right amount of medication for a single dose, which should be applied, with clean hands by injecting it into the urethra, using the single-use applicator pump provided.

The penis should then be kept upright for 30 seconds so that the cream can be absorbed. Any leftover cream can be rubbed in around the tip.

Vitaros will usually take effect in 5-30 minutes after application. It is not an aphrodisiac, and sexual stimulation will therefore be necessary to achieve an erection.

For most people, the effects last between one and two hours.

A full, warm sensation in the penis is not a cause for concern, and may remain for several hours after use.

Vitaros should not be used more than once within any 24-hour period.

Vacuum pumps can relieve the symptoms of erectile dysfunction. A specialized mechanical pump is used to cause an erection by placing it over the penis and sucking air out of the pump, drawing blood into the penis.

Erections created with the use of a vacuum device require a band to be applied to the base of the penis to trap the blood for the duration of the intercouse.

For safety reasons, the rubber band should be removed within 30 minutes.

Penile prosthesis is a surgical procedure in which a rod is implanted inside the penis in order to simulate an erection.

Advanced procedures involve the insertion of an inflatable rod. This is an uncommon treatment method for ED, used only in severe cases, but is generally effective. Though it may not always be possible to prevent erectile dysfunction, certain steps can be taken to reduce the risk of the condition.

These include: [20] Staying healthy, with regular exercise and a balanced diet, including meeting the recommended daily intake of all vitamins and minerals Stopping using tobacco products Avoiding drugs and excessive amounts of alcohol Seeking treatment for conditions such as high blood pressure and diabetes. Complications associated with erectile dysfunction. There are no serious physical complications associated with erectile dysfunction.However, the condition can negatively affect a person’s mental health, causing issues such as: Stress and anxiety Low self-esteem Embarrassment An unsatisfactory sex life Problems within a relationship.

A: The root cause of erectile dysfunction is insufficient blood flow to the penis, which makes it difficult to get or maintain an erection. This can be due to a great variety of different physical and psychological reasons. The main causes of ED include: Aging Conditions which affect the blood vessels and/or nerves responsible for erections, including Parkinson’s disease, multiple sclerosis and diabetes Excessive intake of alcohol or drugs Certain medications, that may cause impotence as a side effect Damage to the nerves responsible for erections from an injury or surgery Psychological factors, such as anxiety, depression or loss of libido.

ED can be a sign of other, more serious conditions which affect the function of the nerves and blood vessels, including those listed above, so it is always important to identify the root cause if ED persists. If you or someone you know is affected, you can get a free symptom assessment at any time by downloading the Ada app. Q: What can cause young people to be affected by erectile dysfunction? A: Although ED is more likely to occur in people older than 50, it has become increasingly common in younger men, i.e.

Unless it occurs due to a medical condition or structural damage to the nerves from surgery or injury, ED in young men is likely to be psychogenic, i.e.

caused by psychological factors such as anxiety, depression and stress. Common characteristics of young men with erectile dysfunction include: [21] No history of conditions which typically may physically cause ED, such as diabetes, hypertension or pelvic injury A psychiatric diagnosis, for example, of depression, anxiety, post-traumatic stress disorder (PTSD) or bipolar disorder Difficulty sleeping or insomnia A demanding job Relationship or performance anxiety A high level of anxiety about the health implications of ED A fixation on finding a cure or a treatment with instant results. Treatment for young men affected by ED caused by psychological factors may involve taking medications such as PDE-5 inhibitors. However, any course of medication prescribed will usually be combined with psychotherapeutic interventions designed to identify and address the problems which are causing ED, [21] for example by improving a person’s self-esteem or mediating their response to stress. Q: Is there a permanent cure for erectile dysfunction? A: Although there is no guaranteed cure for erectile dysfunction, there are a number of treatment options that can provide long-term relief.

Treatment options affect everybody differently, meaning what proves effective for one person may not be the best option for another. Doctors can help advise on the best treatment methods.

Q: Are there any home remedies or natural products that can be used to prevent or treat erectile dysfunction?

A: Seeking medical advice before using any home remedy is advised.

Many people report the use of home remedies to treat ED.

However, natural products, including those listed below, are not recommended treatments for ED, because they are insufficiently scientifically researched for their effectiveness to be proven, and furthermore may be harmful in some cases. Some natural remedies for ED include: [17] L-arginine. A natural supplement that may help to widen the blood vessels in the penis, but should not be taken alongside Viagra.

A natural supplement that is anecdotally reported, but not scientifically proven, to help improve blood flow to the penis.

However, a doctor should always be consulted before using natural products, particularly in conjunction with other medications to avoid cross-reactivity.

What pills are available to help treat erectile dysfunction?

A: Phosphodiesterase-5 (PDE-5) inhibitors are the most common pill-form drugs that are used to treat erectile dysfunction. A doctor should be consulted before using any of these pills as they may be unsuitable in some cases and/or cause intolerable side-effects. Q: Are erectile dysfunction and premature ejaculation (PE) related? A: Premature ejaculation ‒ meaning when a person ejaculates more quickly than they would like, i.e.

before or very soon after penetration ‒ is one of the two main complaints in male sexual medicine, alongside ED. When this happens, doctors will usually try to identify and treat the root cause of ED first, with the assumption that PE may get better as a result. If the cause(s) of ED are physical, this is particularly likely to be the case.

[23] If the cause(s) of concurrent PE and ED are psychological in nature, they may be interrelated and reinforce one another.

For instance, performance anxiety relating to ED may cause a person to ejaculate prematurely and, likewise, worries related to the possibility of ejaculating prematurely may bring on ED. While medications may be prescribed in some cases, a predominantly psychotherapeutic treatment approach will usually be taken, with a focus on learning behavioral techniques for reducing anxiety around both getting and losing erections. [24] Q: What are the best ways to deal with erectile dysfunction in a relationship?

A: There are certain ways you can help support a partner who is affected by ED. These include: [25] Encouraging them in finding out the root cause by seeking a doctor’s opinion and offering to accompany them to medical appointments.

Participating as needed in psychotherapy, sex therapy or other treatments which may be recommended for your partner. Being communicative about your own perspective, empathetic and ready to listen will help a person with ED feel emotionally secure as they begin to explore the reasons for their condition and possible treatment options.

Many partners of people with ED feel that it is a reflection on them, but this is rarely the case. It is important not to cause a person with ED to feel that they have let you down, as this can intensify feelings of related anxiety. Finding alternative ways to connect physically and emotionally, thereby taking the emphasis off penetrative sex and reducing a partner’s pressure to perform. If you think your partner may be experiencing sexual dysfunction, you can get a free symptom assessment at any time by downloading the Ada app. **How long does erectile dysfunction last after prostate surgery? A: The sooner after surgery a man begins exploring his erectile abilities, the more likely he is to regain most or all of his normal sexual functionality.

[26] Doctors will usually encourage the affected person to consider resuming sexual activity as soon as the catheter is removed in order to preserve their erectile function.

The success of penile rehabilitation depends foremost on whether or not a man has undergone a nerve-sparing prostatectomy. Non nerve-sparing prostatectomies and unsuccessful nerve-sparing prostatectomies damage the two bundles of nerves associated with producing erections.

However, there is a range of different treatments available for ED which may help.

(For more information, see the section on treatment.) **Q: In addition to potential problems getting or maintaining an erection, can a prostatectomy cause any other types of sexual dysfunction?

A: Occasionally, men who have undergone a prostatectomy report experiencing pain when orgasming after they have recovered.

It is possible for the pain – which usually affects the perineum and pelvis – to occur either occasionally, at regular intervals or every time the affected person engages in sexual intercourse.

The incomplete removal of the seminal vesicles during the prostatectomy procedure is thought to be a principal cause of postoperative pain on orgasming. [12] In some men, the orgasm ceases to be as intensely pleasurable or ceases to be pleasurable at all. This change in sensation is principally caused by the fact that, in radical prostatectomies, both the glands which make seminal fluid and the vas deferens – the sperm ducts – are no longer operational, so the male orgasm must occur without the ejaculation of semen.

Sometimes the semen ejected will not leave the body, but will be transported into the bladder.

This is especially common after a type of surgery called a transurethral resection of the prostate (TURP). A: No, it is a myth that masturbating itself, even excessively, can cause ED.

[27] In fact, after a prostatectomy, a person is actively encouraged by their doctor to resume their sexual practices, including masturbation, as normal in order to restore sexual function.

[28] However, if a person has a particular masturbation technique ‒ i.e. using intensive pressure ‒ then, over time, this may result in problems developing.

These may include ED and taking a reduced interest in ‒ or getting reduced satisfaction from ‒ sex. A doctor will therefore take a detailed sexual history when making a diagnosis of ED, in order cialis price walmart canada to find out if a person’s specific habits in this regard have contributed to their condition. A: Porn-induced erectile dysfunction is a concept which was first identified by the Kinsey Institute in 2007, soon after internet-based pornography became a worldwide phenomenon.

[29] Research suggests a correlation between becoming addicted to watching porn and developing forms of sexual dysfunction, including ED. A recent study indicates that men who masturbate using pornography are at greater risk of developing ED with a partner than those who do not and, when this occurs, cutting out pornography is often recommended as part of the overall treatment approach. [30] However, the full relationship between watching porn and developing ED is not yet fully understood. Neuroimaging findings suggest that watching porn may have a similarly harmful effect on the brain as that of addictive substances. As their porn habit develops, a person’s neural structure may change, thus increasing their reliance on an external reward system to achieve certain psychological states. This may explain a person’s tendency to depend increasingly on porn for feelings of sexual excitement themselves (rather than being able to generate these mindstates, and associated bodily changes such as erections), and/or to feel the need to seek out media with increasingly extreme subject matter.

[31] “Erectile Dysfunction (Impotence).” Patient.

↩ ↩ ↩ “Erectile dysfunction (impotence).” NHS Inform. ↩ “Management of sexual dysfunction in Parkinson’s disease.” Therapeutic Advances in Neurological Disorders.

↩ “Treatment of erectile dysfunction in multiple sclerosis.” Expert Review of Neurotherapeutics. ↩ ↩ “How to use Vitaros: an introductory guide.” Treated.com.

↩ ↩ ↩ “Erectile dysfunction (impotence).” The British Association of Urological Surgeons.

↩ “Erectile dysfunction (impotence) - Diagnosis](http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Diagnosis.aspx).” NHS Choices.

↩ “Erectile dysfunction (impotence) - Treatment.” NHS Choices.

↩ “The PDE-5 inhibitors.” Sexual sildenafil citrate 25 mg price dysfunction after radical prostatectomy.

↩ ↩ “Alprostadil for erectile dysfunction.” Patient. ↩ “Alprostadil: side effects.” National Institute for Health and Care Excellence (NICE).

↩ “Preventing Erectile Dysfunction - What You Should Know.” Urology Care Foundation.

↩ “A syndrome of erectile dysfunction in young men.” Translational Andrology and Urology. ↩ “How erection problems can affect your relationship.” Patient. ↩ “Penile rehabilitation following radical prostatectomy.” Current Opinion in Urology.

↩ “Does maturbation cause erectile dysfunction (ED)?.” International Society for Sexual Medicine. ↩ ↩ “Sex and relationships.” Prostate Cancer UK. ↩ “Porn use linked to erectile dysfunction.” Medscape. ↩ Erectile Dysfunction (ED) Appointments and Referrals. Call us at 401-793-4636 (4MEN) for more information about our services, or to make an appointment, or refer a patient. The Men's Health Center 180 Corliss Street, Suite C Providence, RI 02904. Erectile dysfunction is defined as the inability to attain and or maintain an erection adequate for sexual intercourse. The main categories of erectile dysfunction are vasculogenic (due to poor blood flow), neurogenic (when the nerve pathways that trigger an erection are affected as in diabetes) and psychogenic (when physical changes triggered by worry or anxiety interfere with normal erection).

Most men suffer from a combination of factors, and a careful history of the problem often leads to a diagnosis. Nearly 50 percent of men ranging in age from 40 to 70 years of age are affected by ED.

Men report guilt, shame and frustrations related to inability to perform.

Due to repeated failed attempts, performance anxiety may present with subsequent attempts. What is a little known fact about erectile dysfunction that the public should be aware of? The presence of the condition is a precursor to the nation’s leading cause of death in men, cardiovascular disease. Since ED usually presents 3 to 5 years prior to cardiovascular disease, recognizing risk factors is crucial in addressing potential heart disease in men with ED.