NORMAL SEXUAL FUNCTION AFTER PROSTATECTOMY OR RADIATION THERAPY
Libido is stimulated by the male hormone, testosterone, which is produced mainly by the testicles. When testosterone levels drop, the sex drive is diminished.
Erections are controlled by nerves that lead to and from the penis; particularly important are the nerves in two bundles that sit on either side of the prostate. In normal erection, sexual stimulation causes these nerves to release chemicals that increase blood flow into the penis. As the penis becomes engorged with blood, veins clamp down—shutting themselves off, so the blood can’t leave the penis. This keeps the penis erect during sexual activity. But sometimes these nerves are damaged—during a surgical procedure, for instance. Sometimes the arteries that pump blood into the penis are injured—after radiation therapy, perhaps. Or sometimes, for various reasons, the veins that are supposed to keep blood trapped inside the penis just don’t do their job. When a man has trouble with an erection, doctors call this “erectile dysfunction.”
Ejaculation involves powerful muscle contractions in the epididymis, vas deferens, prostate and seminal vesicles. During orgasm, a muscular valve in the bladder neck slams shut, forcing semen out the only possible exit—through the urethra and penis to the outside world, rather than backward into the bladder. But certain prostate treatments can result in the loss of this fluid. In a TUR procedure to treat BPH, for instance, the valve in the bladder neck is sometimes destroyed—so, because there’s no barrier to keep sperm from going back into the bladder, it isn’t forced out the urethra. After radical prostatectomy, there’s usually no emission of fluid because the prostate and seminal vesicles, which make most of it, are gone and the vas deferens has been shut off. After radiation therapy, many men also have a loss of ejaculate fluid because the glands responsible for making it are “dried up.”
Orgasm doesn’t really have much to do with the prostate. Orgasm happens primarily in the brain; as long as sensation is intact, orgasm can occur even in the absence of an erection and ejaculation. This is the key reason why normal sexual function can be restored to most men who are impotent after prostate treatment. (The one exception here is men receiving hormone therapy; because this causes a loss of libido, there is a general lack of interest in sexual activity.)
The most common sexual problem that troubles men after prostate treatment is the loss of erection, and there are several good ways to restore this, including vacuum erection devices, penile injections (injecting tiny amounts of erection-producing drugs into the penis), and penile prostheses.
The take-home message here is that after treatment for prostate disease (except for men treated with hormone therapy), recovery of sexual function is almost certain. Take heart!
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Tags: Erectile Dysfunction, Men’s Health