Old-fashioned beliefs suggested erectile dysfunction to be psychological in origin. While anxiety and stress are factors that can cause ED, scientific advances now provide proof that in a majority of cases, it is traced back to physical conditions which interrupt nerve functioning and restrict blood flow.1 Diabetes, arthrosclerosis, cardiovascular conditions, as well as some types of prostate disease and their treatments are responsible for most cases of ED.3 This article will focus on how prostate diseases have impacted erections and sexual activity.
Erection is a matter of synchronous body function, which fills the penile tissue with blood, allowing it to swell and stand erect. This process requires an orchestrated mechanism, lead by blood vessels, endocrine system, and the nervous system, and obviously, any interference can affect the quality of an erection.2 Nitric oxide promotes vasodilatation while neurotransmitters such as norepinephrine and acetylcholine increase the production of chemicals such as guanosine monophosphate, prostaglandins, and polypeptides which initiate the erection process by shifting chemical gradients in the muscles and capillaries of the corpora cavernosa, which runs along the shaft, causing inflation and swelling of the penis.1
It is important to understand how conditions such as prostate disease can interrupt the above mentioned process, leading to abnormal erections or inconsistency in the erectile functioning. It is also helpful to realize limited erections for one or two nights does not mean you have ED.
Prostate Cancer
Sudden and frequent erectile problems can be a symptom associated with prostate cancer, so a prostate-specific antigen, PSA test, accompanied by a rectal exam is performed to assess the situation.
Prostate surgery to remove tumors is often associated with the high risk of nerve damage or cardiovascular complications due to the site specificity of such surgeries. Many choose radical prostatectomy, which only 25% to 80% of men can regain their abilities to maintain any erection.1 Patient’s medical background and the surgeon’s experience are often taken into consideration when evaluating the chances to regain sexual abilities after a surgical procedure.4 Rehabilitation takes up to eighteen months, and that alone takes away from the sexual functioning of men in many cases. Radiation therapy very often harms erectile mechanisms, as both the radiation beam and the radiation-emitting seeds implanted in the prostate can severe the nerve and the muscle cells.2
Hormone therapy is another treatment option which men with prostate cancer opt-in for, but such medication such as goserelin and leuprolide may also translate to ED symptoms, since interference in the endocrine system can greatly impact the erectile mechanism.6
Benign Prostate Hyperplasia
BPH is a non-cancerous enlargement of the prostate, which can greatly impact erectile and ejaculatory function. An enlarged prostate, does not lead to ED, rather some of the treatments used for this condition can lead to ED. Finasteride is an example of an anti-testosterone which is used to treat BPH, can cause reduction in libido, and in turn switch off the erectile engine in men. Transurethral resection, a surgical procedure used in the reduction of the prostate gland has also failed to skip ED as one of its side-effects.6
Prostatis
Simply known as the inflammation of the prostate gland, prostitis can be acute, or chronic, which is either caused by an infectious agent or not respectively, can trigger ED in many men. Aside from pain, frequent urination, and discharge from the penis, this condition can directly cause ED. It can also be accompanied by painful ejaculation and lack of sexual pleasure for men. The infection can clear in several weeks if treated, but the chronic form can be a permanent problem for some men.7
However, there is no need to panic. Every failed attempt to maintain an erection is not ED. When the male genitals don’t get hard enough, or it loses the rigidity and softens soon after an erection, there might be some speculations about ED. It might take longer to get an erection, and in other occasions, the erection might not be as firm or last as long. With such conditions witnessed regularly, it would be time to contact your doctor, and figure out a way to stop this condition in its tracks. With all the new medical discoveries and pharmaceutical advances, a right solution for you might be easier to access than you might imagine.
Diagnosis Methods*
In order to confirm a case of erectile dysfunction, a visit to your primary care physician, urologist or ED specialist would be required. Below is a table from Harvard Health Publishing which summarizes the procedure followed by doctors for each possible cause of erectile dysfunction:
| Possible cause of erectile dysfunction | What the doctor does |
| Vascular (circulatory system) | Takes your blood pressure and listens to your heart. Checks pulse in groin and feet. Checks your abdomen for aortic aneurysm. |
| Neurological (nervous system) | Tests reflexes of your knees and ankles, as well as anus. Checks for sensation in your legs and feet. |
| Hormonal (endocrine system) | Assesses testicular size and breast development. Checks your thyroid gland. |
| Local (reproductive system) | Examines your penis for Peyronie’s disease. Checks your prostate. |
| Psychological (stress, anxiety, emotional) | Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected. |
*Table from Harvard Medical School’s Health Publishing: Sex and Prostate (2009)1
Doctors who specialize in ED treatments often use advanced diagnostic equipment to measure: blood flow, nerve sensitivity, and hormonal levels.
Treatment Method
Despite the fact that there is no definite cure for ED, we can remain hopeful on not giving up sexual activities due to such conditions that limit our sexual abilities. We live in an era where we are offered multiple treatment options to overcome such limitations and to regain the sexual abilities and cravings. Men with prostate diseases might be at most risk for developing ED, right next to cardiovascular disease patients, inactive individuals, and individuals who do not pay attention to their diet and mental health.7 Overcoming erectile dysfunction while dealing with prostate cancer is not an easy job but we can’t sit around and hope for a miracle to happen. The first step for a healthier sex life post-diagnosis of a prostate disease is the will and determination to make it happen. The next step is contacting specialists and evaluating the treatment options available to you. You can also help the recovery and treatment by remaining active, consuming a balanced diet, and taking the treatment seriously. Below is a list of all the modern and most popular treatment options available:
| Therapy | Duration of Action Mechanism | Effectiveness Duration | Pros | Cons |
| IC Injections
(ICP, Fx) |
10-15 Minutes | 30-75 Minutes | Highly Effective
(98%), Few side effects |
Training required; Injection might be uncomfortable for some men; may cause pain or priapism |
| Sound Wave Therapy
(Rejuvapulse) |
While In Use | Long-term | Non-invasive, Effectiveness varies (up to 85%), Non-pharmaceutical | Takes longer to see results. |
| Sildenafil
(Viagra) |
30-60 Minutes | 3-5 Hours | Oral form, Effective (70%), | Not suitable for men with cardiovascular diseases or on blood pressure medication and nitrates.
Side-effects. |
| Vardenafil
(Levitra) |
15-30 Minutes | 3-5 Hours | Oral form, Effective (70%) | Not suitable for men with cardiovascular diseases or on blood pressure medication and nitrates.
Side-effects. |
| Tadalafil
(Cialis)
|
30-45 Minutes | 2-3 Days | Oral form, Effective (70%) | Not suitable for men with cardiovascular diseases or on blood pressure medication and nitrates.
Side-effects. |
| Alprostadil
Pellets |
Immediate | While In Use | Effective for some (80%) | Requires training; may cause burn; awkward and might cause bruising |
| Penile Bands | Immediate | While In Use | Needs adjustment. Cheap | Tricky to use |
| Stem cell Technology | On-going sessions | Long-term | Next-Gen;
Permanent results; Personalized |
Expensive |
There are some misconceptions about this condition which gives an inaccurate image to many individuals dealing with erectile dysfunction.
MYTH: Erectile dysfunction only affects the elderly.
FACT: After the age of 45, almost 1 out of 2 men experience some sort of ED. It is true that ED occurs more prevalently as men age, however, men can retain their erectile functioning well unto their 80s, but it is medication and age-related conditions that exaggerates the occurrence of ED.3
MYTH: Men must accept and live with erectile dysfunction.
FACT: Effective and modern treatment options are readily available. Contact an ED specialist.4
MYTH: ED is a psychological disease.
FACT: Studies show only 10%-30% of ED cases are linked with psychogenic factors. Vascular disorders, abnormalities, nerve damage, endocrinologic disorders and prostate problems build up the remaining 70%-90% of ED cases.3
MYTH: Erectile dysfunction is not common.
FACT: A case study found 52% of Americans have some degree of ED between the ages of 40 to 70 years, and approximately 35% had moderate to severe ED.3
Sources:
- https://www.health.harvard.edu/blog/sex-and-the-prostate-overcoming-erectile-dysfunction-when-you-have-prostate-disease-20090331100
- https://www.healthline.com/health/enlarged-prostate/sexual-function
- https://www.prostateconditions.org/about-prostate-conditions/prostate-health-conditions/erectile-dysfunction
- https://www.pcf.org/c/help-for-ed-after-prostate-surgery-the-basics/
- https://www.webmd.com/erectile-dysfunction/news/20040611/enlarged-prostate-sexual-dysfunction
- https://www.issm.info/sexual-health-qa/does-having-an-enlarged-prostate-bph-affect-sexual-performance/
- https://www.medicalnewstoday.com/articles/320954.php
