Erectile Dysfunction

As men get older it may become more difficult for them to achieve and/or maintain an erection. The anxiety created by this may be further exacerbated following cancer treatment. Damage to the erectile nerves due to the effects of radiation therapy or during surgery may cause a temporary or permanent loss of erectile function.

Nerve sparing surgery exists that can lessen the impact on erectile function, however the suitability of such surgery depends on a number of factors including the stage and extent of the tumour.

Symptoms of Low Testosterone

Low sex drive
Emotional, psychological and behavioural changes
Decreased muscle mass
Loss of muscle strength
Increased upper and central body fat

Very good responses to testosterone have been reported for men with low testosterone in various clinical studies and they include:

• Improvement in mood and sense of well-being
• Increased mental and physical energy
• Decreased anger, irritability, sadness, tiredness, nervousness
• Improved quality of sleep
• Improved libido and sexual performance
• A decline in biochemical markers of bone degradation and an increase in bone density
• An increase in lean body mass, a decline in fat mass
• An increase in muscle strength (hand grip, upper and lower extremities).
  Potentially, a decrease in the risk of heart disease
• With testosterone therapy, one's attitude improves, reinforcing self-esteem and self-confidence in success at work, and increased energy at home and in social activities.
• Most men will feel more vigorous, experience improvement in energy levels, mood, concentration, cognition, libido, sexual performance and overall sense of well-being.
• This effect is usually noted in 3 to 6 weeks. Other potential benefits include maintenance or improvement in bone density, improved body composition, muscle mass and muscle strength, as well as improvement in visual-spatial skills.

If you do experience problems maintaining or achieving an erection, there are a number of treatments that can help.

Tablets are available that can increase blood flow to the penis, thus achieving an erection. Common side effects of this method include hot flushes and headaches. However, men you have had cardio-vascular problems should consult their doctor, as this method of treatment may not be appropriate.

Another popular form of treatment is penile injection. This involves injecting a substance into the base of the penis that dilates the blood vessels enabling them to fill with blood and thus creating an erection. This method is successful for most men, but it is essential for your doctor to work out an accurate dosage for you to prevent your erection lasting too long.

Other popular methods include the use of surgical implants to help create an erection. Implants are permanently surgically implanted into the penis under general anaesthetic; they can only be removed through another operation. There are two main types of implant, the Semi-Rigid implant or the Inflatable implant.

Semi-Rigid implants involve placing a semi-rigid rod into the penis. After having this operation you will have a permanent erection, although this will not be as firm as your previous erections, it is adequately suitable for sexual intercourse. It is also flexible enough to be pulled down and tucked away when you are clothed, thereby avoiding any unwanted attention or embarrassment.

Inflatable implants involve the insertion of two cylinders into the penis and a reservoir of 60-100mls of saline deep behind the pubic bone. A pump and valve are inserted into the scrotum allowing the saline to be pumped into the penis, thus producing an erection. When an erection is no longer needed the valve can be released allowing the saline to drain back into the reservoir and the penis to become flaccid (soft).

Problems with Implants

As with all surgical procedures there are risks associated with the anaesthetic that your doctor will discuss with you.

The implants themselves carry a specific risk, associated with slight risk that your body will reject the implant or that the implant may become infected. Although these risks are minimal, the result is that the implants would need to be removed and it is unlikely that another could be put in. While the inflatable method gives a more natural feeling erection, there are the added potential problems of tubes blocking or pumps and valves malfunctioning

It is essential that, if you are experiencing problems associated with erectile dysfunction, you discuss this with your doctor.