Erectile Dysfunction Following Surgery: Ask the Expert

Dr. Justin Harmon Health Pro
  • A question was recently posted about erectile dysfunction following surgery to the rectum and anus. Erections are generated from a complicated cascade of nerve signaling that is generated in the brain or locally at the penis. Once mental or physical stimulation occurs, nerves deep in the pelvis that lie along side the rectum, bladder and prostate are necessary to propagate the full erection. During surgery for the removal of pelvic organs, such as the rectum, these nerves can be temporarily or permanently disabled or damaged. Often bladder dysfunction is affected for the same reason.


    A patient's ability to recovery full function definitely depends on how good their erections were before the operation. For example, if a patient is on medications for erectile dysfunction, major operations such as this (abdomino-pelvic resection or APR) can further complicate the problem. The severity of the cancer being removed can also be a factor.

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    A consideration to keep in mind following major cancer surgery can be the patient's mental or psychological recovery from such a major operation. The physical appearance of a colostomy (this is a bag to collect stool after part of the colon is removed) can be inhibiting during sexual activity. Depression, which is often associated with cancer, can lead to less confidence sexually and a decreased libido. It is vital to discuss this with your primary physician and your urologist because things can be done to improve these feelings.


    If the oral therapies fail for the erectile dysfunction, the next step is usually the urethral suppositories or the injectable therapies. Remember that more advanced and even the more basic therapies must be managed under strict physician supervision.


    If all of these fail, several other options exist prior to surgery. Combination therapy involves the use of two medicines simultaneously that may work in different ways. This can also mean the use of the vacuum tumescent pump with, let's say, a oral medication or an injectable. For example, a patient may be taking the maximum dose of Viagra, which is 100mg, with only marginal results. His physician may then institute the use of an injection at the same time to further enhance the erection. Once again, this is not to be experimented with at home. It must be performed under the close eye of a physician.


    If surgery is chosen, many options exist. One must keep in mind that every surgery/therapy has its side effects and possible adverse outcomes. For example, anytime a prosthetic device is placed in to the body, there is the risk of infection. The more complicated the devices get (we will discuss these in future posts), the higher the risk of malfunction of the parts.


    Patients are generally very satisfied with penile prostheses. It is more common for a patient to state that they feel their penis is larger both in length and girth after such an operation. We cannot change the person's anatomy during this procedure, but the reaction usually comes from the fact that patients are not used to seeing an erection. The sensation to the penis is not affected.


Published On: February 19, 2008