Radiation. Although it is generally believed that radiation poses a lower risk for impotence than does surgery, studies have reported similar rates after 3 years. Experts suggest radiation injures the blood vessels and so lead to erectile dysfunction over time. Some studies report a lower risk for impotence from brachytherapy, a radiation technique that involves the implantation of radioactive "seeds" compared to external-beam radiation. Still, there have been very few studies that have lasted more than 2 years. One 5-year study reported a high long-term rate of impotence (53%) with brachytherapy, which is close to that of standard externally administered radiation. Early use of alprostadil injections and Viagra may help these men as well as those who had surgery.
Drug Treatments. Prostate cancer medical treatments commonly employ androgen-suppressive treatments, which cause erectile dysfunction.
Surgical Treatments that Affect Intestinal Tracts
Surgery for Colon and Rectal Cancers. Surgical and radiation treatments for colorectal cancers can cause impotence in some patients. In general, colostomy does not usually affect sexual function. However, wide rectal surgery can cause short term or long-term sexual dysfunction. Total mesorectal excision (TME) may pose fewer risks than standard surgery. Sildenafil (Viagra) may help many men who experience this after surgery.
Surgical Treatment of Inflammatory Bowel Disease. Rectal excision for inflammatory bowel disease (IBD) can cause impotence, but rates are low (2 - 4%). Sildenafil (Viagra) is very effective in restoring potency after IBD surgery.
Operations for Fistulas. Surgery to repair anal fistulas can affect the muscles that control the rectum (external anal sphincter muscles), sometimes causing impotence. (Repair of these muscles may restore erectile function.)
Treatments for Benign Prostatic Hyperplasia (BPH)
Surgery and drug treatments for benign prostatic hyperplasia (BPH) can also increase the risk for impotence, although to a much lesser degree than surgery for prostate cancer.
- Between 4 - 10% of patients who have transurethral resection of the prostate (TURP) and open prostatectomy for BPH report impotence afterward. The risk is very low, however, in men who were functioning normally before surgery.
- Finasteride (Proscar) has been associated with impotence in 6 - 19% of patients. Anti-androgen drugs used to treat BPH can also cause erectile dysfunction.
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