by Dr Kiran Sodha - All posts, Erectile Dysfunction, Mental Health and Wellbeing, Sexual Health - 10/04/201914/05/2019 Reduce Your Chances of Erectile Dysfunction after Surgery This is for Male Cancer Awareness and we are talking about erectile dysfunction in men who are affected by cancer. Dr Kiran Sodha – GP and founder at The Doctor Service talks about erectile dysfunction in men who are undergoing surgery for cancers such as prostate cancer, bladder cancer and colorectal cancer. Surgeries that affect the pelvic region which is the area in between the hips – all of these surgeries can increase the risk of erectile dysfunction. and actually there’s an 80% chance of a man experiencing some sort of erectile dysfunction after these surgeries. What are the causes? Psychologically, surgery and cancer can affect the way we feel about ourselves and it can actually reduce our sex drive. A lack of blood supply or nerve dysfunction due to surgery can be a major issue too. Why are we talking about it? It’s really important that we talk about it because it’s so under-reported, even with health professionals we don’t talk about it with our patients, and it affects the ability to havesex. And if it affects the ability to have sex, it can affect people’s self-esteem, it can affect what people feel about masculinity, it can affect relationships with your partner and ultimately it’s going to affect your quality of life. My patients aren’t getting the advice they need. I saw a patient yesterday, he’s in his 70s, had prostate cancer, and had the operation last week. He’a be given the all-clear which is fantastic. And during the conversation, I asked him if he was having any erection problems. He’s not having any erections at the moment because it’s not impacting on his quality of life: him and his partner are not currently in a sexually active relationship. But he did say that it was never really approached properly in hospital. No-one really sat him down and tell him about the options he had to minimize his risk or the treatment available. What you need to know. To minimize the risk and duration of erectile dysfunction with our patients, we want to improve the blood flow and make sure the nerve supply stays intact. We want to protect your tissue. And did you know that if the penis blood flow or nerve supply is affected or you’re not ensuring that the blood flow to the penis stays active after or before your cancer operation, the size of your penis can actually shrink? As a GP I didn’t know this and it’s not something my training taught me. So what can health professionals actually do about it? Well, the first thing is psycho-sexual is counseling which can be helpful. especially if you have a partner or you feel that your sex life is being impacted because of the diagnosis and impending surgery. Secondly, it would be really useful for patients to start conversations because often health professionals aren’t initiating the conversations. I don’t think it’s because we’re avoiding it, I actually think it’s because we’re so focused on managing and treating the cancer, we’re not thinking about the collateral damage the cancer is causing. If you talk it with your oncologist or with your surgeon, they may be able to tell you whether there is a risk to the nerve supply to your penis or whether there’s a risk to the blood supply and crucially what you might be able to do about it. So what can you actually do about it? So one thing is, before your operation, you can actually take a low dose of Sildenafil, Viagra or Tadalafil every day in the evening and what that will do is open up the blood flow to the penis. This method works if you take medication for at least a week before your operation,as it can reduce the risk of you having erectile dysfunction problems in the future. To preserve the size of your penis, we need to find out your baseline. We need to find out if there are any specific issues that you’re worried about too. There are devices that can help promote erections, maintain erections and also ensure that you’re having a sex life as well. Is your surgery going to affect your nerve supply? That is the question that you want to ask your surgeon or your oncologist because that is going to affect whether tablets can help you, which are the most useful in prevention and treatment. If tablets are not going to be able to help you, there are other options including giving small tablet in a pellet form through the middle of the penis or injection treatments. Look after your pelvic floor. Physiotherapists can really help with making sure that you have good pelvic floor function. The pelvic floor is your core muscles that hold everything together at the bottom of your pelvis and they hold all the organs together. A strong pelvic floor can improve blood flow, nerve function and therefore the strength of your erections. So it comes back to the question – whether you’re having an operation that’s going to affect the nerves or not as to what’s going to help you the most. Another important thing to remember is you don’t have to be sexually active or wanting to be having sex during this whole period for these medications to be having a benefit for you but you’ve always got to speak to a health professional first before trying things on your own. Taking Sildenafil or Tadalafil on demand even if you don’t have ED, may still provide longer term benefits. What’s coming next? We’ve got a video coming out on pelvic floor dysfunction with Sally Sheppard – who is a physiotherapist and you’ll see how you can stimulate your pelvic floor to try and improve the strength of your erections! Find out more. If you go to our website onto the blog, we’ve got links to the main websites which provide really good information not just to the public but also to health professionals. That includes Macmillan Cancer Support, Prostate Cancer UK, the British Society of Sexual Medicine and the Sexual Advice association. So please like and share, talk about this with your friends, your family, and with your health professionals.