Title : Erectile Dysfuntion: Erectile Dysfunction and Cancer - Angela's Blog
URL Link : Erectile Dysfuntion: Erectile Dysfunction and Cancer - Angela's Blog
Erectile Dysfuntion: Erectile Dysfunction and Cancer - Angela's Blog
Erectile dysfunction (ED) occurs as a consequence of many cancer treatments, and can impact heavily on a patient's quality of life. The psychological effects of ED may result in loss of self-esteem, disturbed romantic relationships, and emotional distress.
Erectile Dysfunction (ED) is a significant problem for cancer patients�both cancer survivors and those being actively treated for cancer. Exact statistics for ED in cancer patients as a group are difficult to measure due to the effect of different diseases and treatments on ED and its multifactorial nature. ED has been studied most frequently in prostate cancer patients, but it can come about as a consequence of many cancer diagnoses and treatments.
In addition to those with prostate cancer, patients with colorectal, bladder, rectal, penile, testicular, colon, and hematologic malignancies, among others, may experience ED. It is estimated that 60-90% of men experience erectile dysfunction following prostatectomy and 67-85% following radiotherapy for prostate cancer, and that 30-51% of men treated for localized prostate cancer use an erectile aid within five years of receiving cancer therapy. Despite a large amount of research and many recent advances in surgery for prostate cancer, such as nerve-sparing techniques, laparoscopic procedures, and robotic-assisted procedures, a significant number of men continue to experience ED after prostatectomy.
No matter what the cancer diagnosis, factors such as surgeries, radiation treatments, chemotherapy treatments, hormone therapy, changes in testosterone levels, changes in physical functionality, and depression/anxiety all play a role in sexuality, and thus contribute to the problem of ED. Erectile function is key to a man's sense of identity and his relationship with his significant other, and has a significant impact on quality of life for cancer patients due to its impact on many psychosocial areas, including affect, loneliness, psychological adjustment, marital happiness, and depression, among other things.
Pathophysiology of Erectile Dysfunction in Cancer Patients
Penile erection occurs as a result of a complex intracellular cascade of reactions. The nervous system may be triggered as a response to stimulation of the senses, as a reflex to direct genital stimulation, or during REM sleep as a nocturnal erection. Any of these types of stimulation will initiate a very complicated cascade of reactions. Nitric oxide, guanylate cyclase, guanosine triphosphate (GTP), cyclic guanosine monophosphate (cGMP), intracellular calcium, and phosphodiesterase-5 all play a role in the cascade.. As a result of these chemical reactions, penile cavernosal smooth muscle is relaxed, sinusoidal blood flow to the penis is increased, and venous outflow from the penis is occluded, resulting in a penile erection. Interference with any part of this intricate system will result in ED.
Surgeries to the pelvis done to remove tumors or organs may alter both vascular supply to and enervation of sexual organs, thereby contributing to ED. ED after radical prostatectomy is thought to be due to injury to the nerve plexus that provides the autonomic enervation to the corpora cavernosa of the penis. Additionally, hormonal balances may change with the removal or alteration of organs. Surgery for colorectal cancer can damage the pelvic nerve, and also may result in the use of an ostomy appliance, thus affecting ED in both a physiological and psychological manner. Radical cystectomy for bladder cancer results in urinary diversion, which may affect ED due to mechanical reasons as well as affecting body image, self-confidence, as well as sexual desire. After surgical resection, men with penile cancer are also faced with body image issues, as well as problems with physical functioning, although their pelvic nerves may still be intact.
Many patients are treated with pelvic radiation for various types of cancer, and this can also be a significant contributor to ED. Prostate cancer patients can receive photon external-beam radiation, brachytherapy, transperineal implantation of radioactive ioidine-125 seeds, proton beam radiation, or conformal external beam radiation. Other types of cancer are treated with pelvic or abdominal radiation as well, depending on type of cancer and size and spread of the malignancy. The exact mechanism by which radiation therapy (RT) leads to ED is unknown. It is known, however that RT usually does not damage the nerves of the pelvis; it creates scar tissue within the pelvis and hardens and constricts vasculature, which can lead to ED. DNA damage caused by RT is also thought to play a role. The effects of ED caused by radiation treatment may not become apparent until months or years after treatment has finished.
Chemotherapy treatments can affect erectile function in cancer patients for several reasons. Its effects on fast-growing gonadal tissue may alter hormone levels in the body, and fatigue, nausea, and altered body image all may contribute to altered sexual functioning if not directly to ED.
Hormone therapies for prostate cancer are designed to work against androgens in order to prevent further cancer growth in the prostate, but because androgens play a large role in sexual desire and performance, patients receiving hormone therapies often have difficulties with ED. Additionally, androgen deprivation may cause depression, mood swings, anxiety, hot flashes, loss of libido, and body composition changes such as gynecomastia, which affect body image.
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Erectile dysfunction affects an estimated 18 million men in the U.S. alone
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