Sexual dysfunction after pelvic surgery

Abstract

Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management. International Journal of Impotence Research (2006) IntroductionErectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. 1 Several factors have been implicated in the etiology of ED. Vascular and neurogenic causes are the most common among them. Diabetes, smoking and hypertension are the most important risk factors for vasculogenic sexual dysfunction. Neurological dysfunction is mainly associated with certain neurological syndromes like autonomic neuropathy. Sexual dysfunction after pelvic surgery has been an important and underreported cause of ED. The pathophysiology of sexual dysfunction after pelvic surgery is unique because it can be either vascular or neurogenic factors alone, or a combination of both. The pelvic surgeries in males that are associated with considerable ED include radical prostatectomy (RP), radical cystoprostatectomy (cystectomy) and low anterior or abdominoperineal resections (APRs) for rectal cancer. The pelvic surgeries in females associated with sexual dysfunction include radical cystectomy (RC) for bladder cancer, radical hysterectomy for cancers of the cervix and endometrium and, potentially, simple hysterectomy for benign tumors.In this article, we summarize male and female sexual dysfunction following pelvic surgeries for prostate, bladder and rectal cancer. We also discuss our experience in the treatment of sexual dysfunction following RP and RC. than 10%, urologists still report that the majority of patients experience ED following RRP. [3][4][5] Until recently, ED following RP was not an overwhelming concern, as most prostate cancers were detected in older men. 6 However, since the adven...

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

“…[1][2][3]9 Despite recent improvements in performing RP that have led to a considerable decrease in the treatmentassociated sequelae, ED still represents a major problem. 4 The main postulated cause of ED in these patients is the temporary cavernous nerve damage, resulting in penile hypoxia, smooth muscle apoptosis, fibrosis and veno-occlusive dysfunction.…”

“…23 Reviews of the literatures have shown that age, obesity and urinary tract symptoms are the mostimportant factors attributed to the occurrence of ED. 1,5,[8][9][10]12,23 The appropriate dose of PGE1 used for ED treatment depends on the etiology. For instance, men with peripheral vascular causes for ED require higher IC dosing than men with neurogenic causes.…”

“…Men with RPinduced ED and those in whom oral therapy has failed or is contraindicated often require intracavernous (IC) injections. [1][2][3][4][5] IC injections were previously reported as an excellent option for maintaining erectile function among nerve sparing (NS) patients in whom oral therapy has failed. In this prior study, no difference in the efficacy of IC was observed between the type of RP performed (bilateral NS, unilateral NS and non-NS) or between the regimen options (PGE1 single, triple therapy).…”

Sexual foreplay incontinence in men with erectile dysfunction after radical prostatectomy: a clinical observation

“…Since penile rehabilitation is now being advocated by centers when erectile dysfunction is noted clinically after radical prostatectomy, 5 it would seem prudent to identify men who are having sex-related incontinence, since the embarrassment it causes might thwart the positive effects that are being attempted with penile rehabilitation. It seemed important to identify this variation of postoperative incontinence, and to attempt to obtain an initial estimate of its prevalence.…”

Transient impotence after transrectal ultrasound‐guided prostate biopsy

“…Sexual dysfunction after pelvic surgery has been described in detail elsewhere. 5 Seddon classification of nerve injury includes 3 degrees of injury: neuropraxia, axonotmesis, and neurotmesis. Neuropraxia is the mildest form of nerve injury, which occurs from transient demyelination, and healing takes place over weeks to months.…”