Dr. Patrick Walsh's Guide to Surviving Prostate Cancer by Patrick C. Walsh

Author:Patrick C. Walsh
Language: eng
Format: epub
Publisher: Grand Central Publishing
Published: 2018-05-14T16:00:00+00:00

Sexual Potency

Chapter 11 is devoted to erectile dysfunction, so you should consider this just an introduction to this difficult subject. The first thing we need to do is make sure we’re all talking about the same thing. What do we mean by potency? The medical definition is simple—“an erection sufficient for penetration and orgasm.” Having said that, it’s worth repeating that men who are impotent after radical prostatectomy have normal sensation and normal sex drive, and can achieve a normal orgasm. Their only problem may be in achieving or maintaining an erection.

Potency after radical prostatectomy can be affected by many things: a man’s sexual function before surgery, his age, the stage of his cancer, the surgeon’s skill, and the extent of tissue removed—in other words, whether one or both neurovascular bundles were removed during the operation.

For men in their forties, potency is similar (about 90 percent) in men who keep both neurovascular bundles intact and in men who have one nerve bundle removed. This suggests that all that’s needed for men to achieve erection is one of these nerve bundles, and that nature has provided a “spare.” Over age fifty, however, sexual potency is better in men who have both neurovascular bundles preserved than in men who lose one bundle. When the relative likelihood of impotence after surgery is adjusted for age, the risk is higher if the cancer has penetrated the prostate wall, if it has invaded the seminal vesicles, or if one neurovascular bundle has been removed. Thus, the men most likely to remain potent are younger, with disease confined to the prostate. These also are the men who will benefit most from surgery.

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