Tag Archive | "sexual function"

Prostate Surgery Causing Problems for Sexual Function


A new long-term follow-up study indicates that many men continue to feel distressed about their reduced sexual function years after prostate surgery.  In fact, the study reveals that sexual function is so important to them that adapting to a lower level of functioning is much more difficult than adapting to temporary urinary problems, explains Dr. Walter R. Parker and colleagues from the University of Michigan Health System in the Ann Arbor report.

Of the 434 men in the study with localized prostate cancer, all underwent radical prostatectomy, which is the complete removal of the gland.  This type of surgery is creating controversy among urologists and surgeons because it is commonly used to treat early-stages of the disease.  Men with early-stage prostate cancer are at a low risk that the disease will be fatal, yet the impact of the surgery is quite negative on the men’s quality of life.

Long-term quality of life is extremely important in men when they have a high likelihood of survival from prostate cancer.  Parker’s team at the University of Michigan developed a survey called the Expanded Prostate Cancer Index Composite (EPIC), which is designed to assess various aspects of quality of life after prostate cancer treatment.  This study is the first to compare men’s scores before the surgery and five years after the surgery.

The study shows that 38 percent of the men who had undergone radical prostatectomy reached baseline levels of urinary function 12 months after the surgery (despite an instantaneous, but temporary, decrease in urinary function and incontinence right after the surgery).  But by four years the improvement declined.

The study revealed even less promising results in regards to sexual function of the men.  Although sexual function began to improve after the surgery, only 28 percent had actually returned to the level of sexual function they reported before the surgery.  After three years from the surgery, 37 percent reported the same level of sexual trouble they reported before undergoing the surgery.  Only 11 percent of the men returned to their pre-surgery sexual function after two years from when they underwent the surgery.  This means that about 63 percent of the men were experiencing low sexual function after undergoing prostatectomy surgery.

The recommended recovery program for sexual function after the surgery includes Kegel exercises and prescription drugs.  These are intended to restore erectile function.  Yet studies have shown that many prescription drugs for erectile dysfunction leave the patients feeling sick and with many side-effects.

Researchers are initiating a “structured early and long-term erectile rehabilitation program to augment sexual recovery as early as possible, yet also convince patients to maintain their erectile rehabilitation efforts long-term,” states Reuters.

But something different needs to be included in these rehabilitation programs.  Many men are searching for alternative treatments for their erectile dysfunction and sexual function problems.  Natural supplements offer safe, often effective, and clinically proven results.  If you have undergone prostatectomy surgery and are considering natural supplements, contact your urologist for further information.

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Pre-op Counseling For Prostate Surgery Not Effective


Researchers have found that over half of men undergoing radical prostatectomy have unrealistic expectations about some of the outcomes.

Daniela Wittmann, MSW, and colleagues at the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan found that despite a pre-operative education program, 61 percent of men expected the same or better sexual function a year after surgery as they had before.  Sixty percent of men expected difficulties with urinary incontinence to be the same or better.  These findings were published in the Journal of Urology.

Wittmann and colleagues found that a substantial proportion of patients, 17 percent and 12 percent, respectively for both effects, expected better performance a year after surgery than before even though they had been told that such an outcome was improbable.  The researchers argued that this finding suggests that pre-op education should be followed up with post-surgery support for prostate cancer survivors.

The research team asked men undergoing radical prostatectomy to fill out the short form of the Expanded Prostate Index Composite questionnaire, both before and a year after surgery to get an idea of their urinary, bowel, hormonal, and sexual function.

The men were also asked, after pre-op counseling but before surgery, to fill out the Expanded Prostate Index Composite-Expectations questionnaire, which detailed what level of function they expected a year later.  Both questionnaires assess five domains: incontinence, urinary irritative symptoms, bowel function, hormonal function, and sexual function.

Analysis of the 152 participants showed that 36 percent and 40 percent expected the same function at one year as at baseline in urinary incontinence and sexual function, respectively, while 12 percent and 17 percent expected better function.  Forty-seven percent and 44 percent of patients had lower than expected function for urinary incontinence and sexual function, respectively.  Expectations matched or were better than outcomes for 78 percent of patients for urinary irritative symptoms.  Expectations of bowel and hormonal function largely matched outcomes, with 92 percent and 86 percent, respectively, having outcomes that were the same as or better than expected.

Wittmann said that these differences may arise from the way that the pre-op counseling is given.  The research tem cautioned that the study had a low response rate.  Out of 526 patients who signed consent forms, only 152 completed all the questionnaires.  This makes it difficult to generalize the findings.  Also, while the counseling on sexual matters was standardized, the information provided by surgeons on other outcomes was not.

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Weight Loss Increases Libido in Obese Men with Type 2 Diabetes


A small Australian clinical study showed that sexual function improved significantly and quickly in obese men with type 2 diabetes after weight loss with reduced-calorie diets.  For 31 men who lost five percent to ten percent of their body weight in eight weeks, erectile function, sexual desire, and urinary symptoms all improved significantly.  According to an article published in the Journal of Sexual Medicine, metabolic parameters, including blood glucose, insulin sensitivity, and lipid profile, also responded favorably to either a low-calorie, meal-replacement diet or a high protein-low carbohydrate diet.

The improvements were maintained during a year of follow-up.  Joan Khoo, MRCP, of Changi General Hospital in Singapore, and Australian co-authors wrote, “Further improvements during weight maintenance, using a high-protein low-fat diet, suggest that both nutrient quality and caloric restriction contribute to these benefits.”  Although the favorable effect of weight loss on sexual function is not new, this study may be the first to demonstrate an impact on sexual desire.

Another important finding was weight loss’ apparently favorable effect on systemic inflammation.  Obesity and type 2 diabetes increase the risk of erectile dysfunction and lower urinary tract symptoms (LUTS), which are associated with each other and with systemic inflammation and endothelial dysfunction.

Rapid weight loss through dieting can improve erectile dysfunction and LUTS. Previous studies also have shown improved endothelial function and reduced inflammation after weight loss, especially for people who lose at least 10 percent of body weight.  Not much data had been collected regarding the influence of macronutrient composition on associations between weight loss, endothelial function, systemic inflammation, sexual function, and LUTS in obese men.

All 31 men involved in the study had type 2 diabetes, a body mass index greater than 30, and a waist circumference of at least 102cm.  They were randomized to two dietary plans.  The first plan was a liquid meal-replacement consumed twice daily and one small, nutritionally balanced meal, providing a total energy of about 900 kcal/day (low-calorie diet).  The second plan was a low-fat, low-carbohydrate diet designed to reduce energy intake by about 600 kcal/day.

The first assessment occurred after eight weeks, and follow-up continued for an additional 44 weeks.  The participants who opted to stay in the study for long-term follow-up consumed the high-protein diet during the follow-up.

Men in the low-calorie diet group had about ten percent reduction in mean body weight and waist circumference at eight weeks, as compared with about five percent among men assigned to the high-protein diet.  Weight loss at eight weeks averaged 9.5kg with the low-calorie diet and 5.4 kg with the high-protein diet, both of which were statistically significant.

In general, inflammatory markers decreased significantly in the high-protein group but not the low-calorie group, but the men assigned to the high-protein diet had higher baseline levels of the markers.  About half of the men remained in the study for the entire 52 weeks. Of those who did, improvements were either maintained or increased.

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Sexual Potency After Radiation Therapy for Prostate Cancer Stabilizes After Two Years


According to data from a prospective cohort study by Richard Valicenti, MD, of the University of California Davis and colleagues, sexual function declines in the first two years after external beam radiation therapy (EBRT) for prostate cancer but stabilizes thereafter.  Pretreatment sexual function was the strongest predictor of sexual function at any time after EBRT.  These findings were reported in the International Journal of Radiation Oncology.

These findings debunk the perception that sexual function declines continually after radiation therapy for prostate cancer.

Valicenti said that the results of the study allow patients and their partners to have a fuller understanding of long-term sexual side effects of EBRT and what they can expect after treatment should aid in deciding on a treatment course.

Reported rates of impotency after EBRT for prostate cancer have ranged from eight percent to 85 percent.  The authors attributed this variation to the different instruments used to assess sexual function.

Additionally, many studies included men who received androgen deprivation therapy with EBRT, possibly covering up the contributions of radiation therapy to changes in sexual function.  Many recent studies have suggested that rates of sexual dysfunction increase with follow-up, but few studies included pretreatment assessment of sexual function or conducted serial assessments of sexual function after EBRT.

The investigators prospectively followed 143 men who completed a sexual function questionnaire prior to EBRT for prostate cancer and at each follow-up visit.  The questionnaire assessed four domains of sexual function: sexual drive, erectile function, ejaculatory function, and overall satisfaction.  Scores on all four of these domains and the total score declined significantly in the first two years after EBRT compared to baseline values.  The average age of the patients was 69 year old.

During a median four years of follow-up, the patients completed 1,187 questionnaires.  Some participants were followed for as long as eight years after EBRT.  The baseline scores for sexual drive and erectile function were significantly correlated with age of patient.  Ejaculatory function was significantly correlated with age, race, and marital status.

The patients were grouped according to baseline sexual function.  The scores for the patients above and below the median sexual function value showed that differences in sexual function persisted over time.  Baseline score was the best predictor of later scores for all of the domains assessed.

There were indications that 74.1 percent of the study participants were sexually potent before EBRT.  Of these patients, 74.4 percent remained potent at one year and 70.4 percent at two years after EBRT.  There were no statistically significant changes in potency from year’s two to six.

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Simple Postage Stamp Test Objectively Assesses ED


According to the results of a small clinical study at Fox-Chase Cancer Center in Philadelphia, a simple, inexpensive home test for erectile dysfunction showed a good correlation with prostate cancer patients’ and partners’ subjective assessments of their sex life.

Objective measures of nocturnal tumescence, erectile dysfunction (ED), and overall sexual function had significant associations for up to a year with the “stamp” test, a do-it-yourself nocturnal penile tumescence assessment.  This test supplements subjective information provided by patients and their sexual partners.  The findings were presented by Lanea Keller, MD, at the American Society for Radiation Oncology.  Dr. Keller found that after high-dose IMRT (intensity-modulated radiation therapy), both the patient’s and the partner’s perception of their overall sex life was reflected by a positive stamp test as well as their own perception of erectile dysfunction.

After radiation therapy for localized prostate cancer, men often have concerns about sexual function.  According to Keller, the information clinicians use to assess erectile and other aspects of sexual function comes mainly from standardized questionnaires, which elicit responses that may be subjective.

Adding the results of an objective test, which involves a strip of postage stamps, could help in the assessment and decision making related to sexual function.  The test involves a man wrapping a strip of postage stamps around the base of the penis.  If he has a normal nocturnal tumescence response, the stamps separate at one or more of the perforations, resulting in a positive test.  Ninety-four prostate cancer patients were evaluated using this test.  The men completed the Expanded Prostate Cancer Index Composite (EPIC) and International Index of Erectile Function (IIEF) questionnaires at baseline and at six, 12, and 24 months after treatment. During the weeks that they completed the questionnaires, the patients also performed stamp tests on various nights.  Their partners also completed an IIEF partner questionnaire at the same time intervals.  The correlation between patients’ and partners’ questionnaire responses and the stamp test was analyzed.

The median age of the patients was 62.5.  Ninety-seven percent of the patients had stage T1c or T2a cancer.  Keller reported that 68 patients had positive stamp tests at baseline. The number of positive tests declined to 33 at six months, 32 at 12 months, and 30 at 24 months.  A positive stamp test at baseline had no relationship with patients’ or partners’ overall satisfaction with their sex life. At all of the follow-up periods, the stamp test had one or more significant or borderline-significant associations with the subjective assessments of sexual function and satisfaction.

At all three time intervals after IMRT, a positive stamp test was associated with patients’ overall satisfaction with their sex life, the partner’s perception of the patient’s erectile dysfunction, and partners’ overall satisfaction with their sex life.  A positive stamp test’s correlation with subjective measures tended to be strongest at one year.

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Men’s Expections for Urinary and Sexual Function After Prostate Surgery Are Not Met


A recent study in the Journal of Urology, led by Daniela Wittmann at the University of Michigan, found that man’s expectations to have better urinary and sexual function a year after the surgery than before it went unmet.

The study used a survey of 152 men, recruited between June 2007 and November 2008, undergoing radical prostatectomy before the surgery after they had received counseling on the risks of the procedure.

Of the patients 36% and 40% expected the same as baseline function at one year in urinary incontinence and sexual function, respectively, and 17%, 45%, 39%, 15% and 32% expected worse than baseline function at one year in urinary incontinence, urinary irritable symptoms, bowel function, hormonal function and sexual function, respectively. One year after prostatectomy fewer than 22% of patients attained lower than expected urinary irritable symptoms, and bowel and hormonal function, but 47% and 44% of patients attained lower than expected function for urinary incontinence and sexual function, respectively. Twelve percent and 17% of patients expected better than baseline urinary incontinence and sexual function at one year after surgery.

Other recent studies have shown that about one in four men recovered the ability to have intercourse one year after surgery and that some amount of incontinence was common even though men were generally not significantly bothered by it.

Tracey Krupski of the University of Virginia, who wrote an editorial that was published with the study, said that a support network may help new cancer patients understand the realities of life after surgery, while Wittmann said that involving patients’ partners is important to successfully regaining sexual function.

Although the study did not examine whether men would make a different treatment decision given what they know after the surgery, Wittmann said that she thinks that only a small proportion of these men would choose not to have surgery given the cancer-related risks.

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Sexual Function May Improve After Prostate Surgery


Hope is still alive for men’s sexual function after prostatectomy. Mainly, those men who are still experiencing erectile function two years after surgery may still see an improvement in function. This improvement may leave men able to sufficiently function during sexual intercourse.

“The message to patients who have erectile dysfunction—even those who have failed to have erections after surgery—is that improvement does occur in a substantial number of men,” says researcher Jeffrey Schiff, MD, a resident in urology at the State University of New York Downstate Center in Brooklyn, New York.
According to Dr. Schiff, nearly one-third of men with marginal erectile function and one-fourth of men with serious erectile dysfunction after surgery continue to have improvement in erectile function on follow-up visits, even 24 months after the surgery was performed.

Schiff and fellow researchers examined the medical records of 128 men who had a radical prostatectomy and were evaluated for erectile function at follow-up visits to the doctor. The men were asked to rate their level of erectile function on a 5-level scale, with 1 corresponding to normal function and 5 representing no erections.

Before the surgery, two-thirds of the men evaluated themselves at level 1, meaning they had normal erectile function. The remaining one-third said they had diminished erections, but were still able to have intercourse.
After surgery, however, 51 men had rated themselves at level 3, meaning “partial erections occasionally satisfactory for intercourse.” At subsequent follow-up visits, 10% of these men had normal functioning and 22% recovered enough to have intercourse, although they did have diminished erections.

Eighty-seven men rated themselves at level 4 or 5, corresponding to partial erections not sufficient for intercourse, or no erections two years after surgery. Of these men, 1.1% recovered to normal erections and 10% recovered diminished erections, routinely sufficient for intercourse. Thirteen percent recovered partial erections occasionally satisfactory for intercourse.

Although those men who experienced the most severe erectile dysfunction still did not see any improvement after three years, men who had partial erections that were occasionally sufficient for intercourse continued to make progress for up to four years after surgery, explains Schiff.

“It’s common for men to have erectile dysfunction after prostatectomy and this shows they shouldn’t get discouraged if sexual functioning doesn’t come back right away,” says AUA spokesman Ira Sharlip, MD, of the University of California, San Francisco. “Even after two years, many will still improve.”

One confounding factor of the study is that about half the men in the study who suffered from sexual dysfunction took ED drugs like Viagra.

“This was not a controlled experiment, so we don’t’ know if these drugs were helpful in overcoming erectile dysfunction,” says the study’s head, Farhang Rabbani, MD, associate professor of urology at Montefiore Medical Center.

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5 Toxics That Are Everywhere: Protect Yourself


(CNN) — A growing body of research is linking five chemicals — among the most common in the world — to a host of ailments, including cancer, sexual problems and behavioral issues.

We encounter them every day — in plastic bottles, storage containers, food wrap, cans, cookware, appliances, carpets, shower curtains, clothes, personal care products, furniture, television sets, electronics, bedding, cushions and mattresses. In short, every room in almost every house in the United States is likely to contain at least one of these chemicals, many of which did not exist a century ago.

They are bisphenol A, or BPA; phthalates; PFOA; formaldehyde; and polybrominated diphenyl ethers, or PDBEs. Tests reveal most of us now carry them in our bodies, but are they putting our health — and the health of our children — in jeopardy?

Here’s what you should know about:

BPA – Bisphenol A

What it does: BPA is a building block of a lightweight, clear, heat-resistant and almost unbreakable plastic called polycarbonate. It’s also used in epoxy resins.

Where it’s found: Water bottles, baby bottles, reusable food containers, plastic tableware, infant feeding cups, linings of infant formula cans and other cans, jar lids, CDs, electrical and electronic equipment, dental sealants.

How we’re exposed: Eating food or drinking liquids stored in containers containing BPA. Infants and small children may also be exposed from hand to mouth contact with materials containing BPA. BPA also migrates from dental sealants into patients’ mouths. Fetuses are exposed in the womb by their mothers. Almost everyone has been exposed. The Centers for Disease Control and Prevention found BPA in the urine of 93 percent of the people it tested.

Health effects: The American Chemistry Council, an industry trade group, says exposure is so low there are no ill health effects. A new five-year Kaiser Permanente study of Chinese factory workers found higher BPA exposure linked to reduced male sexual function. This research joins a growing body of research on animals that suggests BPA poses a potential cancer risk and may mimic the female hormone estrogen and disrupt the extremely sensitive chemical signals in the body called the endocrine system. According to the Food and Drug Administration, these studies suggest BPA could affect “the brain, behavior and prostate gland in fetuses, infants and young children.”

Regulation: BPA is an Environmental Protection Agency “chemical of concern,” one of five substances the agency has targeted for increased scrutiny and potential new regulation. (The others are phthalates, short-chain chlorinated paraffins, PBDEs, and perfluorinated chemicals including PFOA.)

The Food and Drug Administration allows BPA in flexible food packaging.

What you can do to reduce exposure: Buy stainless steel bottles and glass food storage containers. If you buy plastic, check for the recycle number on the bottom. If there is a number 7, assume the container contains BPA unless it explicitly says otherwise. Switch to fresh or frozen vegetables instead of canned. Other precautions include not microwaving or putting hot liquids in BPA plastic containers and throwing away baby bottles and feeding cups that are scratched.

Phthalates

What they do: This family of chemicals softens plastics. They also are used to bind chemicals together.

Where they’re found: Shampoos, conditioners, body sprays, hair sprays, perfumes, colognes, soap, nail polish, shower curtains, medical tubing, IV bags, vinyl flooring and wall coverings, food packaging and coatings on time-release pharmaceuticals.

How we’re exposed: Absorbed into the body through personal care products, ingested in drugs, on food, in water and dust. Infants can be exposed through infant care products like baby shampoos, lotions and powders. Fetuses are exposed in the womb. Virtually everyone is exposed to phthalates.

Health effects: A new study by the Mount Sinai Center for Children’s Environmental Health and Disease Prevention Research found a statistical association between prenatal exposure to phthalates and incidence of attention deficit hyperactivity disorder years later. Phthalates are considered endocrine disrupters, and studies have shown a statistical association between phthalate exposure and male sexual development. Research has also shown phthalates disrupt reproductive development of male laboratory animals.

Regulation: Phthalates are an EPA “chemical of concern.” The FDA allows for plastic containing phthalate in flexible food packaging. The U.S. government last year banned or restricted six phthalates for use in children’s toys and children’s products.

What you can do to reduce exposure: Avoid shampoos, conditioners and other personal care products that list “fragrance” as an ingredient. These may contain phthalates. (Companies are not required to disclose the ingredients in their scents, and the industry says this phthalate is safe.) The federal government recently ended one source of exposure, banning the sale of toys containing any of six phthalates.

PFOA — Perfluorooctanoic acid (also called C8)

What it does: PFOA is used to make Teflon and thousands of other nonstick and stain- and water-repellent products.

Where they’re found: PFOA is present in Teflon and other nonstick or stain- and water-repellent coatings as a trace impurity. These coatings are used on cookware, waterproof breathable clothing, furniture and carpets and in a myriad of industrial applications. PFOA can also be produced by the breakdown of these products.

How we’re exposed: Inhaling contaminated air, eating contaminated food and drinking contaminated water. Some researchers say nonstick pans give off PFOA vapors, which contaminate food.

Health effects: Almost everyone has PFOA in his or her blood. PFOA causes cancer and developmental problems in laboratory animals. The EPA concludes research on PFOA is “suggestive of carcinogenicity but not sufficient to assess human carcinogenic potential.”

Regulation: PFOA is an EPA “chemical of concern.”

What you can do to reduce exposure: The EPA does not recommend any steps to reduce exposure to PFOA. You can reduce potential exposure by using stainless steel or cast iron cookware. If you use nonstick cookware, do not overheat, which releases toxic gas.

Formaldehyde

What it does: Formaldehyde is an ingredient in resins that act as a glue in the manufacture of pressed wood products.

Where it’s found: Pressed wood products such as particle board, plywood, paneling and fiberboard; also, glues and adhesives and durable press fabrics like drapes.

How we’re exposed: Breathing “off-gassing” from products containing formaldehyde. Car exhaust and cigarette smoke also contain formaldehyde.

Health effects: Formaldehyde is a known human carcinogen, causing cancers of the respiratory or gastrointestinal tract. Formaldehyde fumes can also cause nausea, skin irritation, watery eyes, or burning eyes, nose and throat.

What you can do to reduce exposure: Buying furniture free from formaldehyde eliminates much of the exposure we face from the chemical. One option to reduce “off-gassing”: purchase “exterior grade” pressed-wood products, which emit formaldehyde at significantly lower rates. If you have wood products containing formaldehyde, increase ventilation, reduce humidity with air conditioning or dehumidifiers and keep your home cool.

PBDEs – Polybrominated diphenyl ethers

What they do: PBDEs are a group of chemicals used as flame retardants, meaning they reduce the chance of something catching fire and slow how fast it burns when it does catch fire.

Where they’re found: PBDEs are found in televisions, computers and wire insulation, and furniture foam. Over time, televisions and other products shed PBDEs, which accumulate in dust. More than 124 million pounds of PBDEs are produced annually worldwide and they do not break down easily.

How we’re exposed: Swallowing PBDE-contaminated dust and contact with this dust are the primary routes into our bodies, where they collect in fat tissue. We can also be exposed through food and water. Breast-feeding infants are exposed to PBDEs through their mother’s milk and have the highest exposure compared to their body weight, followed by infants and toddlers, according to the data collected by the Centers for Disease Control and Prevention. Levels in humans have been rising rapidly since PBDEs were introduced in the 1960s and ’70s.

Health effects: PBDEs accumulate in the body. Toxicology tests show PDBEs may damage the liver and kidneys and affect the brain and behavior, according to the EPA.

Regulation: In December, the EPA named PBDEs “chemicals of concern.”

What you can do to reduce exposure: Try to find products without PBDE flame retardants and be sure to sweep up dust.

Article courtesy of CNN.

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