Radiation therapy and erectile dysfunction
According to the prevalence of prostate cancer and the decrease in the mean age of people infected with this disease, it is important to discuss the ways of treating sexual dysfunction resulted from radiation therapy for prostate cancer. In spite of the great efforts made by the scientists over the last years to minimize the negative effects of the radiation, some people still suffer from this problem even with some improvements in reducing radiation achieved by 3D conformal x-ray therapy and brachytherapy, but, there is still a hope that intensity modulated radiation therapy (IMRT) will decrease the impotence rates.
It was shown in a review of the recent external beam radiation therapy literature that 38-62% of people who was treated in this way suffered from erectile dysfunction after the treatment; however, these results are suspect because they were collected by questionnaires or telephone interviews which are not accurate, also, it is known that as the patient lives longer after the radiation therapy, the erectile dysfunction problem will be evolved, but, the review considered situations only in an interval of three years. But the question is: How does radiation therapy cause erectile dysfunction? In fact it can cause erectile dysfunction in three ways:
1- A condition called endarteritis obliterans can be developed to arterial blockage, also, direct damages may occur in the lining of the blood vessels; these problems make it difficult for blood to flow into the penis.
2- The number of erection-inducing nerves in the penis may be reduced after the exposure to low doses of radiation.
3- Leakage of blood from the erectile veins resulted from a direct erection tissue damage.
There are two determinants of erectile dysfunction after the radiation therapy; the first is the dose, where the high doses cause a vessel injury, the second is the field of radiation, where the ability to recover blood vessels minimize with the wide fields of radiation. Also, if the erection artery exposed to radiation, it may limit blood flow into the penis.
Treatment of radiation-induced erectile dysfunction problems
The treatment of the radiation-induced erectile problems should follow three lines of therapy:
1- This line includes the identification and treatment of the underlying health conditions beside the psychological support, also there ais the oral and the management of these conditions with the therapy such as Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) … etc.
2- This line includes vacuum erection device therapy, penile injection therapy, and transurethral prostaglandin suppository administration.
3- The final line is the penile implant surgery.
