Erectile Dysfunction and Ejaculation Issues After Surgery

Q: Erectile Dysfunction and Ejaculation Issues After Surgery

Hello： In response to your question： Based on your description, it is likely that neuropathy is causing your erectile dysfunction. <br>The nerves that control our erections and ejaculation include the autonomic nerves as well as somatic motor and sensory nerves. <br>You mentioned

Erectile dysfunction and inability to ejaculate?

Hello: I have been troubled by this issue for a long time and would like to consult a doctor.
I underwent surgery for a herniated lumbar disc (L4-L5, with associated spinal cord involvement) in mid-September last year due to lower body paralysis, which left me unable to stand or have normal bowel movements.
Although I have recovered after a year, I am unable to achieve normal erections as I could before the surgery (they are unstable; sometimes I can, sometimes I cannot) and I am unable to ejaculate (though I do experience normal nocturnal emissions).
I have consulted both my surgeon and a urologist; my surgeon assured me that there are no issues, while the urologist suggested using Viagra.
However, I would still like to ask: Given my history of lower body paralysis, is my unstable erection purely a psychological issue? Are there methods to address this psychological problem on my own? Additionally, why am I unable to ejaculate during sexual intercourse? If I do need to use Viagra, will there be a risk of dependence? What dosage should I take? I am extremely grateful for your response! ^^

Edgar, 20~29 year old female. Ask Date: 2002/10/22

Dr. Xu Wencang reply Urology

Hello: In response to your question: Based on your description, it is likely that neuropathy is causing your erectile dysfunction.
The nerves that control our erections and ejaculation include the autonomic nerves as well as somatic motor and sensory nerves.
You mentioned experiencing lower body paralysis; I wonder if you have any abnormal sensations in the genital area.
If so, it may not be possible to trigger reflexive erections and ejaculation through touch.
However, visual stimulation or nocturnal erections and nocturnal emissions may still occur normally.
If there is dysfunction in the anal sphincter during bowel movements, it could indicate damage to the autonomic nervous system, which may also lead to erectile dysfunction.
Peripheral nerve repair is a slow process and may take several months or even years.
However, your condition is gradually improving, and with more time, you may achieve full recovery.
For psychogenic and neurogenic erectile dysfunction, Viagra (sildenafil) generally has a good treatment effect, but sufficient sexual stimulation is still necessary for it to be effective.
You might start with 25 mg (a quarter of a 100 mg tablet) and, after some time, if you feel more confident, you can try without medication, which may also lead to normal erectile function.
Delayed ejaculation may be due to diminished sensory nerve responsiveness; visual stimulation can be combined to assist.
Of course, patience is key as the sensory nerves repair themselves, and they will gradually recover.

Reply Date: 2002/10/22

More Info

Erectile dysfunction (ED) and ejaculation issues can be complex and multifactorial, especially following significant surgical procedures like lumbar disc surgery. Your experience with lower body paralysis and subsequent recovery can certainly contribute to the challenges you are facing now. Let’s break down your concerns and explore potential solutions.

Understanding the Causes
1. Neurological Factors: Given your history of lower body paralysis, it's important to recognize that the nerves responsible for erections and ejaculation may have been affected during your surgery or due to the underlying condition. The lumbar region of the spine is crucial for sexual function, as it houses nerves that control the pelvic region. Damage or irritation to these nerves can lead to erectile dysfunction and ejaculation issues.

2. Psychological Factors: Psychological aspects can play a significant role in sexual function. Anxiety about performance, fear of pain, or concerns about your recovery can all contribute to ED. The mind-body connection is powerful, and stress or anxiety can inhibit your ability to achieve or maintain an erection.

3. Physical Factors: After surgery, physical changes, including reduced blood flow or hormonal changes, can also impact erectile function. Additionally, medications prescribed for pain or other post-operative issues may have side effects that affect sexual performance.

Addressing Erectile Dysfunction
1. Consultation with Specialists: It’s good that you have consulted both your surgeon and a urologist. If you feel your concerns are not fully addressed, consider seeking a second opinion from a specialist in sexual medicine or a urologist with experience in post-surgical ED.

2. Psychological Support: If you suspect that psychological factors are at play, consider speaking with a therapist or counselor who specializes in sexual health. Cognitive-behavioral therapy (CBT) can be particularly effective in addressing anxiety and performance issues.

3. Medication: Your urologist suggested using Viagra (sildenafil), which can help increase blood flow to the penis and facilitate erections. While there is a potential for psychological dependence on medications like Viagra, they are generally safe when used as prescribed. Start with the lowest effective dose, typically 50 mg, and adjust based on your response and under your doctor's guidance.

4. Lifestyle Modifications: Regular exercise, a healthy diet, and avoiding smoking and excessive alcohol can improve overall vascular health and potentially enhance erectile function. Engaging in pelvic floor exercises (Kegel exercises) may also help strengthen the muscles involved in erections and ejaculation.

Ejaculation Issues
1. Understanding Anejaculation: The inability to ejaculate can be linked to nerve damage or psychological factors. If the nerves that control ejaculation are affected, this can lead to anejaculation (the inability to ejaculate).
2. Exploring Treatment Options: Discuss with your urologist about potential treatments for anejaculation. Options may include medications that can help facilitate ejaculation or techniques such as pelvic floor exercises.

3. Communication with Partners: Open communication with your partner about your experiences and feelings can alleviate some of the pressure and anxiety surrounding sexual performance. This can foster a supportive environment that may help improve your sexual function.

Conclusion
Your situation is understandably distressing, but it’s important to remember that recovery from surgery can take time, and sexual function may improve as you continue to heal. Addressing both the physical and psychological aspects of your condition is crucial. Regular follow-ups with your healthcare providers, combined with lifestyle changes and possibly therapy, can help you regain confidence and improve your sexual health. Don’t hesitate to reach out for support, whether from medical professionals or mental health experts, as you navigate this challenging time.

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