This weekend, I received an email from a man, who described a history of prostate cancer, impotence / erectile dysfunction (as a result of prostate surgery) and penile curvature (Peyronie’s disease).  At the present time he is no longer responding to medications for erectile dysfunction.  He has already seen another urologist who suggested that he undergo surgery to place a penile implant for his condition.  His question for me was about my approach.  Here is a snippet of how I replied:

•  In general, men with erectile dysfunction and Peyronie’s disease (curvature) are best treated with a penile implant, which can correct 20-30 degrees of curvature just by placing the device. This will recover some of the lost length that comes with Peyronie’s disease. Additional sutures are sometimes placed to further straighten the penis, but have the risk of some shortening of the penis.  More invasive reconstruction is an option, and it involves incising the scarred area on the penis then placing the graft.  It restores some of the lost length but has the added risk of temporary numbness because usually we will have to elevate the nerves that give sensation to the penis to place the graft.  Permanent numbness is rare, however.

Further questions

He then asked about which implant I use and why:

• In my practice, I only use Boston Scientific penile implants because they feel more natural and have antibiotic coating, lowering the risk of infection.  Specifically, in men with curvature I will only use the CX700, because use of the LGX700 will result in an erection, but it won’t be firm enough because of the scar tissue in the shaft of the penis where the scar originates.

Finally, he asked about sex drive (libido) and insurance coverage:

• Libido is a separate function and is not affected by penile implant.  Similarly, men will still orgasm.
• Many insurances cover penile implant and Peyronie’s surgery, and Medicare covers both.  We obtain authorization at the time of scheduling surgery to confirm.

Having implant surgery for incontinence with an artificial sphincter or undergo penile implant is an important decision.  Preparation in the days and weeks before surgery is also critical.  Achieving a good outcome starts before you arrive at the hospital and it is my primary goal for men.

• You will be notified if your urine culture or nose swab is positive for MRSA bacteria, in which case you will need to have this cleared before surgery.

• Skin care / preparation
  • Do not shave or clip the hairs in the groin or around the penis for 2 weeks prior to surgery;  I will do this at the time of the operation
  • Purchase the skin cleanser, Hibiclens.  
  • Starting 3-4 days before your surgery you will use the cleanser daily.  In the shower, lather up the soap from the naval / belly button to the top of the thighs and include the penis and scrotum.  Leave on the skin for 5 minutes then rinse.
  • If you develop open sores, rash or cuts in the skin leading up to surgery please let us know.  This will need to be examined.  Rarely, surgery is postponed until these things resolve.

• Please read all of the paperwork provided by the surgery scheduler.  This is where your surgery time, arrival time and preop information will be found.
  • You will be instructed to call the hospital preoperative program (or attend the appointment if it was required).  They will instruct you on which medications to take and which to stop.
  • If you have a pacemaker or defibrillator, take blood thinners or have a history of heart problems, it is best to get clearance from your cardiologist or primary doctor.  This is elective surgery and we want to ensure that you are healthy at the time of the operation.

• Good blood sugar control, for diabetics, facilitates better healing and less risk of infection after surgery.

• If you use a C-PAP device, bring this to the hospital on the day of surgery.

• Likely you will spend the night in hospital, and you may be sent home with a catheter.

• Please contact us for clarification or if you have further questions about the preparation.

Consider reading my blog post on Recovering from Penile Implant Surgery.

• Photo by Erol Ahmed on Unsplash

Treatment is an important step for those suffering from depression–but treatment can also present an additional host of unexpected and uncomfortable circumstances for patients. Regardless of the side effects, treating depression is critical to maintaining optimal mental and physical health, and the benefits certainly outweigh the consequences. It can be frustrating, however, when treatment interferes with a patient’s sexual health. Commonly prescribed antidepressants can have a negative impact on libido and/or orgasm–but there are solutions that mean you won’t have to sacrifice your sex life to maintain your mental health.

Depression and sex

Anyone that has suffered from depression knows that it can have a significant impact on your overall physical well being. Oftentimes, this means a decrease in energy. Coupled with lower self-esteem and feelings of inadequacy, depression is a recipe for a sex drive disaster. From this perspective, there’s generally no place to go but up in dealing with depression; but patients undergoing treatment are often surprised to find that while other areas of their life are improving, their sex drive remains low and they may experience decreased sensitivity during intercourse.

Sexual side effects

Approximately 30-70% of patients taking an antidepressant experience some form of sexual dysfunction as a side effect of their medication. Typically men may experience a lower than normal sex drive or that it’s hard to achieve an orgasm during intercourse. While side effects can certainly contribute to sexual issues, low self-esteem or self-image may also be a factor. These negative thoughts can persist even after depression has been treated. Feeling bad about your body or yourself can be equally as damaging to a healthy sex life as the chemical impact of medications.

Reduce the impact

A study from the American Academy of Family Physicians found that “Decreased libido disproportionately affects patients with depression. The relationship between depression and decreased libido may be blurred, but treating one condition frequently improves the other.”

In addition to taking prescribed medication, therapy can help patients break out of negative thought patterns. Therapists can teach patients healthy coping methods to deal with the depressive thoughts and low-self esteem that impact sexual performance. Couples therapy can also be a good way to open the lines of communication between a patient and their partner.

If you’re still experiencing lowered libido, talk to your doctor about other options available to you. They’ll help you identify whether or not it’s your SSRI or some other factor that’s impacting your sex life. Under the direction of your doctor, you may be able to switch or reduce your medication, experiment with the time of day you take your prescription, add erectile dysfunction medication, or take a doctor-supervised “drug holiday,” a temporary break from your medication. There’s no reason to suffer.

Photo credit Pexels.com

This past weekend I received a text from mother, wishing me a ‘happy anniversary’!  Each year it takes me a moment to remember that she is referring to my surgery for testicular cancer 12 years ago.  It seems so long ago.  Mothers have a way of remembering 🙂

It is unusual for me to discuss an issue like this in my workplace, but occasionally, I have found it very helpful to disclose to men upon hearing that they have cancer.  Your world changes when you’re told you have cancer, even in the ‘best’ case scenarios, where the problem is lower risk (as mine was).  I understand how my world changed, and when I receive the annual anniversary text from mother, I give pause and am grateful to be healthy.  I found my cancer doing a Testicular Self-Examination, and since I’m a urologist I knew what I was feeling and I found it early.

This month is MOVEMBER  Men grow a mustache as a symbol of awareness to men’s health and cancer issues.  I’m not doing it this year, but have done it in the past.  It’s about men taking action about their own health, receiving screening and routine medical care.   Sooner is better than later, as it was in my case!

Here’s my MOvember pic from a few years back…  No captions please!