Erectile Dysfunction Following Prostate Surgery

Dear Annie, I had my prostate removed due to cancer about 8 months ago and am now having problems with intimacy.  Would a testosterone booster help?  Any other ideas?

Thank you for your question.  Yes, there are natural solutions to address intimacy issues following prostate removal.  Let’s start by understanding a little more about what’s going.

• About Erectile Dysfunction
• Natural Solutions
• Herbal Solutions
• Recipes
• More Natural Suggestions
• Product Suggestions

Some Statistics about Erectile Dysfunction following Prostatectomy

Erectile Dysfunction (ED) is a normal side effect of radical prostatectomy, after the removal of the prostate.  Pretty much all men have difficulty with intimacy during the first few months.  Most men suffer from temporary nerve paralysis, which can last for months to years.  In the first year after surgery 40% to 60% of men recover their pre-surgical sexual function.  During the second year about 30% to 50% of those heal and resume a normal sex life.  Healing time depends on many factors including your age, level of health and pre-cancer sexual function. We also need to take into account psychological factors such the presence of and quality of intimate relationships. And of course the type and quality of surgery.  Other issues that can make recovery more difficult include diabetes, obesity, alcohol, smoking, chronic kidney disease, cardiovascular and disease.

About ED

Erectile dysfunction following prostate surgery is a normal problem following the procedure because of the trauma involved with both the cancer diagnosis and surgery.  After the initial trauma, there is almost always a disruption of blood flow to the penis.  A fine network of nerves and blood vessels run along both sides of the prostate. These networks are essential for normal erections.  When blood flow is disrupted difficulties ensue.  According to experts, some degree of nerve damage is always present. Depending on the level of damage, nerve injury can lead to penile scaring, causing further complications.  It is also normal to experience some form of urinary incontinence or urinary frequency after the prostate is removed. 

The penis itself is composed mostly of muscle.  And, like any muscle, it needs to be exercised to stay fit.  Also Like any muscle in the body, the penis may atrophy if not used.  The old saying “use it or lose it” is true in this case. Exercising the penis as soon as possible after surgery is called penile rehabilitation.  Studies show that when the penis is exercised regularly, as soon as possible after surgery, recovery is smoother and swifter.  The goal of penile rehabilitation is to increase blood flow and oxygen to the penis and to prevent scarring and permanent damage.

The prostate gland is responsible for ejaculation of semen.  Even when the body has recovered and sex is again possible, almost all men say that even though they are able to enjoy sexual function, it is not the same as it was before their prostate was removed.

Erectile Dysfunction and Penile Rehabilitation

Modern medical practitioners use Phosphodiesterase 5 (PDE5) inhibitors to encourage penile rehabilitation.  PDE 5 inhibitors stop a particular enzyme (phosphodiesterase type 5), from working properly.  PDE5 is found in blood vessel walls and helps control blood flow to the pulmonary arteries.  This causes the blood cells to relax and increases the blood flow to the penis.  They are used to treat ED and pulmonary hypertension because the same type of blood vessels are in the lungs and the penis.  There are two types of PDE 5 inhibitor currently used:

• sildenafil (Viagra, Revatio)
• tadalafil (Adcirca, Cialis)

Lots of studies suggest drugs of this type are beneficial for erectile dysfunction following prostate surgery, especially for short term rehabilitation.  However, they do come with risks and side effects.  Contact your doctor if you are interested in learning more about pharmaceutical penile rehabilitation.

Testosterone supplementation is sometimes recommended for the treatment of erectile dysfunction following prostate surgery, but requires extensive testing and is not always successful.  It really depends on the person and their situation.  Testosterone increases sexual desire; it does not increase blood flow or repair nerve damage.  However, herbal solutions can support a man’s natural production of hormones and help repair surgical damage.

Natural Solutions for Erectile Dysfunction:

Holistic methods work differently than pharmaceutical medications.  Herbs and supplements work to support bodily systems, repair the damage and address symptoms.  This means a longer period may be needed to tell if things are working.

Yohimbe for Erectile Dysfuntion

With effects that are very drug-like, Yohimbe is a notable exception to how herbs may not work as quickly as pharmaceuticals in cases of erectile dysfunction. Yohimbe is an African evergreen tree. The exact mechanism of action is unknown; however, we do know that it acts as a vasodilator to increase peripheral blood flow and on receptors of the brain associated with libido and penile erection.  We know Yohimbe increases the release of norepinephrine, meaning that it acts to increase the force of skeletal muscle contractions and the rate and strength of heart contractions.  It also affects dopamine and serotonin levels.  Dopamine affects the strength and rate of the contraction of the heart (and other muscles), Serotonin helps regulate mood and social behavior (among other things). 

The risks and drawbacks to Yohimbe are also significant.  It should not be used if taking antidepressants or if you are on medications for high blood pressure.  Its use should be avoided by men who have angina or other heart disease, hypertension, kidney or liver disease, anxiety, or BPH.   Yohimbe is reported to work about 50% of the time for men with phylogenic ED.  That means it is most likely to be helpful once the organism is healed and the physical problems are addressed.

See the Product Suggestions below for a link to a superior Yohimbe product.

Herbal Solutions

When looking at botanical solutions for erectile dysfunction, especially following prostate removal, we want to address the following issues;

1. Improve circulation/blood flow to the penis
2. Repair nerve damage/scaring
3. Hormonal Support
4. Physiological support for the change and condition

Remember when working with holistic health and herbal therapies there is no one size fits all approach.  No prescription to any physical or emotional condition.  Everyone is unique.  We all live life and experience things in our own way.  We all have a different constitution, diet and background.  The whole picture is always taken into consideration when making any kind of individualized suggestion.  It’s always a good idea to talk to a qualified professional be that your Dr, Herbalist or a knowledgeable friend.

I am always available to answer questions and to provide support on your healing journey. Click here to contact me with questions or to schedule an individual consultation.

Herbs to help treat erectile dysfunction and promote healing after surgery.

Ginkgo Biloba

Many men have good luck using Ginkgo to heal from surgery and recover sexual function. Ginkgo is usually thought of as a cerebral vascular tonic (to increase the blood flow to the brain), but studies show it increases peripheral circulation anywhere in the body. One human study showed this herb useful to reduce the occurrence of tissue hypoxia (the starving of oxygen and atrophying of muscle and tissue).     The suggested dose for addressing erectile dysfunction in most of the studies is 120 mg per day of the encapsulate herb.

Panax Ginseng

A well-known male “aphrodisiac”,  Asian Ginseng has a lot of valuable actions.  It acts as a cardiovascular tonic with positive effects on the nervous, endocrine and immune systems.  Panax Ginseng enhances gonadotropin activity, so it increases testosterone when needed and supports the hormonal system and sex organs in general.  In a double-blind crossover study published in the Journal of Urology, over 60% of the participants using Panax reported improved erections.  The dose is 900 mg capsule or ¼ to ½ teaspoon of the tincture 3 times per day.

Ginger Root (Zingiber officinale)

A very useful and versatile herb.  Ginger is a circulatory stimulant that increases peripheral circulation, improves blood viscosity and improves circulation to the muscles and skin.  As a bonus Ginger directs the other herbs in a formula to these locations.  Fresh Ginger is best used as a tea or as a prepared herb in formula.

Maira Puama Root (Ptychopetalum olacoides)

This South American tree is also known as potency wood. An official herb in the Brazilian pharmacopoeia, Maira Puama is a common aphrodisiac and central nervous system stimulant.  It is used for impotence, loss of libido, erectile dysfunction and to enhance pelvic circulation.  Its effects are reported to be like Yohimbe, but much milder and with less potential of drug interactions or adverse reactions.

Wild Oats (Avena sativa)

Nerve tonic extraordinaire.  Avena is useful whenever the nervous or adrenal system is overtaxed or damaged.    It helps restore normal function to nervous tissue while cooling and calming the mind and relaxing the body. All indispensable actions with dealing with erectile dysfunction.

Ashwagandha (Withania sumnifera)

A powerful sexual tonic and rejuvenating herb in Ayurveda.  Ashwagandha means “Horse Smell” referring to the smell a stallion has when attracting mares for mating.  Said to give men the strength of a stallion.  It is an adrenal tonic that revitalizes and restores vitality.  This herb is often given for wasting diseases, recovering from emaciation and erectile dysfunction.

Damiana (Turnera diffusa)

Damiana is a reproductive system tonic and pelvic decongestant for both sexes, Damiana helps keep the physical and emotional channels open.  It works to stimulate gonadotropin activity, thereby supporting the gonads and other endocrine organs.  Damiana supports and enhances the sexual steroids (and other steroids) while supporting the urinary system.  It is well known for its uses for erectile dysfunction especially when working with or through trauma.  This herb strengthens weakened and lax tissues of the reproductive, urinary and central nervous systems.  It may also be helpful when dealing with urinary incontinence or urinary frequency.

Other herbs that may also be useful when recovering sexual function include Schisandra berries (Schisandra chinensis), Rhodiola (Rhodiola rosea), Maca (Lepedeium meyerii), Rose (Rosa spp.) and Catuaba (Catuaba erythroxylum)

Recipes

One possible erectile dysfunction tincture formula
Mix the following herbs or herbal extracts
2 parts Panax Ginseng
2 parts Ashwagandha
1 part Damiana
1 part Wild Oats
1 part Maira Puama
1/2 part Ginger 
Take 1 or 2 dropper fills (30 – 60 drops) 3 times per day 

In addition to this formula it may be a good idea to include standardized Ginkgo Biloba Capsules.  120 mg 2x per day.

Always listen to your body and pay attention to what’s going on when starting something new.  If something feels off, then it is.  All plants and supplements work differently with and for different people.  That means that if something isn’t working you, you may have the wrong formula or combination of herbs. It doesn’t mean herbs don’t work.  

If you begin to feel uncomfortable in any way after beginning a new herb or supplement STOP taking it.  Give me or someone else a call and chat about what’s going on and how you feel.  Contact me here if you have and questions or want to discuss your herbal plan.  Always keep your Doctor in the loop about what your doing with herbs and supplements. 

More Natural Suggestions for Erectile Dysfunction

Supplements to consider for the treatment of Erectile Dysfunction –

• Zinc – We all need 10-40 mg of zinc per day.  It is involved in protein synthesis and the production of many enzymes in the body.  Zinc plays a role in taste, hearing and vision and is important for reproductive functioning.  It’s best to supplement 30 to 50 mg per day.  Over supplementation may decrease immune function.
• A balanced multi-vitamin that includes;
  • Magnesium – 600 mg per day may improve the sex drive, heart health, circulation, nervous system health and much more.
  • Phosphorous – about 700 mg per day.  Phosphorous taken together with calcium and magnesium help maintain sexual desire.
  • Manganese – Important for sexual performance and orgasm.  The supplement should contain around 11 mg per day.
  • Selenium – may improve sexual performance and stamina.  The recommended daily supplement is 100 micro-grams per day.

Acupuncture

Although I don’t personally know a lot about acupuncture.  I do know that it improves the circulation of qi in the body.  Qi or chi is the energy flow created along the pathways that connect the acupuncture points on the body called meridians.  In Ayurveda and Yoga Therapy we call these pathways nadis and the life energy prana.  A qualified Acupuncturist can help open life energy to the reproductive organs, help prevent penile atrophy and assist in removing energy blockages.  Worth a try.

Yoga Therapy for the individual treatment of Erectile Dysfunction

Yoga has been used for thousands of years to maintain and improve circulation and energy flows.  A personalized yoga practice that includes postures and breathwork designed to increase circulation and prana to the pelvic area may prove useful for anyone experiencing ED.  Yoga helps remove blockages, support the entire system and provide a space for healing. 

Product Suggestions for Erectile Dysfunction

Wonderment Gardens

My handcrafted herbal products are available at Wonderment Gardens LLC. Please click on the following links to shop for . 

Please contact Annie and Wonderment Gardens to purchase the formula listed above.

Affiliate Product Suggestions for the Treatment of Erectile Dysfunction

I am an affiliate marketer with Amazon and some other companies.  If there is a link please assume, I am an affiliate.  That means, if you purchase a
product through one of the links, I make a commission at no additional cost to you.  Rest assured I only suggest products I can support and feel confident about.  Thank you for your support.

Herb Pharm has great quality you can always count on. Their Yohimbe extract is expertly prepared from the sustainably wildcrafted bark of Pausinystalia johimbe trees. Herb Pharm is an old and trusted brand.

NootroPeak Naturals makes a simple blend of Panax Ginseng and Ginkgo.  Both botanicals are at the recommended dosages for optimal supplementation.  The 1000 mg or Ginseng and 120 mg of Ginkgo.  This may be a good place to start if you wanted to take a supplement from “off the shelf”.

TRUWILD ADAPTOGENS makes a nice supportive formula that fits many of the herbal needs listed above.  I like this Adaptogen blend.  It contains Maca, Ashwagandha, Gotu Kola, Cordyceps, Astralagus, Eleutherococcus, Holy Basil and may help balance hormonal systems, support reproductive organs and elevate the mood.  Adaptogen herbs help the body and mind deal with stress and change.

The Panax/Gingko mix taken together with the adaptogen formula makes a fairly well-rounded approach.  Of course, you understand I am not making medical recommendations.

If you prefer a liquid extract over a powder, Secrets of the Tribe makes a nice tincture extract they call Libido Secret.  This formula may hold a bit more of a punch.  This also contains many of the herbs we talked about above and contains the Brazilian herb Maira Puama or potency wood.

Nutritional Supplements and Vitamins for Erectile Dysfunction

Integrative therapeutics offers a professional quality high potency multivitamin that meets most of the suggested daily amounts.  You may need to add an additional supplement of magnesium.   I like magnesium glycinate because of its more absorb able than many other forms of magnesium.

Innate Vitality offers a nice Magnesium Glycinate.  It’s chelated for higher absorbsion and is dosed at 500 mg per capsule, so you only have to take 1 per day.  I suggest taking it before bed.  Magnesium settle the body and mind for a good night’s sleep.

Thank you for taking the time to read my blog.  It is my bliss to have the opportunity to share my experience and research with you.  I hope you find it helpful.  I would love to hear from you.  Please contact me about your thoughts, ideas and experiences you’d like to share. 

Warm Blessings

Annie

References

Stansbury, Jill E, ND; Gonadotropins and Botanical Medicines, 2001 Southwest Conference on Botanical Medicine Lecture notes.  Tempe AZ.

Mace, Jade Alicandro; Rosa Multiflora in Practice, 2018 American Herbalist Guild Symposium Lecture Notes,

Winston, David RH (AGH); Men’s Health Issues: Herbal and Nutritional Treatment for Common Genito-Urinary Problems, 2015 Southwest Conference on Botanical Medicine Lecture Notes

Francis, Deborah RN, ND; Botanical Therapies for Diseases of Pelvic Congestion in Men and Women, 2003 Southwest Conference on Botanical Medicine Lecture Notes

https://pcri.org/insights-blog/2018/4/4/recovering-sexual-function-after-prostate-cancer-surgery

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304365/#R2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304365/

https://www.health.harvard.edu/mens-health/penile-rehabilitation-after-prostate-cancer-surgery

https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/erectile-dysfunction-after-prostate-cancer

https://www.researchgate.net/figure/Neurovascular-supply-of-prostate-gland-Prostate-gland-receives-sensory-and-autonomic_fig2_266028801 (picture of prostate structure)

Phosphodiesterase 5 inhibitors

https://www.sciencedirect.com/topics/neuroscience/yohimbine

Testosterone for Erection Problems

Disclaimer

These statements and products have not been evaluated by the FDA. They are not intended to diagnose, treat, cure, or prevent any disease or condition. If you have a health concern or condition, consult a physician. Always consult a medical doctor before modifying your diet, using any new product, drug, supplement, or doing any new exercises.

Herbs taken for health purposes should be treated with the same care as medicine. Herbal remedies are no substitute for a healthy diet and lifestyle. If you are serious about good health, you’ll want to combine diet, exercise, herbals, a good relationship with your doctor and a generally healthy lifestyle. No one of these will do it alone.

This information is designed to be used as part of a complete health plan. No products are intended to replace your doctor’s care, or to supersede any of his/her advice or prescriptions.