Do all forms of ED get worse?

[Benjohn]

Hey guys,

I am just wondering if all forms of ED get worse? I understand that conditions like Diabeties and MS are progressive and the ED would therefore be progressive too.

However, what about those who have had a prostectamy. In this instance, surely the damage would be done during the operation and then there would be healing to some extent in the 2 years after. For prostectamies, does the ED stop getting worse as theoretically no more damage is being done to the nerves post-operation?

[ftwabeck3533]

I had my prostate removed via "nerve sparing" robotic surgery in October of 2018. Erectile function, for me, prior to surgery was 100%. At 62 years old, I could achieve and maintain a very strong erection.

Day 1 after surgery my ED was 100%. Today, almost three years later, I am unable to achieve an erection which allows for vaginal penetration. I can manually stimulate my penis and achieve perhaps 80% of the pre-surgery erection quality. So, in 32 months I have progressed from 0% to 80% EF (Erectile Function) -- and improvement continues even now. This history summarizes EF without the aid of PDE5s (viagra or similar) or injections (trimix or similar).

Since surgery, I have been prescribed Sildenafil and take 20mg almost every day. I have tried the "challenge dosage" of 100mg a few times but am unsuccessful in achieving an erection. In June of 2019 (eight months after my prostatectomy) I started using trimix. It is a wonder drug and the injections (approx 0.15 ml) have resulted in erections of pre-surgery quality. I have injected about 1-2 times per week over the last two years with excellent results (not without failure, sometimes the injection goes into a vein and no erection is produced).

An erection involves so many aspects of the male anatomy that I continue to learn more about my past, present, and future every day.(https://www.youtube.com/watch?v=33m9pN_vAI4 ).

[Simbarn]

Hey guys,

I am just wondering if all forms of ED get worse? I understand that conditions like Diabeties and MS are progressive and the ED would therefore be progressive too.

However, what about those who have had a prostectamy. In this instance, surely the damage would be done during the operation and then there would be healing to some extent in the 2 years after. For prostectamies, does the ED stop getting worse as theoretically no more damage is being done to the nerves post-operation?

No, not all forms get worse.
Psychogenic ED can improve for some even though it is a very difficult form of ED to treat as anxiety’s can be with one for life.
ED generated by pelvic floor dysfunctions can be fixed completely given the correct treatment and persistence with treatment.
Possibly even ED generated by an unhealthy lifestyle and lack of exercise can be markedly improved if caught early enough with a reversal of endothelial damage and improvement in natural testosterone levels.
Sometimes ED caused through low T can be rectified with T replacement if low T is the sole cause.

The issue with nerve sparing prostectamy surgeries is the hypoxic conditions caused from nerve damage and loss of nocturnal erections. This increases levels of oxidative stress in the penis and the consequent loss of smooth muscle and NO pathway dysfunction. The chronic use of PDE5 inhibitors soon after the surgery can help to improve blood flow on a consistent basis. This has been shown to improve the chances of erectile function recovery while the nerves heal if the damage done to the nerves is not at the point whereby they cannot heal.
The issue with oxidative stress is once the process starts it is difficult to stop. PDE5 inhibitors have shown great promise with reversing the cascade of oxidative stress in recent studies as has Resveratrol. The combination of the two possibly being even more potent.

Generally speaking though ED is a condition that all men will get if they live long enough, some just get it sooner than others. The penis is a barometer of vascular health as it is simply a very sensitive extension of the peripheral vascular system.