The Prostate Cancer Foundation reports that about half of men who undergo nerve-sparing surgery will regain their pre-surgery function within the first year after the operation. Please note that we are unable to respond back directly to your questions or provide medical advice.
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Erectile dysfunction or impotence is a sexual health issue that affects many men, particularly as they get older.
Aside from the physical effects of impotence, experiencing persistent erectile dysfunction can also have an emotional and psychological impact on men. Many couples struggle to find a way to confront the issue, but support and assistance can be key to helping your partner manage the symptoms.
In the normal process of an erection, the penis rapidly fills with blood, causing it to become erect. Neurotransmitters are released from the nerves within the penis, which stimulates the release of another chemical called cyclic guanosine monophosphate and causes the penis’ arteries to widen. Erectile dysfunction (ED) is also occasionally known as impotence, and it happens when the penis is unable to begin or maintain an erection.
This can be due to a variety of factors, as the process of sexual arousal in men involves a mixture of influences and effects on the brain, hormones, nerves, muscles, blood vessels and emotions. In men over the age of 40, the most common physical cause of ED is reduced blood flow to the penis, which occurs when the arteries transporting blood into the penis become narrower.
In other cases, diseases that affect the nerves going to the penis (such as multiple sclerosis and Parkinson’s) can play a role and so can lower levels of the hormone testosterone.
Of course, drug abuse, tobacco and excessive alcohol consumption also take their toll on a man’s ability to sustain an erection, just as they impair the healthy function of other parts of your mind and body. Those are just some of the most frequent physical problems behind ED, but it’s important to remember that mental health also has an effect on the normal erection process. When a man is under intense stress or pressure and is dealing with high levels of anxiety, this can all combine into a cocktail of obstacles preventing a healthy erection. For many people, ED is something that is swept under the rug whether through fear, shame or embarrassment.
It can be difficult for men to accept and deal with, so if your partner is going through the symptoms of impotence you can help by encouraging discussion and offering your support. In some cases, a penile prosthesis is used to physically support the penis into sustaining an erection. Quitting smoking, getting treatment for alcohol or drug problems, committing to a healthier lifestyle and exercising regularly can all help contribute to a healthy blood flow. It’s not an easy conversation to have, but supporting your partner through ED can be an important part of your relationship. Solgar L-Arginine stimulates nitric oxide, a substance that signals smooth muscle surrounding blood vessels to relax. If yes, do you have any advice you would like to share with others who may also experience Erectile dysfunction?
Friendly Reminder: The information on this website is intended for your general information. CONSIDERAZIONI ANATOMICHE Preservazione dei nervi cavernosi contenuti nei neurovascular bundles (NVBs) I NVBs decorrono sul margine posterolaterale della capsula prostatica bilateralmente tra i due foglietti della porzione laterale della fascia pelvica costituiti dalla fascia dellelevatore e dalla fascia prostatica. Representative potency rates after radical retropubic prostatectomy StudyPotency Rates (%) Jonler 199411 Ritchie 198912 Brendler 200018 Pedersen 199319 Leandri 199256 Catalona 199968% bil. Il Cavermap e costituito da una complessa strumentazione che presenta la duplice funzione di nerve stimulator e ditumescence monitoring.
Efficacy of first-generation Cavermap to verify location of cavernous nerves during radical prostatectomy: a multi-istitutional evaluation by experienced surgeons Walsh PC, Marschke P, Catalona WJ, Lepor H, Martin S, Myers RP, Steiner MS 50 Pz. Intraoperative nerve stimulation predicts postoperative potency Chang SS, Peterson M, Smith JA Jr 63 Pz.
Does epidural anaesthesia affect intraoperative nerve stimulation during radical prostatectomy?
Psychotherapy can often help to sort these terrible contributors out and clarify the true source of dysfunction. Exercises That Cause Back PainExercises that cause back pain is a controversial topic that always creates heated debate among patients and doctors alike. Diagnosis of Pinched NervesThe diagnosis of pinched nerves is not always a certain science and many compressive neuropathies are misdiagnosed. Overcoming Back SpasmsOvercoming back spasms story, sent in by Cyrus, details a long history of muscular issues and an eventual all-natural solution.
Our blog post Young Porn Users Need Longer To Recover Their Mojo describes a startling phenomenon: Guys in their early twenties with porn-induced erectile dysfunction typically need months longer to recover their sexual health than guys forty and older. Needless to say, many guys bail out of recovery at this point and rush back to their addiction, scared that they will permanently lose it if they don't use it. However, each natural reward (food, water, love or sex) also has its own dedicated micro-circuits in the brain. It may be that long standing porn addiction similarly alters deep brain structures that govern male sexual behavior (hypothalamus) as well as the brain circuits devoted to erections.
Grey matter is where nerve cells communicate, and less grey matter indicates fewer dopamine-producing nerve cells and fewer dopamine-receiving nerve cells.
Years of overconsumption of Internet porn may weaken dopamine signaling in the hypothalamus in ways that do not occur in other addictions. Certainly many of today's porn users reports loss of attraction to real partners, morphing sexual tastes, loss of libido, and sexual dysfunction with a partner (delayed ejaculation, erectile dysfunction and even premature ejaculation with a somewhat flaccid penis). Guys who started out masturbating to Internet porn need longest to heal from the flatline, which shows that they are doing something very different from guys who didn't.
The guys who start young on Internet porn also generally have more trouble responding sexually to real partners. Tim: What you're likely wondering is, "For the love of god does the ED get better or am I torturing myself for no reason?!" I wondered that too. Ian: I went through a long phase of sluggish libido, just doing porn because I had nothing better to do. Tyler: I was in college, had a ton of free time and was away from my girlfriend, so I watched A LOT. Research on male rats shows that ejaculating beyond the point of normal satiety causes some of the same symptoms and brain changes seen in rats using drugs to excess. It's possible that when porn users consistently override their natural sexual satiety mechanisms with the help of Internet porn, they cause similar plastic changes in their brains. Sergio: I understand my flatline as a natural response of the brain to find sexual normalcy.
Josh: Honestly, I think the scariest part of flatlines is the fact that you are without urges and truly face life with no buffer, no illusion of escape by consoling yourself with sexual arousal.
Toby: Flatlines are scary because they shatter a lie that we have bought for so long—namely that the world's "man" is hypersexual.
Edging to Internet porn without orgasm is particularly detrimental, because 1) internet porn appears to cause ED, and, 2) dopamine levels are typically elevated for very long periods, which can foster desensitization. If your flatline is not improving after months, and you sense you are stuck, try kick-starting your libido. Dietmar: I have been at this off and on for 10 months, with some dating, masturbation and porn use in between, and I am now really feeling the progress. Leo: I started NoFap 146 days ago along with quitting smoking, quit getting drunk, quitting smoking weed.
Kent: When I didn't feel awesome libido at 8 weeks I got pretty worried, but everything worked out. Hans: (Age 21) I didn't have spontaneous erections at all before meeting this girl [He had just had sex for the first time, quite successfully]. Even after you start to notice signs of life, it's quite normal to see them followed by phases of sleepy-libido before you are completely back to normal.


Ahmed: [After rebooting] Yesterday we were on the couch watching a movie, and she started kissing me. There's still much to learn about the flatline phenomenon, but for now, self-reports are the best data we have.
Having experienced it in three stages, I can tell you that flatlining is a strange phenomena, that quite frankly no one has been able to explain. I started the no PMO for physical reasons (PIED), but my motivation to get over my urges and keep at it have been for the psychological reasons. My question is have you encountered any instances where people have experienced the flat line psychologically but not physically.
This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. Both of which will support, guide, and inspire you toward the best possible health outcomes for you and your family. The process is triggered by sexual arousal, which prompts messages from the man’s brain to travel down the nervous system to the penis. As a result, this enables the rush of blood that causes the penis to swell up into an erection.
Any one of these can affect the process of arousal and erection, although physical causes are most common. The natural ageing process, a high blood pressure and cholesterol level and smoking can all contribute to narrowed arteries just as they can affect the arteries in other parts of the body such as the heart.
Sometimes, it can also stem from problems with the relationship or depression and the reluctance of many men to discuss ED can lead to a cycle of symptoms and heightened anxiety feeding into each other.
ED can be an early indicator of other conditions such as a cardiovascular disease, so early detection and treatment can be essential. There are several forms of medication that can be taken orally, via injection or even through the urethra. However, there are also several lifestyle changes and at-home remedies you can use to aid in improving blood flow to the penis. If the root cause behind ED is mental health related, taking time out to work on your relationship or resolve the issues that are causing stress can also help. Relaxation of smooth muscle in the penis allows for enhanced blood flow, which in turn may help promote a healthy erection. It is not a substitute for medical advice from a health care professional and is not intended to diagnose, treat, cure or prevent any disease. I NVBs sono distanti dalla capsula prostatica circa 1,5mm a livello della base della prostata e circa 3 mm a livello dellapice, pertanto la loro dissezione deve essere meticolosa.
Worse yet, the younger guys tend to linger far longer in the temporary "flatline"" (zero libido, "dead-dick"), which guys of all ages usually experience to some extent when recovering from porn-related ED. A few years ago, however, a 26-year old Australian kept going—and discovered that somewhere around week seven, his flatline ended and his libido (and erections) came back.
Recovering porn addicts report surprisingly severe withdrawal symptoms, not unlike drug addicts. With less dopamine, a desensitized reward circuit may not provide sufficient stimulation to men's erection centers in the brain. However, the percentage of those who report flatlines is rising as the guys who started on highspeed comprise a growing portion of ED sufferers. Is the flatline due to changes in the sexual centers of the brain unique to Internet porn use? For example, overeating to obesity brings about additional alterations in the brain's regulation of feeding, satiation and metabolism.
We know that erections require adequate dopamine in the reward circuit and the male sexual centers. In other words, the study is evidence that psychogenic ED is not psychological, but rather physical. Such changes could help account for stubborn ED (and lingering flatlines) in healthy young men. I wonder if my flaccidity means I have weakened the connections between my brain's pleasure pathways and erection pathways. In some of those who started on the Internet flatlines recur for the first year or so of their recovery. This may be because they spent their adolescence wiring exclusively to videos, endless novelty and a voyeur's detached, visual perspective.
The answer is 'kind of,' then 'Yes!' What you're likely going to experience once you do engage in sex is your brain saying, "What the hell?" It is not used to actual sex as its primary way of being sexual. All of a sudden one day I couldn't keep it up anymore and had zero libido, so I stopped watching porn.
Researchers believe the changes are a natural protective measure against overstimulation, which (ideally) works by temporarily putting on the brakes.
When you became exhausted, your brain and body enters sleep mode (that we call flatline) in order to recover so it can react to stimulation again. It's not that I want to be desire-less forever, but right now I'm having all the success I want with women. Knowing that, I actually started liking the flatline because I kinda feel that my sexuality is not controlling me. When your libido flatlines, or you have other symptoms such as “lifeless penis,” it is easy to panic and want to test yourself with porn to see if you can still force an erection. Remain in The Void until your body gives you signs that your brain and sexual responsiveness are back to normal, or until you sense it is time to kick-start your libido (below). The immediate benefits I had were definitely increased energy and an almost hyperactive feeling all the time.
I was hard, and I knew it was a different erection, an old erection, a healthy, awake one, and guess what? I was actually flatlining a little before I started, but I kept masturbating because that was just a habit I had developed. From what I read, I understand its only natural that every one recovers differently and length of recovery varies greatly.
I have always been mildly depressed but over the last two years my depression has been severe.
When I started my PIED was somewhat severe, but not extreme to the point I could never get an erection. We are making such material available in our efforts to advance understanding of the science behind addiction. These are designed to relax the muscles in the penis and increase blood flow to the area, helping to support an erection. Always consult your doctor or other qualified health care professional with any questions you may have regarding a medical condition. Oncology 2000 Lesplorazione rettale sottostadia le neoplasie organoconfinate Partin: J Urol 1993 601 Pz.
A little voice from the porn beast nagged at me in the back of my mind, but mostly, I just didn’t care. Less stimulation there means fewer nerve impulses traveling down the spinal cord to enable erections. Chronically elevated dopamine in the reward center (nucleus accumbens) leads to accumulation of DeltaFosB, and addiction-related brain changes, such as decreasing sensitivity to dopamine (desensitization).
The central player is the hypothalamus—the pearl-sized control center for a multitude of important body functions—including both hunger and sexual desire. Recently, Italian researchers' brain scans of guys with "psychogenic ED" (as opposed to "organic ED," which arises from issues below the belt) revealed atrophy of the grey matter in their brain's reward center (nucleus accumbens) and the sexual centers of the hypothalamus.
This is not the case with guys who started out masturbating to fantasies of real partners or magazines.
Adolescence is a key window when mammalian brains are primed to adapt their mating behavior to arousing cues in the environment.


But then I felt worse and my dick would shrivel, so I figured quitting porn actually made it worse and would watch again. When a rat hits sexual satiety, massive drops in androgen (testosterone) receptors, as well as sharp jumps in estrogen receptors, occur in the brain's reward circuitry and sexual centers.
If we had let it rest back then it would probably been a flatline of only a few days before things returned to normal. You're not doing it for sexual reasons, which means you really aren't thinking the kinds of thoughts your penis should even respond to. Meanwhile, if you need help regulating your mood, try vigorous exercise, flirting, socializing with friends, meditation or even a cold shower regimen. As you might expect, the most effective way to do this is in a relationship with a trusted partner who will engage in lots of affectionate contact without demanding sexual performance. This is the first time I have rebooted where I didn't jump into a flatline after the first week or 2. We made love, without any ED, without any fantasies, and it felt like she was a new person I was discovering. In this video, a 25-year old needed 9 months to respond normally in bed—and he had the luxury of a girlfriend. When you masturbate, your dopamine levels shoot up, but as you ejaculate, prolactin overrides all levels of dopamine causing that lethargic, lazy, unmotivated feeling.
I would still wake up with morning wood occasionally, but I definitely couldn't get healthy erections regularly. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. Do not disregard medical advice or postpone consultation with your health care professional because of information that you have read on this website.
Whatever its origins, it's a sign that Internet porn use has altered the flatliner's brain circuits in fundamental ways. These findings align perfectly with the hypothesis I put forward years ago in the precursor to this Porn & ED slideshow. Thereafter, brains begin to prune away unused circuitry—perhaps the very circuitry related to the pursuit of real partners, which would have been thoroughly developed in these guys' ancestors. And then, after I realized that couldn't be true and quit again, after about 8-10 days I would start to have a HINT of a libido and would watch porn again. Choosing to mix in occasional orgasm with a partner is great, but if it's too soon, some men find it stalls their reboot. The more you break down how faulty the logic is to "check" yourself, the better you'll understand that forced erection serves zero purpose and usually just discourages you.
If you severely sprained your ankle, would it make sense to play six hours of full court basketball the day after you abandon your crutches? Second, the numbed pleasure response, that causes desensitization, doesn't appear to be directly tied to hours of viewing according to research. Hopefully in a couple years we'll start to see some trends and be able to give better advice to those who have just quit. The flatline is just the prolactin taking over, ridding you of any desire to pursue a sexual interest. No-one comes to nofap looking to castrate themselves, and that is exactly what a flatline feels like.
It could be extended withdrawal symptoms or the unmasking of underlying depression and anxiety. Always read the label of any supplements or natural health products you purchase and use only as directed. I am aware that a lot of people have sex all the time and don't develop ED, but on the other hand, I know few people my age who watch tremendous amounts of porn every day and have normal sex lives. For 6 years I've been slowly getting out of the flatline, and then slowly putting myself back in. Working through those problems without that distraction was difficult, but incredibly important. At first, any orgasm or intense arousal can trigger a powerful “chaser effect," and if the result is a porn binge, it slows recovery.
The point of this test was to see if I could get hard without any sort of external stimuli besides the feel. I'd never planned to give up masturbation completely, but I've definitely learned when my body needs release compared to doing it out of boredom. They were not strong at all (only like 20%) but they have improved and I would say they regularly are around 70% [at one month]. I think some of us are just built differently and need an actual partner to really jump start the libido back to life.
Sex was not foggy anymore, and even after orgasm I didn't feel any sadness, just plain healthy satisfaction.
Of course, it’s easier, since you don’t find yourself tempted as much, but it is a strong blow to your self-esteem.
Section 107, the material on this site is distributed without profit for research and educational purposes. 67% di ripresa di funzionalita erettile nel gruppo sottoposto a FIC postoperatoria 20% di ripresa di funzionalita senza FIC riabilitativa Limportanza della terapia riabilitativa e dovuta alla ossigenazione postoperatoria dei corpi cavernosi al fine di evitare la fibrosi degli stessi Zelner et al.
Sex is nowhere close to that, and that's a good thing because sex after rebooting and rewiring feels WAY BETTER.
Masturbation to physical sensations alone, without intense stimulation, it is less problematic. Understand, that if you are here because of ED, your sexual self-esteem isn’t that high anyway, see this as the world getting darker before the dawn. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
Another goal for my going 90 days was to regain the sensitivity in my penis from too tight of a grip masturbating. Any information you gather here or in the related forum is not professional advice and is provided solely for educational and informational purposes. So there will be a rewiring process where you may sputter and have a few backfires but eventually you fire on all cylinders. I didn’t believe it would pass, I actually bought a subliminal messaging tape to help it pass less naturally. Please know that anything you share, even in posts protected from public viewing, may be included in future materials, although extreme care will be taken to insure that no details that would identify you personally will be included. Well, I put the condom on no problem, was still extremely hard before and after, and had no problems finishing off in the condom.
But still 90 days later my experience of erections is very different to what it was like when I was masturbating. I feel that I'm just starting to come into my sexual self for the first time at the age of 29, and can't wait to see what the future holds.
I only noticed it getting better about 55 days in, I was sitting next to a beautiful blonde girl on a train.
I was actually considering seeing a doctor and having my testosterone levels checked, so this masturbation session saved me a couple hundred dollars!
Our legs were touching and my arm was up around her seat, because I was stretching out as I like to, and she was leaning back into my arm. Remember that erections are good things, and even though they might be uncomfortable at times, like when you’re standing up to get off a train, they are not a problem.



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