abdominal aortic aneurysm and sexual function

I'm 38 years old and was diagnosed with a AAA about 3 years ago.  Its now 5.2cm and we're talking about surgery.  My doctor says that the endovascular method would not be good because of lack of space between the renal artery and the top of the aneurysm.  He did say that i could probably find someone to do it but he wouldn't.

I'm extremely concerned with what I've been reading about loss of sexual function as a complication of the open surgery.  I cannot find any solid information about the odds of this happening.  My doctor would not give me a straight answer and i've read in one place its a 7-10% chance and another that its up to 80% chance.

I understand what retrograde ejaculation is but it would not really affect me since I don't plan on having anymore kids (have 3) from what i understand doesn't affect performance.  

My concern is with erectile dysfunction.  What are the odds of this happening.  Would it be permanent?

Could someone please shed some light on this for me.

Thanks

[Janice M Epp, PhD]

Hello.

This is really a question for a cardiovascular surgeon who specializes in this procedure. I did a little online research. What follows is a composite of what I discovered. It’s important that you discuss these issues with your surgeon and get a second opinion because there seem to be conflicting data about management and treatment of AAA. Most of the authorities quoted state that even patients who do not have symptoms from their AAAs usually require surgical intervention because of the danger of rupture.

However, if an aneurysm is small and there are no symptoms, some doctors often suggest a watch-and-wait approach. If an aneurysm has reached sufficient size to warrant surgery or the aneurysm appears to be enlarging rapidly or leaking, surgery may be recommended, sooner rather than later.

About retrograde ejaculation: you’re correct in that it has no effect on your subjective experience of orgasm.

There are several reasons why men who have this surgery may have sexual side effects. The first has to do with the effects of major surgery on one’s emotions (including post-surgical depression, altered perception of body image, etc.) These are psychological factors which can be helped by seeing a qualified therapist. In addition, there are often other co-existing conditions which contribute, such as smoking, antihypertensive medications, diabetic-associated arteriopathy and neuropathy, atherosclerotic compromise of circulation and psychological reaction to major surgery for life-threatening disease.

Erections depend on receiving “messages” from the spinal chord. If the spinal chord is damaged in any way during surgery, these messages can be interrupted, resulting in diminished or eliminated pathways for erections

Here is a link to a report from the medical journal, “Vascular Disease Management,” detailing some of these issues. I suggest you share this with your surgeons to determine the appropriate treatment for you.

http://vasculardiseasemanagement.com/article/5223

There are many other articles available online. Google “abdominal aortic aneurysm sexual side effects.” Again, get as much information as you can, get a second opinion and have a thorough discussion with your doctors so you can make an informed decision. Best of luck to you. Dr. J