In the United States, gay and bisexual men are the population most affected by HIV. According to the Centers for Disease Control and Prevention (CDC), in 2021, adult and adolescent gay, bisexual and other men who reported male-to-male sexual contact accounted for 67% of the new HIV diagnoses in the United States and dependent areas.

Choose less risky sexual behaviors.

Anal sex is the riskiest type of sex for getting or transmitting HIV. Receptive anal sex (bottoming) is 13 times riskier for getting HIV than insertive anal sex (topping).

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In general, oral sex has a low risk of transmitting HIV. However, it is hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. Other sexually transmitted infections (STIs), such as syphilis, herpes, gonorrhea, and chlamydia, can be transmitted during oral sex.

Limit your number of sex partners.

The more partners you have, the more likely you are to have a partner with poorly controlled HIV or to have a partner with an STI. Both factors can increase the likelihood of HIV transmission. Having an STI may create inflammation or open sores that make it easier for HIV to penetrate your skin. Syphilis, which is especially prevalent among men who have sex with men, can put you at high risk for HIV in the future.

Consider pre-exposure prophylaxis (PrEP).

Pre-exposure prophylaxis (PrEP) is HIV medicine taken to reduce the chances of getting HIV infection. PrEP is used by people who do not have HIV but are at high risk of being exposed to HIV. PrEP can be taken as an oral medicine (pills) or delivered as a long-acting injection once every two months. PrEP can be combined with other prevention methods, such as condoms, to reduce the risk of HIV even further. To learn more, read the HIVinfo fact sheet on Pre-Exposure Prophylaxis (PrEP).

Consider post-exposure prophylaxis (PEP).

Post-exposure prophylaxis (PEP) is the use of HIV medicines soon after a possible exposure to HIV to prevent becoming infected with HIV. For example, a person who is HIV negative may use PEP after having sex without a condom with a person who is HIV positive. To be effective, PEP must be started within 72 hours after a possible exposure to HIV.

The CDC recommends that all sexually active gay, bisexual, and other men who have male-to-male sexual contact get tested for HIV at least once a year. However, some sexually active gay and bisexual men (such as those who have more than one partner or have had casual sex with people they do not know) may benefit from getting tested more often (for example, every 3 to 6 months).

Take HIV medicines every day as prescribed by your health care provider. Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone who has HIV. ART cannot cure HIV infection, but it can reduce the amount of HIV in the body (called the viral load).

Nearly all men will experience some erectile dysfunction for the first few months after prostate cancer treatment. However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement.

About 25 to 50% of men who undergo brachytherapy will experience erectile dysfunction vs. nearly 50% of men who have standard external beam radiation. After two to three years, few men will see much of an improvement and occasionally these numbers worsen over time.

Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours.

About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.

The vacuum constriction device creates an erection mechanically by forcing blood into the penis using a vacuum seal. A rubber ring rolled onto the base of the penis prevents blood from escaping once the seal is broken. About 80% of men find this device successful.

A three-pieced surgically inserted penile implant includes a narrow flexible plastic tube inserted along the length of the penis, a small balloon-like structure filled with fluid attached to the abdominal wall, and a release button inserted into the testicle.

The penis remains flaccid until an erection is desired, at which point the release button is pressed and fluid from the balloon rushes into the plastic tube. As the tube straightens from being filled with the fluid, it pulls the penis up with it, creating an erection.

Assuming the mechanics are working correctly, it is 100% effective, and about 70% of men remain satisfied with their implants even after 10 years. Because this procedure is done under general anesthesia, it is not available to men who are not considered good candidates for surgery because of other health reasons.

Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.

Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.

For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins' noted Sexual Behaviors Consultation Unit.

Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery. With the advent of the nerve-sparing radical prostatectomy technique, many men can expect to recover erectile function in the current era.

However, despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is not common. Increasing attention has been given to this problem in recent years with the advancement of possible new therapeutic options to enhance erection function recovery following this surgery. Visit Dr. Burnett's Neuro-Urology Laboratory

This topic area was handled thoroughly in an article written by Dr. Arthur L. Burnett, entitled "Erectile Dysfunction Following Radical Prostatectomy," published in the Journal of the American Medical Association, June 1, 2005. Using a question and answer format, excerpts from this article are provided below.

In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men; however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.

Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes. Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 (PDE5) inhibitors within 2 years.

The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.

A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.

The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states (e.g., cardiovascular disease, diabetes mellitus), lifestyle factors (e.g., cigarette smoking, physical inactivity), and the use of medications such as antihypertensive agents that have antierectile effects.

At this time, there are several different surgical approaches to carry out the surgery, including retropubic (abdominal) or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.

The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time. 152ee80cbc

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