Erection problems are common after prostate surgery or radiation therapy to the pelvic area – especially when combined with ADT. These problems usually start 6–18 months after treatment and may gradually get worse over time. Not having regular erections can lead to penile shortening.
There are several options for trying to improve the quality of your erections. Ask your treatment team for more information about the options shown here, or other ways to get erections firm enough for penetration.
 | TabletsMedicines that increase blood flow to the penis can help, but only if the nerves controlling erections are still working. Your doctor may suggest taking the tablets before and soon after surgery, as the increased blood flow can help preserve penis health while the nerves recover.You may be able to take tablets after radiation therapy and ADT, but they are less effective used with ADT long-term. These tablets can’t be taken with some blood pressure medicines. Ask your doctor whether this applies to you. |
| Vacuum erection device (VED)A VED or “penis pump” increases blood flow to help you get or keep a natural erection.You place a clear, rigid tube over the penis. A battery-operated or manual pump creates a vacuum that causes blood to flow into the penis, so it gets hard. You put a rubber ring at the base of the penis to keep the erection firm after you remove the pump. The ring can be worn comfortably for up to 30 minutes. Talk to your doctor or specialist nurse about which VED is right for you, and where you can buy one. |
| Penile injection therapy (PIT)Injecting medicine into the penis makes its blood vessels expand and fill with blood. This causes an erection. It usually starts in 15 minutes and lasts for 30–60 minutes.The medicine must be prescribed by a doctor, nurse practitioner or erectile dysfunction specialist service. It comes in a syringe you use once, or in small bottles (vials) from a compounding pharmacy, where you measure the dose into a syringe. You will need to learn how to give the injection. This may sound painful, but the discomfort only lasts for a moment. PIT works well for many people, but it can sometimes cause pain and scarring. One side effect that can happen is a painful erection that won’t go down (priapism). This needs emergency medical attention. |
| ImplantsA penile prosthesis is a permanent implant that helps you get an erection.During surgery, flexible rods or thin, inflatable cylinders are placed inside the penis. These are connected to a small pump in the scrotum. You squeeze the pump to get an erection. Implants may be an option when tablets or injections haven’t worked after 12 months of trying. A rare side effect of penile implants is infection. If this happens, the implant must be removed. This means you will no longer be able to have an erection. |
You may see ads for herbal or natural therapies, nasal sprays and lozenges to treat erection problems. Talk to your doctor before using them as some could be harmful. Products with testosterone, or that act like testosterone in the body, may make some cancers grow.
→ READ MORE: Changes in ejaculation
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Dr Michael Lowy, Sexual Health Physician, Sydney Men’s Health, NSW; Gregory Bock, Clinical Nurse Consultant – Oncology Coordinator, Urology Cancer Nurse Coordination Service, Cancer Network WA; Anita Brown-Major, Occupational Therapist and Director, Thrive Rehab, VIC; Helena Green, Psychosexual Therapist and Clinical Sexologist, Insync for Life Psychology and Women Centre, WA; Dr Lisa Mackenzie, Clinical Psychologist, HNE Centre for Gynaecological Cancer, Hunter New England Local Health District, NSW; Dr Tonia Mezzini, Sexual Health Physician, East Obstetrics and Gynaecology, SA; Sophie Otto, Prostate Cancer Nurse Consultant – Central Adelaide Local Health Network (CALHN), SA; Giovanna Raco, 13 11 20 Consultant, Cancer Council Victoria; Kath Schubach, Urology Nurse Practitioner, VIC; Emily Stevens, Gynaecology Oncology Clinical Nurse Consultant, Southern Adelaide Local Health Network, Flinders Medical Centre, SA; Anja Vukovic, Clinical Specialist Social Worker, Gynaecological Oncology, Westmead Hospital, NSW; Alan White, Consumer; Kathleen Wilkins, Consumer; Merran Williams, Consumer.
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