When a man has trouble getting or keeping an erection firm enough for intercourse or other sexual activity, it is called erectile dysfunction or impotence. The quality of erections usually declines naturally as men get older.
Erection problems are common in men following treatment for prostate cancer, particularly radiotherapy and prostate surgery. The prostate lies close to nerves and blood vessels that are important for erectile function. These can be damaged during surgery or radiotherapy.
The body needs time to heal after surgery. There may be a gradual recovery, with some men noticing their erectile function continues to improve for up to three years after treatment has finished.
There is increasing evidence that sexual rehabilitation before and after surgery and radiotherapy helps recovery. Your chance of a strong recovery of erectile functioning may be improved by:
- engaging in foreplay with your partner
- encouraging erections as soon as a month after surgery
- using medication prior to surgery, or in the early post-operative period
- using a vacuum erection device or having penile injections
For many men, an orgasm can still be achieved without a full erection. See Restoring sex life.
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Other causes of erectile dysfunction
Sometimes cancer treatment adds to existing erection problems, which may be caused by:
- getting older
- diseases, such as diabetes, heart and vascular disease
- certain medications, such as those used to treat blood pressure or depression
- previous surgery to the bowel or abdomen
- a history of smoking or high alcohol intake
- emotional or mental distress
How to improve the quality of your erections
There are several options for trying to improve the quality of your erections, regardless of the type of cancer treatment you have had.
There are prescription medications that can help the body’s natural response to sexual stimulation by increasing blood flow to the penis. These are only effective if the nerves necessary for erections are working.
Side effects – Include headaches, nausea, facial flushing and backache, but these only last a few hours, until the drug is out of your system.
Men with existing heart problems should check with their doctor before using these medications. These medications can cause changes in blood pressure, and some heart medications are not recommended (contraindicated) with these tablets.
Penile injection therapy
Men are taught to inject their penis with medication that causes blood vessels in the penis to expand and fill with blood, causing an erection. An erection usually occurs within 15 minutes and lasts 30–60 minutes.
This treatment works well for most men, but a few may experience pain and scarring.
Side effect – In some rare cases, a prolonged and painful erection (priapism) occurs; this requires emergency medical attention.
Vacuum erection device
A vacuum erection device (VED) or vacuum pump device uses suction to draw blood into the penis. This device can also help to strengthen or maintain a natural erection. Using a VED is painless and relatively easy; however, it may take some practice to feel confident. VEDs are available on prescription or from sex aid shops.
A penile prosthesis is an implant that is surgically placed in the penis. This implant allows men to mechanically create an erection.
Flexible rods or thin, inflatable cylinders are placed in the penis and connected to a pump, which is put into the scrotum during surgery under general anaesthetic. The pump is turned on or squeezed when an erection is desired.
Implants are usually performed no sooner than 12 months after the prostate cancer treatment. They are generally considered only after other less invasive penile rehabilitation options have been trialled, such as medications or injections. Implantation is effective, however the surgery permanently changes the structure of the penis, as part of the tissue within the penis is removed to implant the device. If the device is removed, a man will be unable to achieve an erection.
Other therapies for erectile dysfunction
You may see and hear advertisements for products offering treatment for erectile dysfunction. Products include herbal preparations, natural therapies, nasal sprays and lozenges.
Be cautious about using testosterone or natural products that act like testosterone in the body, as they may involve risks without any benefits.
Talk to your doctor or sexual health physician before taking any over-the-counter or prescription medications to improve erections.