Erection problems

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. It can also be affected by other factors, including health conditions such as diabetes and heart disease; certain medicines for blood pressure or depression; previous surgery to the bowel or abdomen; smoking or heavy drinking; or emotional or mental distress.

Erection problems are common in men after treatment for prostate cancer. The prostate lies close to nerves and blood vessels that are important for erectile function. These can be damaged during surgery or radiation therapy. 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.

Before and after treatment, various methods can help preserve the health of the penis (penile rehabilitation). These may include:

  • engaging in foreplay and other sexual intimacy with your partner
  • encouraging erections, starting a month after surgery
  • taking prescribed medicines to maintain blood flow in the penis
  • using a vacuum erection device to stop the penis shortening or losing flexibility
  • injections of medicine into the penis.

See below for more detail about these methods. For many men, an orgasm can still be achieved without a full erection. See Restoring sex life.

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Ways to improve erections

There are several medical options for trying to improve the quality of your erections, regardless of the type of prostate cancer treatment you have had. Ask your treatment team for more details about these methods.

Oral medicines

There are tablets available on prescription that can help the body’s natural response to sexual stimulation by increasing blood flow to the penis. These can only help with erections if the nerves are working, which is unlikely in the early stages of recovery. However, your doctor may recommend using the tablets before and soon after surgery, as the increased blood flow can help preserve penis health until the nerves recover.

Side effects may include nausea, headaches, facial flushing and backache, but these only last for a few hours after taking a tablet. The drugs can cause blood pressure changes and should not be taken with some heart medicines.

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.

You place a rigid tube over the penis. A manual or battery-operated pump then creates a vacuum that forces blood to flow into the penis so it gets hard. A band at the base of the penis keeps the erection firm after the pump is removed, and can be worn comfortably for 30 minutes.

Injections

Penile injection therapy (PIT) has  to be prescribed by a doctor.

You will be taught to inject the penis with medicine that makes blood vessels in the penis expand and fill with blood, causing an erection. The erection usually occurs within 15 minutes and lasts 30–60 minutes.

Most often, the syringes come pre-loaded with the medicine and are single use. The needle is very short and fine, and usually causes only a moment of discomfort.

This treatment works well for most men, but a few may have pain and scarring. A rare side effect is a prolonged and painful erection (priapism) – this requires emergency medical attention.

Implants

A penile prosthesis is an implant that is inserted into the penis during surgery under general anaesthetic. This implant allows you to mechanically create an erection. Flexible rods or thin, inflatable cylinders are placed in the penis and connected to a pump in the scrotum. The pump is turned on or squeezed when an erection is desired.

Penile implants can be expensive, so check costs with your doctor. They generally won’t be offered for at least a year after prostate cancer treatment, and less invasive options, such as oral medicines or injections, will usually be tried first. Implants can be effective, but part of the tissue within the penis is removed to implant the device. This is a permanent change to the structure of the penis and a man will be unable to achieve an erection if the device is removed.

You may see or hear ads offering treatment for erection problems. Products that are widely available include herbal preparations, natural therapies, nasal sprays and lozenges. Talk to your doctor before using any of these, as there could be risks without any benefits. Those that contain testosterone or act like testosteronein the body may encourage the prostate cancer to grow.

This information was last reviewed in March 2018
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