Improving erections after treatment

After prostate cancer
treatment, many t
āne ex
perience changes in their ability to form (and keep) erections. Most often, t
āne w
ill not get back to where they were before treatment, yet they will see some improvement.
Many tāne (and couples) continue to be sexually active and feel satisfied with their sex lives after having prostate cancer. Keeping healthy, learning how to use sexual aids and relying on personal strengths, can help with this process.

Orgasms and erections

Did you know? You can have an orgasm without an erection and ejaculating.

Most tāne don’t realise that this is possible. An orgasm can also stimulate nerves that help the brain remember sexuality is still important. It’s a way of telling the brain to keep making those connections while erections are recovering.

Medicine and devices
to help with your erections

There are many different sexual aids available to help you improve your erectile function. Remember that each t
āne is
unique, so you may need to try a few different options to find the best solution for you.
Ask your doctor, care team or hauora provider what they would recommend for you.

Erectile aids can be medical, like using tablets and injections, or mechanical, like using a penile vacuum pump. Talk to your doctor or hauora provider about the potential side effects of using any of these. They will also need to teach you how to correctly use the injection and mechanical aids like the pump.

Remember, using these aids may seem intimidating at first, but you can be taught how to use them. Many t
āne f
ind them helpful once they learn how to use them.

Click below to see various aids
that may help your erectile function

The tablets (also called PDE-5 inhibitors) can help you to make and keep an erection for sexual activity. They work by inhibiting an enzyme in the body called “PDE-5”. This allows more blood flow into the penis.


  • easy to use


  • require some level of nerve function, which means the tablets don't usually work well for t
    āne o
    n hormone treatment or for t
    āne w
    ith nerve damage due to surgery

  • not usually recommended if you are taking medications for heart problems

  • can cause side effects like dizziness, facial flushing, headaches, indigestion, muscle aches, and nasal stuffiness


  • Viagra, Vedafil, Silvasta, Cialis and Levitra

Speak to your doctor, care team or h
auora provider t
o find out if PDE-5 inhibitors could be an option for you.

Vacuum Erection Device (VED) or Penis Pump

A vacuum erection device (also known as a vacuum pump or a penis pump) is a tube that you put over your penis to help you get an erection. After you form an erection with the pump, a restriction band (or penis ring) can then be placed around the base of your penis. This helps you to maintain your erection for sexual activity after the vacuum pump is removed.


  • non-invasive, with limited side effects

  • can be used when needed and often

  • can be combined with other erectile dysfunction treatments (such as the tablets)

  • funding may be available from health funds or public hospitals

  • may help prevent penile shortening


  • may feel like an "unnatural erection" that feels cool to the touch

  • may cause your penis to change colour temporarily

  • can cause penis bruising

  • wearing a restriction band can create a “hinge effect”, where your penis rocks back and forth during sexual activity

Penile injections

Penile injections can be a very effective method to help you form erections. They work by injecting medication directly into the side of your penis with a small needle.


  • start working quickly (takes about 10 to 15 minutes to form a firm erection)

  • typically painless

  • more effective than tablets for t
    āne w
    ho have erectile dysfunction due to nerve damage (often caused by prostate cancer treatment)

  • more effective than tablets for t
    āne w
    ho have low testosterone levels

  • may be more cost effective than tablets​


  • can cause erections that are painful or last too long (priapism)

  • can cause pain and bruising where you inject it (on the side of the penis)

  • can rarely cause scar tissue to form (Peyronie’s Disease)


  • Caverject® (alprostadil) and D
    BL™ papaverine

Pellets (suppositories) or cream

Penile or urethral pellets and cream can help you get an erection. This is where you use an applicator to insert a very small pellet or suppository, or the cream, into your urethra. The urethra is the area in the tip of your penis where you “wee” from.

While it sounds uncomfortable to insert a pellet into your urethra, most t
āne s
ay it is tolerable and not usually painful.


  • easy to insert into the tip of the penis with a no-needle applicator

  • does not use needles

  • can be used every day

  • works quickly (within 10-15 minutes)


  • can cause pain or a burning feeling when you use it

  • can cause pain in the penis, testicles, legs, and in the perineum (area between your penis and anus).

  • can cause pain or discomfort for your partner if you leak urine during vaginal or anal intercourse

  • can cause a small amount of bleeding from the urethra (if you hurt yourself putting in the pellet).

  • can be expensive to use


  • MUSE pellets, or Alprostadil gel

Speak to your doctor, care team or hauora provider to check if this is an option available to you.

Penile Implants

If traditional erectile aids (such as the tablets, vacuum pump, or injections) don’t work for you, penile implants can be a good option to get an erection. Penile implants are devices that are put into your penis during surgery to help you get an erection.


  • Once in place, the implant produces an erection quickly and whenever you want one.


  • It must be inserted into the penis during an operation (surgical procedure)
    which involves some risks and can have complications.

  • If it is removed, natural erectile function cannot be restored.

  • It does not make your erection longer or bigger

  • The head of your penis will be softer than a natural erection.

There are 2 types of penile implants:

  • Inflatable (you inflate them before sex)
    To have an inflatable implant, you’ll have a pump put into your scrotum, two inflatable tubes put into your penis, and a small balloon filled with water put into your stomach (abdomen).

    When you’re ready to have sex, you’ll use the pump to push water from the small balloon into the tubes in your penis causing an erection. After you are finished having sex, you can then deflate the tubes which will cause the water to go back in the balloon, and your penis to become soft again.

  • Permanently malleable (they stay partly hard all the time)

    If you get a malleable implant, you don’t need to use a pump to form an erection, yet your penis won’t be fully hard or fully soft. It will stay somewhat firm all the time and can be more difficult to hide under your clothes. Most men point the penis down during normal activities and upwards for sexual activity. This can sometimes damage the tissue inside your penis by pressing on the inside.


The way the body experiences pleasure may be different after prostate cancer treatment. Masturbation can help you rediscover sexual desires and pleasure. The more you know about your own desires, the better you’ll be able to communicate them to a partner.

Masturbation can also be used for more than just personal pleasure. When you masturbate, more blood flows to the penis, which help to keep the tissue in the penis healthy. And orgasms help the brain remember the importance of sexuality. These effects are all part of your sexual recovery.

Some tāne will build masturbation into their daily shower routine. The hot water can improve blood flow to the area.

Although most people masturbate, some feel whakamā (shame) about doing it. This can be because of religious or cultural beliefs, upbringing, or unspoken social rules. If you feel uncomfortable or don't believe that you should engage in masturbation, that's okay. It’s important to note that some tāne come to terms with masturbation because they realise that it’s recommended as a medical intervention as part of their cancer care.

Penile rings

Penile rings (also called tension bands, cock rings or erectile dysfunction rings) can help you keep your erection (once you have one). It's worn at the base of the penis and works by preventing blood from flowing out of the penis.

This text has been written by Robert, a man with prostate cancer. In it, he gives his views and some advice on his experience of using penile rings.

"It is probably worth mentioning the importance of penis rings which are actually called ‘cock’ rings, which come in various shapes and sizes.

The simplest and cheapest type is a smooth thick rubber ring which looks far too small to be of any use. Therein lies the problem. Your penis needs to be partially erect otherwise the ring will be useless. Initially, the ring may feel as if it is cutting your penis in two but given time you will learn what works for you and how the very tightness of a penis ring can be so beneficial.

In terms of type, the problem that I have encountered with some of the pliable smooth rings is their tendency to move up the penis shaft. The type I prefer are the ones with small rubber bobbles or studs in them which help to keep the ring in place. However, it is simply down to personal choice and what works for you. Even if you find success, you could experiment and try different types. Variety is the spice of life and you never know what you might be missing."

Which erectile
aid is best for me?

There are pros and cons for each sexual aid.
Your doctor, care team or hauora provider can help you decide:

  • which aid might work for you

  • how to use it

  • how often you should use it

Some aids might work better for you than others. It will depend on your cancer treatment, other medical problems and if you had erection problems before treatment. It is good to try different types of erectile aids to see which one is best for you.

It’s recommended that you try each erectile aid at least 8 times before trying something else unless you're experiencing any discomfort. Even though something might not work the first time you use it, it can work well months or even years later.

Feel confident that you can combine different approaches to find what works for you.

Remember, your erectile function depends on many things including:

  • your erectile function before treatment

  • the treatment you have had

  • your age

  • other medical conditions (such as diabetes, high blood pressure, heart disease or neurological conditions including stroke or Parkinson’s disease)

  • general lifestyle factors, including level of physical activity, smoking, body weight

  • other medications you’re taking

  • whether you suffer from depression and anxiety

It's important to give yourself time to recover your sexual function. How persistent you are in improving your sex life will determine how successful you are. Include your partner (if you have one) in your discussions and decision-making. It may take time and effort, but in the end, it'll be worth it.

What's next?

Now that you've read up on Improving erections after treatment, here are some related articles to explore as you continue to build your knowledge and understanding of this topic.
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