Improving erections after prostate cancer treatment

Looking for sex and intimacy tips beyond the basics? Explore our new guide Under the Hood.
Under the Hood is currently best for people who’ve had prostate cancer surgery and their partners.

After prostate cancer treatment, many men experience changes in their ability to have erections. Most often, men don’t get back to where they were before treatment, but they see improvement.
Many men (and couples) do remain sexually active and feeling satisfied with their sex lives. 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 men don’t realize 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 try to improve your erectile function. Remember that each man is unique, so you may need to try a few different options to find the best solution for you.
A
sk your doctor or care team what they would recommend for you.

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

Using erectile aids may seem intimidating at first, but you can be taught how to use them. Many men find them helpful.

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

The pills (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.

Pros

  • easy to use

Cons

  • require some level of nerve function, which means the pills don't usually work well for men on hormone treatment or for men with nerve damage due to surgery

  • not recommended if you are taking medication for heart problems

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

Examples

  • Viagra, Cialis, Levitra and Stendra

Speak to your doctor or care team to 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.

Pros

  • non-invasive, with limited side effects

  • can be used when needed and often

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

  • funding may be available from health funds or public hospitals

  • may help prevent penile shortening

Cons

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

  • may cause penis to change color 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.

Pros

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

  • typically painless

  • more effective than pills for men who have erectile dysfunction due to nerve damage (often caused by treatment)

  • more effective than pills for men who have low testosterone levels

  • may be more cost effective than pills​

Cons

  • 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)

Examples:

  • Caverject® (alprostadil)

Pellets (suppositories)

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 “pee” from.

While it sounds uncomfortable to insert a pellet into your urethra, most men say it is tolerable and not usually painful.

Pros

  • 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)

Cons

  • 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

Examples

  • MUSE® (Alprostadil) pellets

If you think this could be a good option for you, speak to your doctor or care team.

Penile Implants

If traditional erectile aids (such as the pills, 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.

Pros

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

Cons

  • it must be inserted into the penis during an operation (surgical procedure)

  • once it is removed, the natural erectile function can't 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)
    When you’re ready to have sex, you’ll pump up your implant using fluid. Your erection will deflate after sex. To have an inflatable implant, you’ll have a pump put into your scrotum and a small balloon
    filled
    with water put into your stomach (abdomen).

  • 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.

Masturbation

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

Although most people masturbate, some feel 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 individuals come to terms with masturbation because they realize 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 or care team 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. You should also find out from your insurance company how the treatment will be paid for.

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 pre-treatment sexual function

  • the treatment you've 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 prostate cancer treatment, here are some related articles to explore as you continue to build your knowledge and understanding of this topic.
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