Erectile dysfunction (ED)
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Erectile dysfunction medication and devices: choosing what’s right for you
Choosing a treatment for erectile dysfunction (ED) after prostate cancer can be intimidating. Not to worry; there is no “one size fits all” approach. What’s best for you may depend on your prostate cancer treatment, other medical problems or whether you had erection problems before treatment.
Depending on your goals for recovery, you might choose a less invasive approach (e.g. ED medication) or a more invasive one (e.g. penile injections). Whatever you choose, it’s important to discuss your options with your doctor.
How does ED medication work?
The goal of penile rehabilitation after prostate surgery is to keep your penile tissues healthy. Different medications or devices are used to create blood flow to the penis. There’s no right or wrong way to do penile rehabilitation—but it’s important that you do something.
Here are some of the more common ED medications and devices used to increase blood flow:
Erectile dysfunction pills (low-dose PDE-5 inhibitors).
Penis pumps (also known as vacuum erection devices).
Regular use of penile injections.
Regular use of urethral suppositories or MUSE.
No one method is definitively the best, and they all take time to get used to. In fact, you may try a number of pro-erection medications or devices before landing on what’s best for you.
The underlying goal is to maintain the health of the erectile tissues. You should use these methods to create blood flow daily, and aim to achieve 1 to 3 erections sufficient for penetration on a weekly basis.
How to get ED medication
Simple: talk to your doctor. It’s essential that you consult with them on what ED medication options are available, the pros and cons, risks and possible side effects of each. Some treatment options can be more or less effective based on what type of surgery you had, or whether you had difficulties getting an erection before prostate cancer.
The first step is always, always talking to a doctor.
Deciding which ED treatments you’re interested in
To help prepare you to talk through treatment options with your doctor, follow this 4-step decision making guide. (NOTE: All treatment decisions must be made in consultation with your doctor.)
Step 1: Are you interested in using medications and/or devices to help with erectile dysfunction?
YES - see Step 2
NO - consider sensate focus exercises instead. These exercises involve sensual touching (instead of medication or devices) to help you re-engage in satisfying, non-penetrative sexual activity. Remember, you do not need a firm erection to reach orgasm, and you can also engage in self-stimulation.
Step 2: Are you interested in using medications to improve erectile function?
YES - see Step 3
NO - consider using a vacuum erection device (or penis pump).
Step 3: Are you okay to go without penetrative sex for the immediate future?
YES - consider erection pills which can help maintain the health of your penis while the erectile nerves recover
NO - consider using urethral suppositories/pellets or penile injections
Step 4: What type of prostate cancer surgery did you receive?
Bilateral nerve-sparing surgery (the nerves were spared on both sides of your prostate) - all pro-erectile medications and devices are available for your consideration
Unilateral nerve-sparing surgery (the nerves were removed on one side of your prostate) - all pro-erectile medications and devices are available for your consideration but erection pills may not be as effective as they rely on healthy nerves to work well
Non-nerve-sparing surgery (the nerves were removed on both sides of your prostate) - only devices (like a vacuum erection device) or urethral suppositories/pellets (MUSE) or penile injections are available for your consideration. Devices and the more invasive medications do not depend on the nerves.
Other options for ED treatment
If you have been using more invasive treatments like suppositories and injections, talk to your doctor about trying erectile pills to see if they work. This is known as “re-challenging.”
If you are unsuccessful using medications over time, discuss with your doctor the possibility of combination therapy in which two types of pro-erectile medications/devices are used together.
Be sure to try each strategy at least 8 times before switching to something else, unless you’re experiencing discomfort. Even though something might not work at first, things might change months or even years later. You may also find success combining different approaches.
ED treatment timeline: a month-by-month guide
Every person is different, but here’s a general overview of what to expect—and what ED treatments you may want to consider—over the first year of recovery after prostate cancer surgery.
4 months after prostate cancer surgery
This early after surgery, and usually within the first year, penis pumps and penile injections are more effective for achieving firm erections. While ED pills can help maintain penile health, they’re unlikely to give you firm enough erections for penetration this early in your recovery.
What treatment you choose depends on whether you and your partner want to engage in penetrative sex now, or if you’re not in as much of a rush (and how comfortable you are with the idea of using injections or devices).
Keep your expectations realistic. Many men think that taking Viagra, Cialis, Levitra, or Staxyn will give them erections like they had in their twenties. Four months after surgery, it’s still too early to expect erections firm enough for penetration using ED pills.
Nerve bundles damaged during surgery can take up to 2 years to recover. In some cases recovery continues for 3 to 4 years after surgery.
Erection pills are dependent on having some nerve bundle function.
Erection pills can work better for some people than others.
6 months after prostate cancer surgery
It’s still too early to expect erections firm enough for penetration using ED pills. But there should be increased blood flow to your penis allowing a semi-erection, and importantly, keeping your penile tissue healthy. If you want to speed up getting back to penetrative sex, then speak to your doctor about using a penis pump or penile injections.
If you have been using urethral suppositories (commonly known by their brand name, MUSE) and are not satisfied with the results, consider trying a penis pump or penile injections—or combining MUSE with erection pills.
If you have been using urethral suppositories/pellets (MUSE), vacuum pump or penile injections with a satisfactory response, consider re-challenging – that is, swapping to the pills to see if you get the same response with a less invasive treatment.
Remember: Always speak to your doctor before making any changes.
12 months after prostate cancer surgery
Many men don’t have success with erection pills in the first year of recovery. In fact, it’s not uncommon for men not to get firm erections from pills until late into their second year after surgery. Remember, even if ED pills don’t lead to firm erections, the increased blood flow may be helping maintain healthy penile tissue. If you are not experiencing increases in blood flow to your penis over time, then you may want to consider a more invasive approach for now, such as MUSE or injections.
If you are using MUSE without satisfactory results, consider talking to your doctor about combination therapies – for example, using MUSE with an erection pill. You could also explore the possibility of injections or a medical-grade penis pump.
If you decide to stop using erection medications or devices at this stage, it may still be important to continue some form of sexual activity with your partner—that’s certainly the case for most couples. Non-penetrative sexual activity can be very satisfying, but it can take some effort and open communication to adjust. The key is to work with each other—communicating openly and not letting performance anxiety get the best of you– so you can find new ways of achieving pleasure together.
Recovering after prostate surgery is a process, but ED medications and devices can help. Always remember to talk with your doctor about your options and what you might like to try.