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Medications and devices for ED: what to expect after prostate cancer surgery

A tall rock shaped like a penis

When it comes to treating erectile dysfunction (ED), there is no ‘one size fits all’ approach. You’ll likely try a number of different medications or devices, before you land on what works best for you.
Whether you choose a less invasive approach (e.g. erection pills) or a more invasive approach (e.g. injections) is up to you based on your own goals and what you value most.
At any time, you can talk to your doctor about switching what you’re trying out. As well, you can choose to stop pro-erectile therapy for the time-being, or start pro-erectile therapy if you haven’t started yet.

Getting erections: 4 months after prostate cancer surgery

In the early period after surgery, and usually within the first year, using the vacuum erection device (also called vacuum pump or penis pump) and penile injections—more invasive approaches—are the most effective in achieving firm erections for penetration. While erection pills, can help maintain penile health, they are unlikely to give you firm erections at this early stage. Both approaches are available—it’s up to you which you choose.

Couples who want to engage earlier in penetrative sex try upfront use of vacuum pumps and injections, while those who are not in as much of a rush or uncomfortable with idea of using injections or devices prefer to start with erection pills.

Keep your expectations realistic. Many men think that they will take Viagra, Cialis, Levitra, or Staxyn and have erections like they did when they were in their twenties. Four months after surgery, it is still too early in your recovery to expect erections firm enough for penetration using erection pills. There should be increased blood flow to your penis in response though—so you may experience ‘semi-erections’. This is a good sign—even slight increases in blood flow can help maintain healthy tissue in your penis.

    Remember:

  • Nerve bundles that are damaged during surgery can take up to 24 months to recover, and sometimes recovery can continue 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 and not others.

If you’re not happy with the erection pills and you’re keen to get to penetrative sex, ask your doctor about using the vacuum device or penile injections.

If you’re using suppositories, vacuum pump or injections without much success, speak to your doctor about swapping between them or combining them with erection pills.

Getting erections: 6 months after prostate cancer surgery

At this point, it’s still too early in your recovery to expect erections firm enough for penetration using erection pills. But there should continue to 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 to penetrative sex, then speak to your doctor about using the vacuum device or penile injections.

If you have been using urethral suppositories/pellets (commonly referred to by their brand name, MUSE) and are not satisfied, you can consider trying the vacuum 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 swapping to the pills to see if you can continue to have the same response with a less invasive treatment. This is also called ‘re-challenging’.

Remember: Always speak to your doctor before making any changes

Getting erections: 12 months after prostate cancer surgery

More men will achieve satisfactory erections in response to erection medications in their second year of recovery compared to during their first year of recovery. Many men do not have success with erection pills in their first year of recovery. In fact, many men do not have success until late into their second year after surgery. A predictor of better responses to erection pills in the second year of recovery is increases in blood flow to your penis in response to erection pills over time.

Remember, even if using the erection pill does not result in firm erections, the increased blood flow may be helping to 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 erection response, consider talking to your doctor about the possibility of combination therapy, such as combining MUSE with an erection pill. If you are using MUSE without satisfactory erection response, consider talking to your doctor about the possibility of trying injections or the vacuum pump.

If you have decided to stop using erection medications or devices, most couples have found that it is important to their relationship to continue with some form of sexual activity. Non-penetrative based sexual activity can be very satisfying but it can take some effort and open communication to adjust. The key to success is to work with each other to find new ways of achieving pleasure.

Performance anxiety

Performance anxiety is just what it sounds like; getting anxious when you become overly focused on whether or not you can achieve an erection. Being too focused on erections can put too much pressure on performance, causing stress and anxiety. The pressure to perform can directly and independently lead to erectile dysfunction.

This results in the confusing and complicated situation of erectile problems that are now based on both the physical complications of the surgery and the psychological influence of performance anxiety. Keeping realistic and hopeful expectations can help keep performance anxiety at bay.

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