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Which ED medication or device is right for me?

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With all of the available treatments it can be difficult to choose one that is right for you or as a couple. There are pros and cons for each. Some might work better for you than others. It will depend on your prostate cancer treatment, other medical problems, and if you had erection problems before treatment. We encourage you to discuss the treatment choices with your doctor.Your doctor can help you decide which treatment might work for you, how to use it and how often you should use it.

Understanding treatment options for ED

As part of penile rehabilitation, it’s important to understand what your options are for erectile dysfunction treatment and keeping your penile tissues healthy. The idea is to create blood flow to the penis by using different methods, like medications, devices or masturbation. There’s no right or wrong way to do penile rehabilitation—it's just important that you do something.

    Here are some methods that are used:

  • Erectile dysfunction pills (low-dose PDE-5 inhibitors)

  • A vacuum erection device (VED)

  • Regular use of penile injections

  • Regular use of urethral suppositories

No one method is definitively preferred or most successful, and they all take time to get used to. This is a process that is rarely solved by a single solution. This means that you may likely try a number of pro-erection medications or devices, before landing on what’s best for you.

The underlying goal for using any of these is to maintain the health of the erectile tissues. You should use these methods to create blood flow daily, and additionally aim to achieve 1 to 3 erections sufficient for penetration on a weekly basis.

Is sexual activity part of rehabilitation?

Yes and no. There is a difference between penile rehabilitation and partnered sexual activity.

The goal of penile rehabilitation is to preserve the health of the erectile tissues of the penis. Men work on it by themselves the same way as they would if they broke a leg and had to do rehabilitation exercises to strengthen it. Rehabilitation is important to do regardless of sexual activity.

Figuring out which treatment options you’re interested in

To assist you in discussing treatment choices with your doctor, we have outlined below a step-by-step approach to decision-making that will help you align your values and goals with the available treatments.

(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. These exercises involve sensual touching, and don’t involve 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

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.

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 you can look into

  • Re-challenging: 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’.

  • Combining treatments: 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 or devices are used together.

It is recommended that you try each strategy on at least 8 occasions before trying something else, unless you are experiencing any discomfort. Even though something might not work at one time it can work well months or even years later. You may also find that combining different approaches works for you.

Remember, you (and your partner) are sharing a real medical concern that is very common for most people who’ve been treated for prostate cancer.

Talk with your doctor about your options and what you might like to try.

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