Prostate cancer is the most common cancer that affects men in the US, after skin cancer. There’s good news though: for many, it’s possible to successfully treat prostate cancer, meaning men can go on to live normal, healthy lives after a diagnosis. With a 98% five-year survival rate, there are more prostate cancer survivors than ever before.
However, one of the most common prostate cancer treatment side effects that survivors struggle with is ED, or erectile dysfunction. ED is a term to describe when a man can’t get or maintain an erection and it can be caused by both physical and psychological factors. With sexuality so linked to masculinity, virility, and even self-esteem, erectile dysfunction can be hard to live with. Fortunately, there are many successful ways to treat ED. If you or a loved one are struggling with erectile dysfunction after prostate cancer, here’s how to manage and treat the issue.
Why do some patients experience erectile dysfunction after prostate cancer?
Due to the physical proximity of the prostate to the nerves that control erections, it’s not uncommon to have erectile dysfunction after prostate cancer. It’s often temporary though.
Both prostatectomies and radiation treatments can cause ED, but urologists aim to perform nerve-sparing procedures. This means the doctor takes care to avoid damaging the nerves near the prostate during the operation or when administering radiation.
Men with advanced prostate cancer may experience ED when taking hormone therapy, which lowers testosterone and can cause a lessened interest in sex.
Treatment options
If you have concerns about ED before or after your prostate cancer treatment, always talk to your medical team. While it might feel a little embarrassing to talk openly about such a personal topic, rest assured that your doctors are there to help.
If you’re in a relationship, talk to your partner as well, discussing how you both feel and think about ways you might be able to enjoy intimacy together, even if physical penetration isn’t possible.
In addition to the below, a healthy lifestyle can play a big role in helping you recover after cancer treatment, so don’t neglect the importance of a balanced diet and a regular exercise regime.
Here are some of the most common methods for restoring erectile function.
Medication
Oral or injectable medications are often the first option for restoring erectile function. Research has shown that 75% of men who had nerve-sparing surgery or radiation were able to maintain erections with the help of medication.
Many urologists will start their patients on oral medication like Viagra or Levitra after surgery as a form of penile rehabilitation to help erections return as soon as possible.
Oral medications, like Viagra, are taken shortly before you wish to have an erection. They work by increasing blood flow to the penis. Some doctors might recommend injectable medications, like Trimix, which help to open blood vessels in the penis to cause an erection.
Medications are very effective, but for some men, they may not work. However, they’re only one out of several options.
Vacuum constriction device (VCD)
Another effective option is using a VCD, also known as a vacuum penile pump or penis pump. These are tubular devices that go over the penis, creating a seal. The device removes air from the tube which causes the penis to swell. Once erect, a band is placed at the base of the penis to maintain the erection.
With the assistance of a VCD, erections should last around 30 minutes.
Penile implant
If no other treatments have been successful, penile implants are an option. For men who are unable to obtain erections with medication or external devices, they might choose to undergo penile implant surgery.
This is a device placed inside the penis to manually create an erection. Most work via inflation, with the user able to control a pump and release valve to control the device’s fluid-filled reservoir.
Counseling
Although ED is often caused by physical changes to the body after prostate cancer treatment, it can also be due to psychological issues. It’s normal to feel frustration from changes to your body after cancer, relationship problems, or stress brought on by a cancer diagnosis—these are all common psychological reasons for erectile difficulties.
After the prostate has been removed, most erections will become dry, meaning without semen—it can be mentally distressing when your body doesn’t respond to sex the way it used to.
Often, it can be beneficial to seek professional help from a therapist or counselor who specializes in cancer. They can help you discuss your emotions, develop coping strategies, and help you come up with ways to stay intimate and connected to your partner, if you’re in a relationship.
Gay and bisexual men with prostate cancer might have specific concerns about how treatment will affect their bodies and their sex lives, so it can be helpful to speak to a professional with expertise in this area.
Always reach out for help
Although ED is one of the most common prostate cancer treatment side effects, know that help is always available. Your doctor is there for guidance and you can also seek out peer support from other men who’ve had similar experiences, via a support group or online forum.
We also recommend being patient, as erectile function doesn't necessarily return overnight. And if one option doesn’t work for you, keep trying and don’t lose hope. If you’re worried about the cost of ED treatment, since we know cancer can be a financial burden, know that many ED treatments will be covered by your insurance if they’re medically necessary, which your medical team can vouch for.
Although erectile dysfunction can be a big issue for many men, there are solutions available, so talk to your doctor to get started on your road to recovery.
