There is a range of treatments for erectile dysfunction (ED). It is very important that you discuss your options with your healthcare team. Some types of treatments for ED can affect other medications you may be taking or have effects on other medical conditions you may have. Your healthcare team will be able to advise and assist you.
Your options involve taking medications or using devices to help your erectile function. These may be offered to you individually or as a combination, for example penile injections combined with a penile ring. Your healthcare team will plan this with you based on a range of factors including the prostate cancer treatment you received, what your previous erectile function was, what your expectations are, and when you would like to resume sexual activity following treatment.
Tablet medication: The first treatment option offered is usually a group of medications known as PDE5 inhibitors. These medications allow you to achieve an erection by causing greater blood flow to the penis following sexual stimulation or sexual arousal. How quickly the medication works and how long it lasts will depend on your individual situation and which of the medications you are taking. The medication may not work the first few times it is used, and it is recommended you trial the medication several times at the right dose before deciding on the success of this treatment option.
NOTE: You should not take PDE5 inhibitors if you are also taking medications in the nitrates group, which are used for chest pain or prevention of chest pain. These nitrates can be given as tablets, sprays or patches. Discuss your medical conditions and current medications with your doctor.
Erectile dysfunction PDE5 inhibitor medications must only be used with a doctor’s prescription and under medical supervision.
Penile injection medication: Penile injections are often used and are an effective option for men with ED following prostate cancer treatment.
These medications are injected into the penis when you require an erection. They work by allowing the blood vessels in the penis to open up; enabling more blood to flow in, while stopping blood from draining away. Penile injection therapy does not require you to be sexually stimulated first. Erections can occur in up to 10 minutes and generally last for up to 30-60 minutes.
You can be taught to inject yourself; however, the technique does require practice and it is recommended that you are trained by a healthcare team member who specialises in this area. Achieving the correct dose of the medication that works for you and having the correct injection technique is critical to the effectiveness of this option.
NOTE: Erectile dysfunction medications can have side effects. Please refer to the prescription information and notify your healthcare team of any side effects you may experience.
Penile rings: These can be used on their own if you can achieve an erection but can’t maintain it long enough for penetration. The rings are made of rubber and are placed onto the base of your penis close to your pubic bone. They enable you to maintain the erection by preventing blood from flowing away out of the penis. You should remove the ring after 30 minutes as there is a risk of damage to the penis if it’s left on for longer periods of time.
Vacuum erection device: This can be used if you are unable to achieve or sustain an erection. It is a clear plastic tube that is placed over the penis and then sealed off. A vacuum is created by a pump-like action which draws blood into the penis and creates an erection. You then place a penile ring around the base of the penis near the pubic bone to sustain the erection.
Healthcare team members who specialise in erectile dysfunction can advise you where to purchase these devices and how to use them correctly and safely. Perfecting the technique can take some time, practice and patience.
Surgical devices (Penile Implants/ Prosthesis): A penile prosthesis is generally offered when other options have not been successful. This more invasive option involves surgery during which a prosthesis is implanted within the penis to create what is known as a “mechanical erection”. The spongy tissue that runs along each side of the penis is removed and the prosthesis placed there. Healthcare team members who specialise in erectile dysfunction can provide you with further information on the range of different prostheses available and their suitability to your individual situation.
PENILE REHABILITATION – FOLLOWING RADICAL PROSTATECTOMY
There is emerging evidence that undergoing a program called ‘penile rehabilitation’ following radical prostatectomy can help erectile function to return more quickly.
Penile rehabilitation programs aim to encourage blood flow to the spongy cylinders that run each side of the penis and improve oxygen supply to the tissues of the penis. This prevents permanent damage to the tissues and potentially speeds the return of erectile function following treatment.
Programs for penile rehabilitation can include:
- the use of tablet medications (PDE5 inhibitors) either before or after treatment
- penile injection medication — vacuum erection devices
- different combinations of the above.
The program will consist of a plan to achieve a certain number of “artificial erections” per week following treatment.
An artificial erection is an erection obtained not for the purpose of intercourse. Recent research suggests improved results are achieved if a rehabilitation program is undertaken in the early stages following surgery.
Like all treatment plans, a penile rehabilitation program will be based on you and your partner’s individual needs and situation. Discuss with your partner and healthcare team before treatment about whether a penile rehabilitation program is an option for you. A referral to a specialist in this area may be arranged for you through your healthcare team.