Erectile Dysfunction After Radical Prostatectomy
A diagnosis of prostate cancer could mean you’ll need treatment to stop cancer from spreading to other parts of your body. One treatment involves surgery to remove your entire prostate gland, called a radical prostatectomy. Unfortunately, this surgery can cause side effects like erectile dysfunction (trouble getting an erection) that may need more treatment.
The prostate is a walnut-sized gland inside your pelvis between the base of your penis and rectum. It helps deliver semen, which allows sperm to migrate and survive. On each side of the prostate, there’s a grouping of nerves and blood vessels that manage your erections.
If you’ve had a radical prostatectomy, you may have trouble getting or keeping an erection firm enough for sex. This happens due to injury to the nerves that send electrical signals from your brain and spinal cord throughout your body, a condition called neuropraxia.
You can get neuropraxia because of direct damage to the nerves, swelling, or a lack of blood flow to the groin area. It can lead to fibrosis (scar tissue) and the death of nerve cells, which can also cause shortening of the penis.
Researchers report that 30%-80% of those who have prostate cancer have erectile dysfunction (ED) afterward. Without treatment, it can last for up to 2 years. But there are steps you can take to help regain your sexual health.
What Is Penile Rehabilitation?
Penile rehabilitation is treatment or therapy that helps you reach or regain an erection after a prostatectomy. Your doctor may suggest a rehab program soon after surgery. Even if you're not sexually active, penile rehabilitation is helpful. That's because using your penis keeps its tissues and blood vessels healthy and prevents scar tissue from forming.
Rehabilitation should start before or soon after your prostate cancer treatment.
The most common treatments include:
Oral medicine. Phosphodiesterase type-5 (PDE5) inhibitors are a type of medicine to treat erectile dysfunction. They’re the most widely used ED treatment after radical prostatectomy. Up to 87% of those who've had the procedure take them. PDE5 inhibitors treat ED by boosting blood flow to the penis. Medications include:
- Avanafil (Stendra)
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra, Staxyn)
Injections. Using a fine needle, you could also inject medicine into your penis. It eases smooth muscles in your penis and raises the blood supply. This triggers an erection that usually lasts for up to 2 hours. You will give yourself twice-weekly shots for 6 months. There are five such injectable drugs:
- Alprostadil (prostaglandin E-1 or PGE-1)
- Bimix (a mix of papaverine and phentolamine)
- Papaverine
- Quadmix (Trimix and atropine)
- Trimix (a combo of papaverine, phentolamine, and alprostadil)
You’ll inject the medication at the midpoint of the penis shaft in the 3 or 9 o’clock position. Be sure to avoid visible blood vessels, and change injection positions to avoid scarring.
Penis pump (vacuum pump or vacuum erection device). With this treatment, you position a plastic tube over your penis. A hand- or battery-powered pump attached to the tube helps pull blood into the penis to give you an erection. Once your penis is firm, you’ll slip a band called a constriction ring around the base to help keep an erection. You can use the pump two times a week for 5-10 minutes at a time.
Other Treatments and Therapies
Less common types of penile rehabilitation include:
Penile implants. If other treatments don't work, you could get surgery to insert a permanent device called a penile prosthesis or implant into your penis. There are two main types of implants:
- Inflatable. The most common variety, these are made up of inflatable tubes that fill with liquid to create erections.
- Semi-rigid. These flexible rods remain slightly hard at all times.
Intraurethral pellet. Twice a week, you insert a tiny drug-treated pellet into the opening of your penis. The medication is absorbed through the tube that runs the length of your penis (the urethra) into the nearby tissue. This causes an erection that could last 30-60 minutes.
Pelvic floor muscle training. Also known as Kegels, these penile rehabilitation exercises help strengthen your pelvic floor muscles. These muscles support your pelvic organs, including your bladder and bowel. And they’re important in sexual health.
To do a Kegel exercise, pull in your pelvic floor muscles for 5 seconds, then release for 5 seconds, repeating 10 times. You can do pelvic floor training up to three times a day. If you feel pain in your stomach or back, you may be using the wrong muscles.
Experimental treatments. One experimental treatment involves a type of surgery called nerve interposition grafting. It helps restore nerves that were damaged during a prostatectomy. The surgeon grafts nerves taken from your legs to the nerves that help you get erections.
Another treatment is neuromodulatory therapy. This can involve various types of therapies to revitalize nerves and help them grow, ranging from medication to stimulation with electrical currents. Other potential treatments for ED include low-intensity shock waves, stem cell therapy, gene therapy, acoustic wave therapy, and platelet-rich plasma.
Side Effects of Penile Rehabilitation
Like other medical treatments, therapies for ED sometimes trigger mild or even serious side effects. Here’s a look at some of the possible side effects of penile rehabilitation therapies.
Oral medicine
Erectile dysfunction medications don’t often cause serious side effects. Still, you could have:
- Skin reddening
- Headache
- Upset stomach
- Vision changes (seeing a blue hue, being sensitive to light, having blurry vision)
- Stuffy or runny nose
- Pain in your back
Less often, people who take ED drugs have serious side effects like a sudden loss of hearing or vision. Experts aren’t sure if the medication or another health condition causes these reactions. See a doctor right away if you have hearing or vision changes.
Injections
Using shots to treat ED could cause scar tissue in the penis, leading to a painful deformity of the penis called Peyronie’s disease. This condition is uncommon, and you can lower your chances of getting it by using a proper injection method.
Another possible side effect of shots and ED drugs is a long-lasting erection (called priapism). If an erection lasts for more than 4 hours, see a doctor right away. If you don’t treat it, you could end up with serious pain and lifelong ED.
Penis pump
Your chance of side effects with a penis pump is lower, compared to other ED treatments, but side effects can include changes to your penis like:
- Bleeding under the skin (petechiae)
- Temperature and color differences caused by the constriction band
- Pain and bruising
- Pain during sexual release (ejaculation)
- A feeling of unreleased semen
Penile implant
Once you get an implant, you'll no longer be able to get an erection on your own or with medications. Side effects are uncommon but may include:
- Infection from the surgery
- Mechanical failure of the implant
- Damage to your penis from the implant
Does Penile Rehabilitation Work?
Studies on penile rehabilitation are mixed. Some research shows that this type of therapy helps restore sexual function and penis length after a radical prostatectomy, especially if you use it in the weeks after surgery. But it’s not clear which treatment – or combination of treatments – is best. For example, you may find that using a penis pump along with an ED medication works best for you.
We need more research to determine which treatments are most effective to treat ED after surgery for prostate cancer.
Takeaways
Penile rehabilitation is a course of treatment that helps you get erections and preserves the health of your penis after surgery to remove your prostate gland (radical prostatectomy). It may involve medications in various forms, a penis pump, or a penile implant. Successful penile rehabilitation therapy can help you regain sexual function and improve your quality of life.
Penile Rehabilitation FAQs
How can I get an erection after prostatectomy?
Your doctor can treat erectile dysfunction after a prostatectomy with:
- Oral ED medications
- Drugs that are injected into your penis
- A vacuum device (penis pump)
- A penile implant
- Drug-treated pellets that you insert in the opening of your penis
- Pelvic floor training (Kegel exercises)
- Experimental treatments such as nerve grafting or neuromodulation
When should you start penile rehabilitation after radical prostatectomy?
You should start penile rehabilitation as soon as your doctor says you're ready, usually within a few weeks after your surgery. Many experts believe that early rehabilitation improves your chances of regaining erectile function.
How long do you have to do penile rehabilitation therapy after prostatectomy?
It depends on your age, which surgery you had, and other factors, but some doctors recommend doing penile rehabilitation therapy for at least a year.
What are the benefits of penile rehabilitation?
Penile rehabilitation can help prevent scar tissue from forming on your penis, restore your ability to have sex, and improve your quality of life.
