Penile Rehabilitation After Prostatectomy: What to Know

Medically Reviewed by Nazia Q Bandukwala, DO on May 09, 2022
Written by Alyson Powell Key
5 min read

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 that may need more treatment.

The prostate is a pingpong ball-sized gland inside your groin between the base of your penis and rectum. It delivers part of the semen, which helps sperm 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 (erectile dysfunction, or ED). This is due to injury to the nerves that send electrical signals from your brain and spinal cord throughout your body, a condition called neuropraxia.

Neuropraxia happens after direct damage to the nerves, swelling, or a lack of blood flow to the groin area. It can lead to the growth of scar tissue (fibrosis) and the death of nerve cells, which can also cause shortening of the penis.

Researchers report that 30%-80% of men have ED after prostate cancer surgery. Without treatment, it can last for up to 2 years after surgery. But there are steps you can take to help regain your sexual health.

Penile rehabilitation is a treatment or therapy that helps men reach or regain an erection after a prostatectomy. Your doctor may suggest a rehab program soon after surgery. 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 men who've had the procedure take them. PDE5 inhibitors treat ED by boosting blood flow to the penis. Medications include:

Injections. Using a fine needle, you could also inject medicine into your penis. It eases smooth muscles in your penis and raises 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:

  • Bimix (a mix of papaverine and phentolamine)
  • Papaverine
  • Alprostadil (prostaglandin E-1 or PGE-1)
  • Trimix (a combo of papaverine, phentolamine, and alprostadil)
  • Quadmix (Trimix and atropine)

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’ll position a plastic tube over your penis. A hand- or battery-powered pump attached to the tube helps pull more blood into the penis to gain 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.

Less common types of penile rehabilitation include:

Intraurethral pellet. Twice a week, you’ll 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 (urethra) into the nearby tissue. This causes an erection that could last 30-60 minutes.

Pelvic floor muscle training. Also known as Kegel exercises, this type of therapy helps 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. Researchers are studying other treatments for ED, including low-intensity shock waves, stem cell therapy, gene therapy, acoustic wave therapy, and platelet-rich plasma.

Like other medical treatments, therapies for ED sometimes trigger mild or even serious side effects. Here’s a look at some of the reactions that could be harmful.

Oral medicine

Erectile dysfunction medications don’t often cause serious side effects. Still, you could have:

Less often, men who take erectile dysfunction 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 (priapism). If an erection continues 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

Studies on penile rehabilitation are mixed. Some research shows this type of therapy helps regain sexual function and penis length after radical prostatectomy, especially for men who 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.

Researchers will need to carry out more reviews to figure out how well these work in treating ED after surgery for prostate cancer.