Dealing with Erectile Dysfunction
Erectile dysfunction is when a man is not able to achieve or maintain an erection sufficient for his sexual needs. It's often a side effect of the treatments for prostate cancer. Some men have chronic, complete erectile dysfunction, called impotence. Others have partial or brief erections. Younger men are more likely to regain sexual potency after treatment than older men. Plus, a man's ability to have an erection before surgery or radiation greatly influences whether he will have erectile function after treatment. Men who were able to maintain strong erections before treatment are also more likely to maintain them after treatment compared with men who had problems before treatment.
In men who have surgery to remove the prostate, called radical prostatectomy, erectile dysfunction rates have been reported to range anywhere from about 10 to 75 percent, depending on the man's age and other factors. For example, the rates of dysfunction are lower when surgeons can use nerve-sparing techniques. In older studies, around half to 75 percent of men had problems with erectile dysfunction after radiation treatment (although some of them had problems before treatment). These numbers may be declining with newer radiation techniques, according to the American Cancer Society.
Despite the incidence of erectile dysfunction after treatment, doctors and nurses may not always discuss the issue with men. It's important to start this discussion with your health care team before treatment so that you have an idea of your risk for erectile dysfunction and what to expect. Keep in mind, though, that doctors and nurses can only give you an educated estimate based on what they know about you and your cancer. They can't tell you for sure what will happen.
Men who have erectile dysfunction after treatment may also feel uncomfortable talking about it with their health care team and even with their partners. The discussions should happen, though, because erectile dysfunction is treatable. Keep reading to learn how to start the discussion about your sexual health after prostate cancer treatment and to learn what your options are if you experience impotence after treatment.
Communication: The first step in overcoming erectile dysfunction
The first step in treating erectile dysfunction is talking about it.
The key message is that if you are willing to bring it up and discuss it with a health care professional, there are multiple alternatives to help you. A significant percentage of men will respond to therapies.
You can bring up the topic by saying something like, "I have a concern. I have not been able to have an erection or have an erection as often." Or you might say, "I can have an erection, but it does not maintain itself."
Some men may find it helpful to discuss erectile dysfunction with other men who are also experiencing it. Many support groups can connect you with others facing similar issues. For example, Us Too is a prostate cancer education and support group that has local chapters where men can talk with each other. See the group's website to find a support group near you.
Treatment for erectile dysfunction
Your choices for treatment include pills, such as Viagra (sildenafil), vacuum devices, penile injections, and penile prosthesis.
Oral medications, such as Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil), are taken in pill form and absorbed into the bloodstream. The drugs work by inhibiting an enzyme found mainly in the penis. The result is increased blood flow to the penis and a fuller erection.
The most common side effects of these pills are headache, facial flushing, and upset stomach. Less common side effects are bluish or blurred vision and sensitivity to light, and a thorough eye exam may be recommended before using these drugs. They can also have serious interactions with some other drugs, such as nitrates taken for chest pains. Men with heart problems should check with their doctor before using these drugs.
Vacuum devices are tools that help men develop an erection suitable for intercourse. The device works by drawing blood into the penis and keeping it there. To use it, a man inserts his penis into a hollow, plastic tube that is then pressed against the body, creating a seal. A small hand pump creates the vacuum, which draws blood into the penis, causing it to become hard. After a few minutes of pumping, the man places a small, rubber ring around the base of the penis so that the erection can be maintained.
Side effects of vacuum devices include coldness or numbness in the penis after the rubber ring has been removed. Also, the vacuum device may interfere with foreplay.
Penile injections are self-injections. A man or his partner uses a tiny needle to inject medicine directly into the side of the penis. The injections begin to work within five to 15 minutes and create an erection. A doctor can teach a man how to inject himself. A similar treatment is a small dissolvable pellet that is inserted into the tip of the penis.
Side effects include dizziness or feeling flushed. Prolonged or lengthy erections may also be a problem. Men should seek medical attention if they have an erection lasting longer than four hours.
Penile implants are a type of prosthesis that a surgeon places inside the penis. Penile implants are tubes that can mimic the erection process. There are three types of implants. They are the semi-rigid, the inflatable, and the self-contained inflatable.
Implants are the most invasive procedure because they require surgery. As with any surgery, there's a risk for infection. In rare cases, after getting an implant, men experience numbness at the head of the penis or find intercourse uncomfortable. If the implants are removed, men are at an increased risk for erectile dysfunction because the implant permanently changes the internal structure of the penis.
The emotional effects of erectile dysfunction
Just as open communication is important between a man and his doctor for getting treatment for erectile dysfunction, communication is equally important between a man and his partner. Being open with your partner about your fears and concerns is the first step in overcoming them.
- Alteri, Rick, MD
- Foster, Sara M., RN, MPH