If your doctor diagnoses you with erectile dysfunction, it is important to understand your treatment options. This article will explain several non-surgical and surgical treatment options for men who have erectile dysfunction (ED) after prostate cancer therapy.
Non-Surgical Treatment Options
There are many treatment options for erectile dysfunction depending on how severe it is. For mild to moderate erectile dysfunction, there are several non-surgical treatments. These include oral and injectable medications, urethral suppositories, and vacuum erection devices that can create and help you keep an erection.
The first line of treatment for erectile dysfunction is oral medications (medicine that you take by mouth). These include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra or Staxyn), and avanafil (Stendra). They work by causing more blood to flow into the arteries (blood vessels) of the penis. They work best for patients with inflow disease. These medications need to be taken before having sex—15 minutes (for avanafil) to one hour (for all others). They also need stimulation to work, which means either you or your partner touching you. Oral medications are easier to get since they have become generic and are a cost-effective treatment option. The most common side effects are headache, nasal congestion (stuffy nose), flushing (face turning red), and upset stomach.
Intracavernosal (Penile) Injections (ICI)
Often, an ICI is the next step if oral medications are not strong enough to get an erection. Instead of taking a medication by mouth, you inject an ICI directly into the penis with a small needle. This helps the medication to work faster because it is acting directly on the penis instead of first having to go through the whole body. It usually works within 5 to 10 minutes after it is injected, so it allows you to have a freer, “in the moment,” experience than oral medications.
The two main types of ICI are single-agent medications (alprostadil) which are FDA-approved and compounded medications (Bimix, Trimix, etc.). They do not have the same kinds of side effects as oral medications. But they can cause priapism — an erection that lasts longer than four hours — which can be an alarming side effect. For this reason, it is important that ICIs are prescribed by a urologist who understands the dosing of injectable medications. Most urologists will have you try injections in the office to make sure you get the correct dose. Other side effects include pain and scar tissue at the injection site if you don’t do the injection properly.
Urethral suppositories are alprostadil pellets (another type of ED drug) that are placed into the urethra to help erections. Like the other medications, they work by increasing blood flow to the penis. Like the injections, they work fast (within 5 to 10 minutes). The most common side effect of this medication is penile and urethral pain/burning. For this reason, they are not a first-line treatment for erectile dysfunction.
Vacuum Erection Devices (VED)
VED is a device that is placed on the outside of the penis that uses suction to pull blood into the penis. These can be mechanical (hand pump) or electric. They also come with a constriction band to place at the base of the penis after the erection is achieved. The constriction band squeezes the base tight to help keep the blood inside the penis. Most patients find VEDs very awkward to use. Some patients will complain of numbness and coldness of the penis because of the constriction band. Many urologists will recommend using them (without the band) to help the penis recover after prostate cancer treatment. This is done to boost blood flow into the penis to keep the tissues healthy with or without low-dose oral medication.
Constriction Rings or Bands
These devices are placed at the base of the penis to help keep the blood in the penis after an erection is achieved. They can be used alone or with a VED. They should be made of soft materials that can be easily removed to prevent injury. You must remove them once you are done having sex. A long period of time with a lack of blood flow (and not enough oxygen) can harm the penis.
Surgical Treatment Options
When the above treatments do work to get an erection, or if you do not like them or their side effects, the next treatment option is a penile prosthesis or implant. All penile prostheses have two cylinders that sit side by side in the corpora cavernosa (erectile chambers) within the penis. The goal of a prosthesis is to make the shaft of the penis hard. It does not make the penis larger.
The best feature of penile implants is they give some freedom back to the patient. There are two main types of penile implants—semirigid or inflatable. The side effects include:
- The implant might not work properly
- An infection could be possible
- You might feel unhappy if you have unrealistic expectations about the device
For more information about a penile prosthesis, please see What is a Penile Prosthesis?”.
As a prostate cancer survivor, you should know that you are not alone if you suffer from erectile dysfunction. There are treatment options available for you. But there are people who will sell “snake oil” or experimental treatments to men desperate to restore their erectile function. Because of this, it is very important that you find a urology specialist to help guide you through these treatments. There are no miracle treatments. But with the treatments outlined in this article, you can perform in the bedroom again.