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Life After Prostate Cancer: ED

What Causes ED after Prostate Cancer Treatment?

An erection happens when the brain sends a signal to the nerves near the prostate. These signals relax the muscles in the penis and allow the blood vessels to open. Blood can flow in, making the penis erect. Erectile Dysfunction (ED) is when the nerves cannot send signals to the muscles in the penis. When this happens, getting an erection or keeping one becomes difficult. Many men have difficulty with erections after surgery for prostate cancer. Nerves are often damaged during surgery. Even when a surgeon takes care to protect the nerves (nerve-sparing surgery), the signal has problems, at least for a while. Radiation therapy can also damage the nerves that help erections. When cancer reaches the nerves, they have to be removed. Getting a natural erection in this case is impossible. To diagnose what caused your ED, your doctor will discuss your medical and sexual history with you.


Who is Most Likely to Experience ED After Treatment?

All men who are treated for prostate cancer will experience ED, for at least a short time. For some men, this problem is temporary and a full erection will return. However, erections are rarely the same after cancer treatment. If the nerves were not removed during treatment, it can take up to 24 months to recover erectile function. In some men, it takes longer. Men under age 60 have a better chance of regaining erections than do older men. The chance of ED after treatment depends on many things: • Your age • Your overall health, including medications you are taking • Erectile function before treatment • Cancer stage • The extent to which your nerves were damaged during surgery or exposed to radiation

How is ED treated?

There are several treatments for erectile dysfunction: • Oral medications (pills): Improve blood flow to the penis. These include the advertised PDE-5 inhibitors (sildenafil, tadalafil, and others). • Vacuum pumps: Mechanical devices that use vacuum pressure to draw blood from the body into the penis. They come with a ring that is placed at the base of the penis to keep blood there for sexual activity. • Injections: Medicine is injected into the penis to boost blood flow for an erection. • Penile or urethral suppositories: Very small pellets are inserted in the tip of the penis. When they dissolve, they boost blood flow for an erection. • Penile implant: A device that is surgically placed in the penis. It can be inflated to cause an erection and deflated after sexual activity. It is only used for permanent ED, or when other treatments don’t help.


What are the Side Effects of ED Treatment?

Each treatment can have side effects. • Oral medications: Can cause headaches. Some men may get an upset stomach and nasal congestion. Few will have problems with vision and long-lasting erections. It can cause unsafe low blood pressure if you have heart disease. It is important to check with your cardiologist to learn if these medications are safe for you. • Vacuum pumps: Pumping an erection larger than your usual size can cause tissue damage. • Injections: Can cause pain in the testicles, scarring or bruising at the site of injection. Sometimes it can cause the penis to curve. If you have heart disease, check with your cardiologist to learn if injections are safe for you. • Suppositories: The release of this medicine can be painful for some men. • Penile implants: The tip of the penis will not become engorged when the penis is inflated. The penis will look shorter. There is a risk of infection and the implant may need to be replaced.


Other Considerations


Before moving forward with an ED treatment, check with your insurance company to learn how it will be paid for. Include your partner in discussions about ED treatment as they will be affected by your choices, and will likely want to be a part of your decision-making. Don’t be discouraged if one treatment doesn’t work. Counseling with a trained sex therapist can also provide support. Talk to your doctor about which treatment is right for you.

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