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Erectile Dysfunction, So Now What?

In this article, I will begin to discuss some ways to proactively recover erections after you have had surgery to remove your prostate due to prostate cancer. I have to warn you, some of these treatment options may seem a bit overwhelming. As you read through this and any other information regarding this topic, remember that these treatments may seem scary at first but usually become more normal as you dive into care. Think of a person diagnosed with diabetes who may have a needle phobia but will now be giving themselves insulin injections daily. It soon becomes your “new normal”. I encourage you to seek out compassionate caregivers who will guide you through this process.

Key facts for active treatment

There are some keys facts that you should know as you begin the process of active treatment.

Fact 1: Most men will have some period of erectile dysfunction. The nerves will be stretched and injured even with a nerve sparing procedure and a highly skilled surgeon. The prostate is surrounded by these nerves and it is a function of the anatomy that the nerves will be injured.

Fact 2: Nerves take a long time to heal. Recovery of erectile function may take as long as 1-3 years.

Fact 3: We know that men who use the current treatments available will regain function more often than those who choose to do nothing. And it is always your choice!

Fact 4: If you had good erections and sexual function prior to surgery, you are more likely to recover more fully and more rapidly post operatively than someone with diminished sexual function.

Fact 5: The old adage of “use it or lose it” applies here. What does that mean if you can’t get an erection, how can I use it? We will talk more about this for sure!

Discussing your medical care

In terms of medical care, there are several options available and you will want to discuss each of these with your doctor to determine which one or combination of these treatments would be best for you.

  • Medications – Doctors are prescribing with more regularity nightly low dose medications such as Viagra and Cialis. These medications are called PDE-5 inhibitors. There are choices based on insurance coverage, nightly versus “on demand” usage. These medications do have some side effects but are overall safe for most men when prescribed and followed by a physician. Many men are able to achieve an erection firm enough for penetration using these medications, following a recovery period. The recovery period can vary from person to person so it is important to be patient.
  • Penile injections – Patients work with their doctor’s office to find a dosage of medication for self-injections. Basically, you use a small needle and inject some medicine that will relax the vessels in the penis to allow blood flow and create an erection that is suitable for intercourse. This is called Intracavernosal injection (ICI) therapy.
  • Penile suppository – This involves the patient inserting the medication into the tip of the penis. The medication helps to bring blood flow into the penis to achieve an erection. You would work with your doctor’s office to find the right dosage. There may be side effects including some discomfort for some men.
  • Vacuum Erection pump – This involves using a small pump to pull blood into the shaft of the penis and using a ring to help hold the blood in the penis. This can be done to achieve an erection for intercourse and also used for penile rehab. You have to be very careful amount removing the ring after the recommended time frame to avoid cutting off blood flow to the penis.
  • Penile prosthesis – This is a surgery that involves placing an inflatable penile prosthesis that consists of two attached cylinders — a reservoir and a pump. This can be a very effective form of treatment but dos involve another surgery.

I hope this introduces some of the medical options available for post-op recovery of erectile dysfunction. All of the above options will require your physician input and guidance. I will continue the conversation with some behavioral interventions — like diet and exercise in future articles.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ProstateCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Will Jones moderator
    5 months ago

    I had surgery to have my prostate removed on April 16, 2018. Eight months later I am still unable to have an erection. I have tried two kinds of medication, but none in the last couple of months. I’m hoping time will restore full function, which I had before surgery. At this time, the other treatments do not look that attractive to me. Maybe at one year I’ll reconsider. In the meantime, my wife and I will continue to enjoy intimacy, including orgasm, without intercourse. It is possible to have an orgasm without an erection.

  • Bajk49
    4 months ago

    Congrats Will. I am glad things are going well heath wise and you have an understanding wife that still enjoys intimacy with you. That’s a big plus for you in the healing process.
    It’s been a year and half since my prostatectomy but without any intimacy. I miss it dearly.
    The best to you on your continued recovery.

  • Will Jones moderator
    3 months ago

    Thanks Bajk49. Given my current inability to get an erection my wife and I have enjoyed finding other ways to satisfy each other sexually. I have to admit that there’s a lot of laughter sometimes because it just isn’t as easy as it once was! It used to be frustrating, but for now we just accept the way it is and hope that someday there’s return to “normal.” In the meantime, the “new normal” is a fun challenge! I’m fortunate to have a willing partner.

  • Erin Glace moderator author
    5 months ago

    Hi Will-
    Thanks for sharing your experience! I think it is important that everyone make decisions that suit them individually when it comes to ED post prostatectomy. I am happy that you and your wife are remaining intimate and finding enjoyment in each other in other ways. Time may change things and you can always explore other options if you choose to later.

  • ChrisPedlar moderator
    1 month ago

    I had my non nerve sparing surgery 3 1/2 years ago (UK) and have used the pump, injections and more recently viagra in a hope of being able to reduce the 30 mg of cavajet needed to be successful in use. One of the main issues being long lasting errection son this level of up to 3 1/2 hours and being fairly uncomfortable too. Being aware that my long lasting erections we’re getting towards the max time limit I wanted to see if viagra would help. To my surprise it worked completely on its own! Not what I was expecting and not sure why as it shouldn’t really work for me but equally not complaining. I did however as part of my rehab make sure to stimulate my mind as well as my tackle and never gave up hope! Chris ProstateCancer.net moderator

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