Finding the cause of problems that appear to be permanent

The best time to talk with your doctor or cancer team about side effects or long-term changes in your sex life is before treatment, so that you can learn about the usual recovery and how long it takes. But you can bring up the subject any time during and after treatment too. Unless you are trying early penile rehabilitation, don’t be surprised if you need several months to recover from treatment. If erection problems last longer, talk with your doctor and try different ways to overcome them. If your problem doesn’t get better, your doctor may ask you some questions about your sex life, and then use special medical tests to help find the cause. You may need to see more than one doctor to find out exactly what the problem is and get the treatment you need.

Tests to measure nighttime erections

One of the tests used most often is done while you sleep. Your doctor may have you spend 2 or 3 nights in a sleep lab to check your sleep erections. A technician watches your brain waves and breathing during the night to make sure that your sleep patterns are normal. At the same time, elastic loops placed around the base and tip of your penis are connected to a recorder. The recorder measures changes in the size of your penis during the night. If your sleep erections are firm and long-lasting, your problem may respond well to some sexual counseling. If your sleep erections are poor or you don’t have an erection, you may need surgery or medical treatment to correct the problem.

Since sleep lab testing costs a lot, most doctors use other ways to check sleep erections. Many send a man home with an electronic monitor to wear on the penis at night. This can be a very good test. A less accurate test is to use a plastic strip (or snap gauge). The patient wears it around the shaft of the penis during sleep. An erection breaks 1 to 3 bands of plastic film on the gauge, depending on the firmness of the erection. Another option is a strain gauge, a circular device placed at the base and tip of the penis that stretches during erection. It also measures the change that happens with erection during sleep.

Other medical tests

Other tests, often done in a doctor’s office, can measure blood flow in the penis. One such test uses a doppler ultrasound. The doctor passes a hand-held device over the penis, and reflected sound waves show the speed and direction of blood flow. This type of test looks for a block in circulation that could be causing the erection problem. Sometimes the test includes using a needle to put medicine into the shaft of the penis to produce an erection. In that case, the ultrasound imaging test is done on the erect penis. Tests of nerve sensitivity and reflexes in the genital area are sometimes done, too. Blood tests are also commonly done to check the levels of the 2 hormones most closely linked to men’s sexual function, testosterone and prolactin.