Sexuality for the Man With Cancer

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What treatments are available to help with erections?

The success rates of these treatments vary greatly, and you may have to try a few to find the one that works best for you. In many cases, some sexual counseling can help a couple discuss their options and plan how to make the new treatment a comfortable part of their sex life.

Pills

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are drugs that come in a pill form and are used to treat erectile dysfunction (ED). All of these drugs help a man get and keep an erection by causing more blood to flow to the penis. If you are having difficulty with erections, these pills are often the first type of treatment that’s tried.

For men who have had certain operations that involve the nerves that help cause erections, using these pills at full strength may not be helpful in getting an erection in the year or so following the operation. These pills work with the nerves responsible for erections. And even with nerve-sparing surgery (saving the nerves responsible for erections that run close to the rectum and along the prostate), the nerves are still damaged and need time to heal. This healing process usually takes up to 2 years. While the nerves are healing, the pills may not work. In fact, men may find the pills don’t work at all the first few months after surgery. Often by about 6 months after surgery, the pills may work a little bit and cause a little swelling in the penis but not nearly enough for an erection. A year after surgery, the pills may be more effective, but still may not produce an erection hard enough for penetration. At 18 to 24 months after surgery, the pills may be very helpful in getting a firm erection. If these pills are not producing a firm erection in the first months after surgery, it’s important to try another treatment to help restore the blood flow to the penis. (See “Early sexual rehabilitation after surgery” in the “How pelvic surgery to treat cancer can affect erections” section for more on this.)

Many drugs are known to interact with pills that help ED. For example, nitrates (like nitroglycerin and other drugs used to treat heart disease) may interact to cause very low blood pressure – this can be fatal. Be sure your doctor knows about all medicines you take, even those you take rarely. You should only take these pills if they are prescribed by your doctor and come from a legitimate pharmacy. There’s a large counterfeit market for pills for ED, so make sure you are buying them from a pharmacy you know and trust.

The most common side effects of ED drugs are headache, flushing (skin becomes red and feels warm), upset stomach, sensitivity to light, and runny or stuffy nose. In rare cases, these drugs may block blood flow to the optic nerve in the back of the eye. This could lead to blindness. Men who have had this problem were more likely to have been smokers or had problems with high blood pressure, diabetes, or high levels of cholesterol or fat in their blood.

Other medicines to treat ED are being studied. You might want to ask your doctor about any new medicines or treatments that might work for you.

Penile injections

Many urologists (doctors who specialize in conditions and diseases of the genitals and urinary tract) teach men to inject their penises with medicines that cause erections. A very thin needle is used to put the drug into the side of the shaft of the penis a few minutes before starting sexual activity. The combination of sexual excitement and medicine helps to produce a firmer and longer-lasting erection.

Penile injections are the most reliable treatment for erectile dysfunction (ED), and work in about 80 to 90% of men who try them. Many men are hesitant to try the injections because they’re afraid they will be painful. But when men are asked to rate the pain of the injection on a 0 to 10 scale, where 0 means no pain and 10 means the worst pain you can imagine, the majority of men rate the pain as a 2 or less.

Penile injections work, but they can have side effects. Because of this, the first injection is usually done in the doctor’s office. Rarely, a man may get an erection that will not go down. If this happens, he needs to go to an emergency room right away for treatment. Some men may develop scarring in the spongy tissue of the penis after repeated injections.

Vacuum constriction devices

Another treatment, the vacuum constriction device (VCD) works well for some men. With a VCD, the man places a plastic cylinder over his penis and pumps out air to produce a vacuum around the outside of the penis. The suction draws blood into the penis, filling up the spongy tissue. When the penis is firm, the man takes the pump off and slips a stretchy band onto the base of his penis to help it stay erect. The band can be left on the penis for up to half an hour.

Some men use the pump before starting sexual touching, but others find it works better after some foreplay has produced a partial erection. The erection from a vacuum device is usually firm, but may swivel at the base of the penis, which can limit comfortable positions for sex. It may take some practice to learn how to use a VCD. Most vacuum devices are prescribed by doctors, but some are available over the counter.

Urethral pellets

Another way to help with erections is a urethral pellet. A man uses an applicator to put a tiny pellet or microsuppository of medicine into his urethra (the opening at the tip of the penis). As the pellet melts, the drug is absorbed through the lining of the urethra and enters the spongy tissue of the penis. The man must urinate before putting in the pellet so that the urethral lining is moist. After the pellet is put in, the penis must be massaged to help absorb the medicine. This system may be easier than injections, but it doesn’t always work as well and can cause the same kinds of side effects. Because the pellet may make some men dizzy, a test dose in the doctor’s office may be needed. It can cause some burning in the urethra, too. Bits of the pellet may also enter the partner during sex and cause burning, itching, or other discomfort.

Penile prostheses or implants

Surgery to implant a prosthesis in the penis was the first really successful treatment for medical erection problems. Over the past 40 years, many of these operations have been done, and they work quite well to treat permanent erection problems. For men who have tried all the treatments listed above, and have not found one that works well, an implant may be an option to consider. Most men who have implant surgery are very satisfied with the results.

The penile prosthesis generally offers the choice of a soft or hard penis. It’s a pump system placed entirely inside a man’s body. Two tough inflatable silicone cylinders are put inside the penis. A balloon-shaped reservoir (storage tank) that contains a mixture of salt water and x-ray dye is tucked behind the groin muscles. (The x-ray dye is used so that the system can easily be checked for problems after it’s in place.) A pump is placed inside the loose skin of the scrotal sac. All the parts are connected with tubing.

Usually, the salt water stays in the reservoir, leaving the cylinders in the penis empty. From the outside, the penis looks the same as it does when not erect, except that it’s always a little fuller. When you are ready for sex, you stiffen the penis by squeezing the pump under the skin of the scrotum several times. This pumps the salt water into the cylinders and inflates the penis just like blood does in a natural erection. When you have finished sexual activity and no longer want an erection, you press a release valve on the bottom of the pump to deflate the cylinders. The salt water then returns to the reservoir, and your penis becomes soft.

If you are seriously thinking about prosthesis surgery, you might want to read the chapters on medical and surgical treatments in the books listed in the “To learn more” section. Implants carry some risk of complications, such as infection. Also, the devices with more parts are more prone to failure, which then requires a second surgery.

Learn as much as you can and ask your urologist questions about possible complications before making your decision. A man who is married or in a committed relationship should include his partner in any decision about implants. Your partner needs to understand the procedure and have a chance to discuss any fears or questions with you and the doctor. You also must be realistic about what a prosthesis can and can’t do for you. Any penile prosthesis is just a mechanical stiffener for the penis. Having a penile implant can’t solve any other problems, such as low sexual desire, lack of sensation on the skin of the penis, or trouble reaching orgasm. It can’t turn a poor sexual relationship into a great one.

A couple needs to talk openly before they have sex after implant surgery. You may need to experiment with different kinds of touching or with different positions. Make sure you are truly excited before trying to have sex, rather than starting sex just because your penis is erect. Couples who have maintained mutual touching, even if an erection problem prevented penetration, tend to adjust more easily to the prosthesis.


Last Medical Review: 08/19/2013
Last Revised: 08/19/2013