Erectile dysfunction following radical prostatectomy is a known potential complication of surgery. Erection recovery is possible for some patients if nerve sparing can be achieved and possibly with the use of oral phosphodiesterase 5 (PDE5) inhibitors within 2 years.
Being told you have cancer can cause shock, fear, anger and anxiety and these emotions will also be experienced by your partner. Usually, partners can help cope with this burden by providing support, consolation and contribute to planning treatment options.
Unfortunately, men with prostate cancer have to cope with the additional stresses relating to sexuality and the impact on their future intimate relationship with their partner. Many men find it difficult to share these worries with their companion. If there is no communication, your partner may start to feel rejected, alone and guilty for wanting intimacy.
While these problems are extremely difficult to cope with it is important to be aware that it also affects your partner especially if you have had a close and satisfying sex life. It is for this reason that prostate cancer is often referred to as the 'couples’ disease'
It is important to talk to your partner about your concerns and in a loving relationship you can work through your difficulties together. Nowadays, there are a number of things you can do to overcome erectile disorder. It may require a willingness to experiment with new ways of enjoying sexual intimacy. Fortunately, there are many medical devices as well as medications available today. A lot of couples also use sex toys to enhance sexual response.
You both should remember that it is important not to just focus on adding years to life but also adding life to years.
If your erectile nerves are traumatised or cut after treatment it is important to remember that the nerves of the penis that contribute to orgasm are still intact. Therefore, it is possible to have an orgasm without having an erection; it doesn’t follow that if you have an erection you will have an orgasm. After surgery, when orgasm occurs, you will not ejaculate fluid as the seminal vesicles, which store fluid for ejaculation, and the vas deferens, the tubes that carry sperm to the prostate, are cut and removed during the procedure.
It is inevitable that men will suffer from erectile dysfunction to some degree after a radical prostatectomy procedure but it should not prevent you from having a fulfilling sex life when you recover. A more positive outcome can be achieved if the nerves, found on both sides of the prostate responsible for erection, are ‘spared’ during the surgery. The extent to which your cancer has spread will determine whether this is possible. Bilateral and unilateral nerve sparing is referred to nerves on both sides and one side being spared respectively. I had unilateral nerve sparing.
Video above from John P. Mulhall, MD, Urologic Surgeon, Director, Male Sexual and Reproductive Medicine Program
If you had some form of nerve sparing there is a chance of recovering erections, but this recovery may be slow. Even if nerves are spared they will have experienced trauma during the surgery and will take a long time to recover. Because of this, the average time to recover erections adequate for penetrative sex, can be as long as three years if at all.
If you wait for your erections to return another problem may have arisen in the meantime. All men will be aware of waking up in the morning or at night with an erection or ‘woody’. It is now thought that this is the body’s way of bringing oxygenated blood into the penis keeping the penis tissues healthy. When oxygenated blood is not supplied to the penile tissue over a long period of time, like after surgery, the penis tissue responsible for erection will gradually decline in effectiveness or vigour due to underuse or neglect. There is evidence to show that irreversible scar tissue results after prolonged periods of having no erections. So it’s very much a case of ‘use it or lose it’. It is not essential that a man has sexual relations or an orgasm; erection is the critical component of penile rehabilitation.
Second video, above, from John P. Mulhall, MD, Urologic Surgeon, Director, Male Sexual and Reproductive Medicine Program.
Below are the options generally recognised to keep penile tissue healthy and all involve getting oxygenated blood to the penis;
1. PDE5 Inhibitors
It is recommended you start taking a very low dose of regular erection-promoting pills such as Viagra or Cialis as soon as possible after surgery. Make sure to check with your doctor that you have no health problems which may prevent you taking them as they do have side effects. I started taking 5mg per day of Cialis (maximum recommended dose is 20mg.) the week after I had the catheter removed. This is primarily to maintain oxygenated blood to the penis preventing cell damage. By the way, taking any of these medications do not give a spontaneous response. Sexual stimulation (in the mood) and penis stimulation will be necessary to increase blood flow to the penis to help to get and keep an erection. If you opt to take this type of medication penis stimulation may help to get more oxygen to the penile tissue. This will be more effective if done while standing.
Generic Viagra has been available in Ireland for a number of years -12 x 100mg tabs cost in the region of 10-12 euro. Generic Cialis is now available in Ireland - 12 x 20mg tabs cost in the region of €12 or less.
2. Vacuum pump
A plastic tube is placed over the penis and a pump is used to create a vacuum. This causes blood to flow into your penis, producing an erection. In normal usage a rubber or silicone ring is then put around the base of your penis to hold the blood in the penis and keep the erection. It is now possible to have sexual intercourse. The ring must be removed after no more than 30 minutes to allow the blood in your penis to circulate and prevent any swelling and damage. When using the pump for penile rehabilitation (not intercourse) you should not use the constriction ring. It is argued that the blood drawn into the penis using this method is not high in oxygen. Alternately vacuuming and then massaging the penis a number of times may increase its effectiveness. Using the vacuum may also prevent the penis becoming shorter – a side effect of surgery. Check with your doctor if it is OK to use a Vacuum pump. Use only medically approved vacuum pumps. A medically approved vacuum pump can be sourced at this location. This has an electric vacuum pump which requires batteries. A manual vacuum pump can also be purchased at lower cost here.
3. Urethral pellets or Penile injections
A drug called Alprostadil is available as an Injection (Caverject®) or as a pellet (MUSE®) that you put into the opening or ‘eye’ of your penis. An erection is achieved in about 15 minutes. This is very effective for penile rehabilitation and may even give an erection sufficient for sexual intercourse. For many people this is prohibitively expensive.
4. Penile Vibrator
As already stated, I immediately took 5mg of Cialis following catheter removal and started using a vacuum pump (without ring) a month later when I felt healing had occurred. Later I changed from Cialis to full dose Viagra approximately every second day. Viagra are much cheaper than Cialis in Ireland. Remember taking any drugs like Viagra will not produce a response without sexual stimulation (both physical and mental). For this you can use a penile vibrator – Vibererect.
The website says ‘Viberect is a hand held medical device intended to provoke erection in men who experience erectile dysfunction. Viberect safely and painlessly stimulates pudendal nerve receptors located on both sides of the penis that initiate penis erection. Viberect's signals for erection reach the spinal cord and "wake up" the sexual centers in sacral spinal cord. Consequently, Nitric oxide is released by the cavernous nerves to increase blood flow and erection. Viberect naturally stimulates this process in 3-5 minutes before sexual intercourse or during foreplay.’ This is an excellent device and is very successful in getting oxygen to the penis for penile tissue rehabilitation and achieving orgasm. The Viberect can no longer be purchased in the UK and not sure if it's still available in Europe. It is manufactured in the United States so if anyone out there knows a legitimate safe online website that sells the Viberect please let me know via my contact page.
Remember stress and anxiety cause the release of adrenaline, your enemy when trying to get an erection.