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Managing erection problems

Some cancer treatments can make it more difficult to get and keep an erection.

Even if you can't get a full erection, you can still have a sex life. You might find you can still get a partial erection and have intercourse. If your erection problems are caused by surgery, they might get better with time.

If you can't get an erection at all, it is worth talking to your doctor or nurse specialist, if you have one. 

There are several treatments that may help you. Sex therapy can also be helpful.

Treatment options

There are different treatments to help with getting and keeping an erection. Your doctor and nurse can discuss the options with you to choose the best option for your situation. 

This is called a penile rehabilitation programme. 

Tablets or cream

The following drugs can help some men to get an erection:

  • sildenafil citrate (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Spedra)

These drugs are tablets. They work by relaxing the smooth muscle of the penis allowing the blood flow that makes the penis stiffen. These drugs have been reported to help some men who have nerve damage due to prostate surgery.

Some of these drugs interact with medicines called nitrates, which are used to treat heart problems such as angina. Your doctor might recommend you use other drugs, or have heart tests before starting treatment. Always tell your specialist about your heart problems.

Cream

Your doctor might also recommend a cream called alprostadil (Vitaros). You use an applicator to put this cream on to the opening of the urethra at the end of the penis. If the cream works for you, you can get an erection within about 5 to 30 minutes after using it.

Injections or pellets

Injections of a prostaglandin drug (also called alprostadil, Caverject or Viridal Duo) can help you get an erection. You give the injection into the shaft of the penis just before you have sex. You need to have a test dose before starting treatment. 

Usually you get an erection about 10 minutes after the injection. Your specialist will teach you how to do the injections. 

Aloprostadil are also available as pellets. They are called MUSE. They are about the size of a grain of rice. You put them in the entrance of the urethra, at the end of your penis, using a small plastic device. The pellet is absorbed into the surrounding tissue. Your specialist doctor or nurse can teach you how to use them.

Vacuum pumps

Vacuum pumps are also called vacuum constriction devices (VCDs). They are useful if you can't get an erection, or if your erection isn't firm enough. The pump fits over the penis and draws blood into the penis to form the erection. You then put a soft plastic ring called a constriction ring around the base of your penis. The ring keeps the erection firm. The ring shouldn't be left on for more than 30 minutes.

Vacuum pumps can work well with practice, but they don't suit everyone. Your doctor or specialist nurse might show you how to use a vacuum pump without the ring to draw blood into the penis. This helps to maintain the health of the tissues in the penis.

Implants

Implants are put into the penis during a short operation. Implants are usually only suitable if other treatments haven't worked. 

There are 2 types of penile implant:

  • inflatable implants
  • semi rigid malleable (positional) rods

Inflatable implants

The most commonly used type of inflatable implant is made up of a pair of hollow cylinders, a pump and a small bag of saline. Your surgeon puts the cylinder part of the implant into the part of your penis that becomes erect. They put the pump into your scrotum and the small bag of saline is put behind your tummy (abdominal) muscles.

When you want an erection you squeeze the pump and the saline moves into your penis, making it erect. When you no longer want an erection you press a valve and the saline moves back into the bag behind your tummy muscles.

Semi rigid malleable (positional) rods 

Semi rigid malleable (positional) rods are two flexible rods that your surgeon puts into the part of your penis that becomes erect. Your penis will be erect all the time, but the implant has joints that allow you to position your penis. You can position your penis up for sexual intercourse and down to pass urine. 

Sex therapy

Sex therapy is also known as psychosexual therapy. Sometimes sex therapy can help you make the most of other treatments for erection problems. Your specialist can refer you to a therapist. Of course you don't have to try any of these treatments. You might want to try to deal with things as they are.

You can still have a satisfying sex life without needing to get an erection. There are other things you and your partner can enjoy besides penetrative sex. A sex therapist may be able to help you find other ways of enjoying intimacy.

Last reviewed: 
02 Aug 2018
  • Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation
    K Hatzimouratidis and others
    European Association of Urology 2015

  • Man cancer sex

    Katz, A (2010) 

    Hygeia Media

  • Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer
    M.Voznesensky and others
    Journal of Oncology Practice, 2016. Volume 12, Issue 4, pages 297 to 304

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