Treatment for Erectile Dysfunction After Oral Medication Failure

William I. Jaffe, MD
Assistant Professor of Urology in Surgery, PENN Medicine
Last Modified: April 10, 2014

Many men may have difficulty obtaining or maintaining erections after various forms of cancer treatment. Erectile dysfunction can cause significant angst and anxiety for the man and his partner. This is a common concern after cancer treatment and you should not hesitate to discuss these concerns with your provider. While there are medications that can help men restore erectile function, these do not work for every patient. For those who do not respond to medication therapy, there are other options. Your healthcare provider can determine which treatment is appropriate for you, and the likelihood you will benefit from a specific treatment. These treatments may include the following:

The Vacuum Erection Device (VED) is an acrylic cylinder with a pump that may be attached directly to the end of the penis. The cylinder and pump are used to create a vacuum which draws blood into the penis so it can become erect. Once the penis is erect, a ring or band slides down onto the lower end of the penis to keep the blood from draining and maintain the erection through intercourse. The ring or band can be removed just prior to orgasm or at the completion of intercourse. Common side effects include penile pain, ejaculatory pain and penile bruising. Some patients do not like the erection produced by the VED as it can be subjectively cold as the penis fills with venous blood. It requires a one-time cost outlay though this may be covered by insurance.

The Medicated Urethral System for Erections (MUSE) uses a small plunger to insert a small suppository into the urethra (the normal pathway for urine). This suppository contains the medication alprostadil, is absorbed into the tissues of the penis and dilates blood vessels, which results in an erection. The intraurethral suppository comes in several doses. Patients are usually started on a low dose and titrated up to effect. The medication needs to be refrigerated to remain effective. Typically, if effective, the medication produces an erection in 5-15 minutes and can last for up to an hour. Patients do not need stimulation in order for this medication to work. There is a risk of priapism, or prolonged erection, and one would need to go to the emergency room if he had an erection that lasted for longer than 3-4 hours. Other common side effects include pain, dysuria and hematuria or urethral spotting.

With Penile Injections the patient uses a small, thin needle to self-administerd alprostadil or Trimix (alprostadil, phentolamine and papaverine) into the cavernosal space on the sides of the penis. This medication also needs to be kept refrigerated. As above, patients generally start at a low dose and titrate up to effect. Erections usually occur in 5-15 minutes and can last up to an hour or longer. There is a risk of priapsim as above. Other risks include penile pain, scar formation, penile curvature, hematoma and infection.

Penile prosthetics are generally reserved for patients who fail all of the other therapies as the operation is irreversible. After having a prosthesis, the man would always need a functioning prosthesis to achieve erections. There are both malleable (bendable) prosthetics and inflatable devices, though most patients prefer the inflatable device. Satisfaction rates are quite high, although the erections are not usually as long or as wide as the natural erections. There are multiple risks/complications with prosthetics including bleeding, prosthetic infection, chronic pain (especially in diabetics), corporal perforation/erosion, urethral injury, device malfunction/failure, need for revision, SST deformity, penile, urethral, bladder or bowel injury during surgery, and others. Learn more about penile prostheses.

All of these options can be discussed in more detail during a consultation with an urologist.

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