Treatment for Erectile Dysfunction After Oral Medication Failure
You may have trouble getting or maintaining an erection after treatment for cancer. This is called erectile dysfunction. Erectile dysfunction can cause stress and anxiety for you and your partner. There are medications that can help you restore erectile function, but they may not work for everyone. If medications do not help you, there are other options. You and your provider will talk about your options and which one is right for you. These treatments may include:
A vacuum device is a cylinder tube that is placed around the penis and attached to a pump. The cylinder and pump are used to create a vacuum that draws blood into the penis, making it 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 to maintain the erection. The ring should be removed within 30 minutes to prevent skin irritation and to return blood flow to the penis. Side effects can include penile pain, pain with ejaculation, and bruising of the penis. The penis may also appear purple in color, feel cold, and feel numb. The vacuum device needs to be bought by the user and the cost may be covered by insurance.
Suppositories are a type of medication that is placed directly into the urethra. A small plunger is used to insert the medication through the tip of the penis, about an inch into the urethra. As the medication dissolves and is absorbed by the tissues of the penis, the blood vessels dilate (expand) causing an erection. The erection usually starts within 8-10 minutes and lasts 30-60 minutes. There is a risk of priapism, or prolonged erection. You need to go to the emergency room if you have an erection that lasts longer than 3-4 hours. Other common side effects are pain, dysuria (pain with urination), hematuria (blood in the urine), or urethral spotting (small amounts of blood from the penis that may show up as spots on your underwear).
Some medications can be injected directly into your penis, causing it to become filled with blood. You use a small, thin needle to give yourself the medication into the sides of the penis in an area called the cavernosal space. Erections usually occur in 5-15 minutes and can last up to an hour or longer. Like suppositories, there is a risk of priapism with penile injections. Other risks include penile pain, scarring, penile curvature, hematoma (a bruise or collections of blood under the surface of the skin), and infection.
A penile implant is a device that is surgically placed in your penis to allow you to get an erection. This device is used for men who do not have success with other erectile dysfunction treatments. The operation is irreversible. After having a prosthesis placed, you will always need a functioning prosthesis to have erections. There are both malleable (bendable) prosthetics and inflatable devices, though most patients prefer the inflatable device. Erections are not usually as long or as wide as a natural erection. There are risks with prosthetics, such as bleeding, infection, chronic pain (especially in diabetics), injury to nearby organs, the device not working, and deformity. Learn more about penile prostheses.
If you are looking for options to treat your erectile dysfunction, you should talk with a urologist.
National Institute of Diabetes and Digestive and Kidney Diseases. 2017. Treatment for Erectile Dysfunction. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
Urology Care Foundation. 2018. Erectile Dysfunction (ED). https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)