Erectile Dysfunction After Cancer Treatment

What is erectile dysfunction?

Erectile dysfunction (ED) is when you are unable to get or keep an erection. Cancer treatment can affect your ability to get and keep an erection. ED may not happen right away, but sometimes starts a year or more after treatment. ED can cause anxiety for you and your partner.

• Surgery: Pelvic surgery can cause changes to the nerves and blood vessels that are used during erections. These changes can make getting and keeping erections more difficult. Even "nerve-sparing" surgery can harm some nerves that make the fluid that is part of ejaculation. You may also have less or no ejaculation (dry ejaculation). This is not harmful and shouldn’t change your ability to have an orgasm.
• Radiation Therapy: The risk of getting ED after radiation treatment increases with age. If you had poor erectile function before treatment, you may have a higher risk of ED after treatment. Radiation can also cause dry ejaculation.
• Chemotherapy: Chemotherapy does not often cause ED, but can affect your sexual health. Your sexual desire (libido) may also lessen while you are having treatment.
• Hormone therapy: Hormone therapy can lead to a loss of desire for sex, ED, and difficulty achieving orgasm.

Treatments for Erectile Dysfunction

ED is a common concern after cancer treatment. Talk to your provider about ED. Try not to feel embarrassed. It can take up to 2 years to get back to normal erectile function after surgery for cancers in the pelvic area (prostate, testicular, colorectal, and anal cancers). Penile rehabilitation (getting erections with the help of medication) should start soon after surgery to get the best results. There are treatments to help you get and keep erections. Your healthcare provider can tell you which treatment is right for you. Some of these treatments are:

• Vacuum Constrictive Devices (VCDs): A pump that you place over your penis. As air is pumped out of the cylinder, blood is drawn into your penis causing an erection. A ring slides over the base of the penis, keeping the blood in the tissues and keeping an erection for up to half an hour.
• Oral Medications: Oral medications can help men get and keep an erection. These medications include Viagra®, Cialis®, and Levitra®.
• Penile Injections: Medications may be injected into the side of your penis, which helps with blood flow. The most common drug used for injection is Prostaglandin E1 (Caverject®). This medication often needs to be adjusted to the correct dose based on how long the erection is maintained.
• Muse System: This system also uses Prostaglandin E1. Instead of an injection, a small suppository is placed into the urethra (opening in the penis where urine & semen exit) using an applicator.
• Penile Prosthesis (Implants): There are different types of penile prostheses. Some are malleable (flexible) rods that are placed in the penis. Most men now use a type of inflatable prosthesis, which can be inflated and deflated as needed.
• Sex Therapy: This is suggested for patients with anxiety-based erection problems. Often, you and your partner are both involved in the therapy sessions.
• Lifestyle interventions: Weight loss, exercise, and quitting smoking may also help.

If you are having erectile dysfunction, you should talk about the benefits and risks of each treatment option with your healthcare provider. You may want to see a urologist (a doctor trained in the care of male genitals), who can offer treatments for erectile dysfunction and other sexual concerns.