Erectile Dysfunction After Cancer Treatment
Surgery and radiation therapy to the pelvic area, hormonal therapy, and chemotherapy may impact your ability to get and keep an erection after cancer treatment. This doesn’t always happen right away and may not happen until more than a year after treatment. Erectile dysfunction (ED) can cause anxiety for you and your partner.
Cancer Treatments and Erectile Dysfunction
Different types of cancer treatment can impact your ability to get and keep an erection.
- Surgery: Pelvic surgery can result in changes to the nerves and blood vessels responsible for erections making it harder to get and keep erections. Even "nerve-sparing" surgery can damage some nerves which produce the fluid that makes up ejaculate. 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 developing 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 it can impact your sexual health. Your desire may change over the course of treatment.
- Hormone therapy: Hormone therapy can lead to a loss of desire for sex (libido), 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 regain erectile function after surgery for cancers in the pelvic area (prostate, testicular, colorectal, and anal cancers). Penile rehabilitation (achieving erections with the help of medications) should start soon after surgery to get the best results. There are treatments to help you restore and maintain erections. Your healthcare provider can determine which treatment is right for you. These treatments may include the following:
- 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 to produce an erection. A ring slides over the base of the penis to keep the blood in the tissues to maintain an erection for up to half an hour.
- Oral Medications: Several oral medications are now available to help men attain and maintain an erection. These medications include Viagra®, Cialis®, and Levitra®.
- Penile Injections: Medications may be injected into the side of your penis, which promotes blood flow. The most common drug used for injection is Prostaglandin E1 (Caverject®). This medication typically 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 various types of penile prostheses, which a man can consider. Some are malleable (flexible) rods that are placed in the penis. Most men now utilize a type of inflatable prostheses, which can be inflated and deflated as needed.
- Sex Therapy: This is recommended for patients with anxiety-based erection problems. Typically, you and your partner are both involved in the therapy sessions.
- Lifestyle interventions: Weight loss, exercise, and smoking cessation may also help.
If you are having erectile dysfunction, you should discuss 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.
Chung, E. (2021). Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. International Journal of Impotence Research, 33(4), 457-463.
How cancer can affect erections: Adult males with cancer. American Cancer Society. (2020, February 5). Retrieved September 16, 2022, from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-men-with-cancer/erections-and-treatment.html
Ju, I. E., Trieu, D., Chang, S. B., Mungovan, S. F., & Patel, M. I. (2021). Surgeon experience and erectile function after radical prostatectomy: A systematic review. Sexual Medicine Reviews, 9(4), 650-658.