Prostate cancer is typically treated with either surgery, radiation, or both. Regardless of treatment option, erectile dysfunction is standard after treatment. Even if a patient starts with perfect erections, it is typical to not have erections adequate enough for penetrative intercourse during the first months after treatment. Medications such as sildenafil (Viagra) and tadalafil (Cialis) can help in the immediate post-treatment period but they typically prove to not be effective enough for adequate erections. As time passes after prostate cancer treatment, most patients do see improvement in their erections. Realistically, however, most patients do not regain their preoperative erection abilities. For this reason a great deal of interest lies in the measures a patient can take to speed up erectile recovery and ultimately end up with better erectile capacity at the end of the estimated 1-2 year recovery period.

A few things are known as to what happens after prostate cancer treatment:

  1. A decrease in the nerve signals to the penis leads to a lack of spontaneous or induced erections.
  2. The inability to achieve a maximal erection leads to decrease distention of the smooth muscle cell lined spongy tissue of the penis.
  3. The decreased distention of the spongy tissue and overall decreased blood flow leads to scarring of the spongy tissue leading to decreased distensibility.
  4. The changes above ultimately lead to a shortening of the penis and a decline in the capacity to obtain adequate erections.

To counteract the above effects the concept of penile rehabilitation was developed.

What is penile rehabilitation?

The basic concept is to “exercise” the penis and help preserve the integrity of the natural spongy tissue of the penis and possibly promote the activity and recovery of nerves that control erections.

What are the penile rehabilitation protocols?

Many protocols for penile rehabilitation have been developed. Dr. Clavijo can discuss options in detail with you in clinic. Some popular options include the daily use of a medication like tadalafil (Cialis) with the use a vacuum erection device. Penile injections are also used by some patients who want to start having penetrative intercourse soon after their surgery. Regardless of what is chosen our clinic can help guide you through your recovery period.

How long should I do penile rehabilitation?

We typically recommend using a protocol for at least 1 year. At that time, most of the erectile recovery has occurred and long-term treatment plans are developed

What happens if I still can’t have adequate erections after my recovery with oral medications?

There are several options available in this case. Most of the time it depends on you and your partner’s goals. Some men manage to have adequate erections with vacuum erection devices, penile injections, and occasionally, urethral suppositories. However, many men prefer the convenience and rigidity that can be achieved with a penile implant. Our clinic can help you choose the ideal option.