Erectile Dysfunction (ED or Erection Problems)
What causes it: Erectile dysfunction – difficulty getting or keeping an erection – is one of the most common side effects of prostate cancer treatment. Surgery can damage the nerves and blood vessels needed for erections. Even with nerve-sparing surgical techniques, the delicate erectile nerves around the prostate may be traumatized during a prostatectomy. This can lead to partial or complete ED after the operation. Radiation therapy can also cause gradual nerve damage or reduced blood flow to the penis, so erection problems might develop slowly over a few years after radiation. Hormone therapy (which lowers testosterone) further contributes to ED, since testosterone is important for sex drive and erectile function. In short, any treatment that affects the prostate or testosterone levels can impact your ability to have an erection.
How it affects daily life: Erection problems can have a significant emotional and relationship impact. You may be unable to have penetrative sex, which can be frustrating or lower your self-esteem. It’s common to feel a sense of loss or worry about intimacy. ED can also lead to less spontaneous intimacy with your partner, as you might need medical help (like pills or devices) to achieve an erection. Some men also notice changes in orgasm – for example, surgery causes “dry” orgasms with little or no semen. It’s important to remember that you can still have intimacy and orgasm even if erections are weaker or absent; it just may be different than before. Many men find these challenges improve over time after treatment, especially within the first 1–2 years post-surgery as nerves slowly recover. However, if you had some ED even before treatment (for example due to age, diabetes, or other health issues), it may be more difficult to recover erectile function.
Ways to manage or reduce it: There are several effective treatments for ED. Medications like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) can boost blood flow to the penis and help produce an erection. These pills are often tried first, typically a few months after surgery once you are healed (they won’t work immediately after surgery when nerves are still inactive). If oral medications aren’t effective or suitable, other options include vacuum erection devices (a pump that draws blood into the penis) and penile injections (medicines injected into the penile tissue that cause an erection). These methods can produce reliable erections suitable for intercourse. There are also urethral suppositories (pellets) that can be inserted into the penis to trigger an erection. Additionally, working with a specialist through an erectile rehabilitation program can be very helpful. This might involve using the treatments above regularly to promote blood flow and keep the penile tissue healthy while nerves recover. Lifestyle changes can improve overall erectile function as well – maintaining a healthy weight, exercising, controlling blood pressure, and not smoking all support better blood flow. If other methods fail, a last-resort option is a penile implant (prosthesis) surgically placed in the penis; implants have high satisfaction rates for couples when done by experienced surgeons, as they allow an erection on demand. It’s also important to communicate with your partner – intimacy can take other forms (touching, oral sex, using vibrators, etc.), and reducing performance anxiety through open communication or sex therapy can help. Remember that ED is a common issue after prostate cancer; you are not alone, and with time and assistance, many men are able to have a satisfying sex life after treatment.