Managing erection problems

Some cancer treatments can make it more difficult to get and keep an erection . This used to be called impotence.

Even if you can't get a full erection, you can still have a sex life. You might find you can still get a partial erection and have intercourse. If your erection problems are caused by surgery, they might get better with time.

Erection problems can be caused by many factors. It can be very upsetting. If you can't get an erection at all, it is worth talking to your doctor or nurse specialist.  There are several treatments that may help you. Sex therapy can also be helpful.

Not everyone chooses to have treatment. But there are options available if this is something that you and your partner, if you have one, would like to explore.

Treatment might include:

• drugs, such as tablets or cream
• vacuum pumps
• surgical implants

Treatment options

There are different treatments to help with getting and keeping an erection. Your doctor and nurse can discuss the options with you to choose the best option for your situation. 

This is called a penile rehabilitation programme. 

The aim of penile rehabilitation is to:

• maintain blood flow to the penis
• reduce damage to the muscle and tissue in the penis
• provide a stimulus for erections

Using and stimulating the penis keeps the tissues active and prevents them from becoming inflexible. This can hopefully help you to adapt to changes in your sexual function and relationships.

Taking tablets

The drugs used to treat erection problems include:

• tadalafil (Cialis)

• sildenafil citrate (Viagra)

• vardenafil (Levitra)

• avanafil (Spedra)

These belong to a group of drugs called phosphodiesterase type 5 (PDE 5) inhibitors. They work by increasing blood flow to the penis. For the drugs to work, men need to be aroused and have some sort of sexual stimulation. In other words, the drugs won’t cause an immediate erection, some foreplay is usually needed.

As drugs work best in men who have sexual desire, they might not help some men who are having hormone therapy. There is limited evidence to say these drugs work when having hormone therapy. But some specialists believe that they are still worth a try if you would like to give them a go.

Talk to your doctor about the best PDE 5 drug for you and the best way to take it. Tadalafil works for 24 to 36 hours, whereas the other drugs work for up to 4 to 6 hours. It’s worth knowing that some men need to take 5 to 6 doses before they start to have an effect. You take a daily dose, or when you need them.

Possible side effects of PDE 5 inhibitors include:

• headaches

• dizziness

• temporary problems with vision

These drugs should not be taken with medicines called nitrates. Nitrates are used to treat heart problems such as angina and are in some recreational drugs (poppers). Taking the 2 drugs together could have serious side effects.

Funding for some of these drugs and treatments are limited on the NHS. So your GP might only prescribe a limited amount of these drugs. For example, not enough for a daily dose. 

Cream

Your doctor might also recommend a cream called alprostadil (Vitaros). You use an applicator to put this cream on to the opening of the urethra  at the end of the penis. If the cream works for you, you can get an erection within about 5 to 30 minutes after using it.

Injections or pellets

Injections of a prostaglandin drug (also called alprostadil, Caverject or Viridal Duo) can help you get an erection. You give the injection into the shaft of the penis just before you have sex. Or if you have a partner, you might prefer them to do it. You need to have a test dose before starting treatment. 

Usually you get an erection about 10 minutes after the injection. Your specialist will teach you how to do the injections. 

Aloprostadil is also available as pellets. They are called MUSE. They are about the size of a grain of rice. You put them in the entrance of the urethra, at the end of your penis, using a small plastic device. The pellet is absorbed into the surrounding tissue. Your specialist doctor or nurse can teach you how to use them.

Vacuum pumps

Vacuum pumps are also called vacuum constriction devices (VCDs). They are useful if you can't get an erection, or if your erection isn't firm enough. The pump fits over the penis and draws blood into the penis to form the erection. You then put a soft plastic ring called a constriction ring around the base of your penis. The ring keeps the erection firm. The ring shouldn't be left on for more than 30 minutes.

Vacuum pumps can work well with practice, but they don't suit everyone. Your doctor or specialist nurse might show you how to use a vacuum pump without the ring to draw blood into the penis. This helps to maintain the health of the tissues in the penis.

It’s worth knowing that the pump can cause the penis to have a blue tinge, this is normal.

Implants

Implants are put into the penis during a short operation. Implants are usually only suitable if other treatments haven't worked. 

There are 2 types of penile implant:

• inflatable implants
• semi rigid malleable (positional) rods

Inflatable implants

The most commonly used type of inflatable implant is made up of a pair of hollow cylinders, a pump and a small bag of saline. Your surgeon puts the cylinder part of the implant into the part of your penis that becomes erect. They put the pump into your scrotum and the small bag of saline is put behind your tummy (abdominal) muscles.

When you want an erection you squeeze the pump and the saline moves into your penis, making it erect. When you no longer want an erection you press a valve and the saline moves back into the bag behind your tummy muscles.

Semi rigid malleable (positional) rods 

Semi rigid malleable (positional) rods are two flexible rods that your surgeon puts into the part of your penis that becomes erect. Your penis will be erect all the time, but the implant has joints that allow you to position your penis. You can position your penis up for sexual intercourse and down to pass urine. 

Research and clinical trials

Scientists would like to improve the treatment for men that are not able to get an erection. Around the world, doctors have been looking at using stem cells as a treatment in clinical trials. There is some evidence that this could be a treatment for erection problems in the future. At the moment, they need more research to be sure.

Sex therapy

Sex therapy is also known as psychosexual therapy. Sometimes sex therapy can help you make the most of other treatments for erection problems. Your specialist can refer you to a therapist. Of course, you don't have to try any of these treatments. You might want to try to deal with things as they are.

You can still have a satisfying sex life without needing to get an erection. There are other things you and your partner can enjoy besides penetrative sex. A sex therapist may be able to help you find other ways of enjoying intimacy.

Healthy living

Making changes to how you live your life can help you feel better and improve your sex life. Being active and having a healthy weight can improve your interest in sex and help you get an erection. Stopping smoking and cutting down on alcohol can also improve erections.

Some studies have shown that pelvic floor exercises can also help erection problems. The pelvic floor muscles are the sling of muscles in between your legs that run from the tailbone to the pubic bone. These muscles support the bladder and bowel.