Managing erectile dysfunction

Some men have problems getting or maintaining an erection after cancer treatment. There are different things that can help. Most treatments aim to increase the blood supply to the penis. The most common treatments are:

  • penile rehabilitation
  • tablets taken before sex
  • injections into your penis
  • a pellet or cream you put into the opening of the penis
  • vacuum pumps that pull blood into the penis
  • sex therapy.

Your doctors or nurses can discuss with you which may be suitable treatments for you. It can take time to get used to some of the treatments. And you may need to try a treatment a few times to see whether it’ll work for you. Some men find they need to use more than one method to get the best result.

It can be helpful to attend appointments with your partner, if you have one, so they can understand how a treatment works before you use it at home.

Having sex therapy can help some people adjust to the changes in their sex life and be able to talk openly with their partner.

Treatments for erectile dysfunction

If you have problems getting or keeping an erection, there are lots of options that can help you. Many treatments work by increasing the blood supply to the penis.

The most commonly used treatments are:

  • penile rehabilitation
  • tablets taken before sex
  • injections into your penis
  • a pellet or cream you put into the opening of the penis
  • vacuum pumps that pull blood into the penis
  • sex therapy.

A treatment may not always work the first time you use it. You may need to try several times before you know how well a treatment works for you.

After nerve-sparing surgery, it can take damaged nerves several months to heal. In this situation, if a treatment doesn’t work at first, you may get better results with it a few months later.

It is often worth trying different ED treatments, as some may work better than others. For some people, using a combination of treatments works best. Trying different ED treatments may be frustrating at times, but most men will find what works best for them.

It can take time to get used to some of the treatments for erectile dysfunction. If you have a partner, it’s a good idea to ask them to come to appointments with you. This will help them understand how a treatment is used before you try it at home. Treatments for ED may not feel very sexy to use. And you may worry you will lose the desire when preparing for an erection. Involving your partner can help you overcome any difficulties together. Some couples use the treatments as part of their foreplay. Having sex therapy alongside using these treatments may help you work through changes to your sex life and talk openly with your partner.


Penile rehabilitation

Most of the time, ED treatments are designed to be used when needed. You usually use them just before sexual activity. But some men are offered a ED recovery package soon after treatment. This is sometimes called penile rehabilitation.

Your doctor may ask you to use it after surgery or radiotherapy that can damage nerves to the penis. You are given ED treatments to use regularly. You can use them even if you do not plan to have sex. This is similar to having physiotherapy to recover from an injury. The aim is to keep the penis healthy and increase your chance of good erectile function. It involves regularly using treatments that encourage blood flow to the penis, such as tablets, a vacuum pump or a combination of both.

Penile rehabilitation is not always available through the NHS. This is because there is not enough evidence at present to prove if it works better than just using an ED treatment before having sex.


Tablets

This is the most widely used treatment for ED. It may not be recommended for you if you have heart problems. It should not be taken with certain prescription drugs, such as nitrates or recreational drugs such as amyl nitrate (poppers).

Sildenafil (Viagra®) increases and maintains the blood supply in the penis. It is usually taken about 60 minutes before sex, on an empty stomach. Then, after direct sexual stimulation, an erection can occur.

Sildenafil should be prescribed by your GP. It can cause side effects for some people, including heartburn, headaches, dizziness and changes in eyesight.

Vardenafil (Levitra®) tablets are similar to sildenafil. They work within 30 to 60 minutes. The most common side effects are headaches and facial flushing.

Avanfil (Spedra®) is similar to sildenafil and vardenafil. It is taken 15 to 30 minutes before sex.

Tadalafil (Cialis®) helps increase blood-flow to the penis during sexual arousal. Your doctor can prescribe it to you in two different ways:

  • You can take it once a day. In this case, it takes about 5 to 7 days to build up in the body. Once you have started, you need to take it every day for it to work.
  • You can take it just when needed. In this case, you take it between 30 minutes and two hours before sexual activity. The medicine stays active for about 36 hours.


Injections

This treatment may be more effective than tablets for men who have ED due to nerve damage.

A drug called alprostadil (Caverject®, Viridal®) is injected directly into the shaft of the penis, using a small needle. This causes an erection in 5 to 20 minutes. The drugs restrict blood-flow out of the penis, making it hard. The head of the penis may not become as hard as the shaft.

A healthcare professional will give you the first dose and teach you how to do this yourself. It is recommended that the injections are only used once in 24 hours and no more than three times a week. You should also change the site of the injections regularly.

A possible side effect of this treatment is having an erection that lasts for several hours. Doctors call this priapism. It is a serious side effect, as it can damage the tissues of the penis. If your erection lasts longer than two hours, you should always get medical help as soon as possible.

To reduce the risk of priapism, you will be prescribed a low dose of the injection to begin with. This is gradually increased to find the right dose for you. The person who prescribes your injections or tablets will explain the risk of priapism and how it can be treated.

I use either injections or a machine to get an erection. Even my consultant said you need a sense of humour to use them!

Mark


Pellets or cream

Alprostadil can also come as pellets (MUSE®) or a cream (Vitaros®). You insert it into the opening of the penis using a specially designed applicator. The cream or pellet is absorbed into the penis and produces an erection. You need to pass urine before inserting the pellets. This wets the urethra and helps the pellet dissolve. Inserting the pellet or cream does not cause any discomfort. But the drug may cause a burning feeling in the urethra or pain in the penis.

Your first dose will be given to you in hospital. You will be prescribed a set dose of the drug to begin with. This can then be adjusted until you find the right dose for you. Priapism may occur with this treatment, but this is rare.


Pumps

Vacuum pumps can also be used to produce an erection. They are also called vacuum erection devices (VEDs).

The pump is a hollow tube that you put your penis into. The pump makes the penis fill with blood by creating a vacuum. You then put a stretchy constriction ring around the base of the penis to hold the erection. The erection can be maintained for up to 30 minutes. Once you have had sex, you take the ring off and the blood flows normally again. The pump can be used as many times as you want, as long as you leave half an hour between each use.

The advantage of the pump is that it doesn’t involve any medication, so it doesn’t interact with other medicines you are taking. You may need to try it a few times before you get used to using it. The pump may make your penis slightly bigger, but colder than usual. The pumps are available on the NHS.

Your doctor or nurse may encourage you to use a pump routinely to help the penis recover, and not just for sex. This is so that when you are ready to start sexual activity, you will have a better chance of getting an erection.


Implants

A penile implant is sometimes used after all other methods have been tried. It is inserted into the penis during an operation. There are two main types of implant:

  • The first type uses semi-rigid rods that keep the penis fairly stiff all the time. They allow the penis to be bent down when an erection is not needed.
  • The second type uses two inflatable rods that are inserted into the penis. A pump is put into the scrotum and a small balloon filled with water is put into the tummy (abdomen). When the pump is activated, the rods fill with water and this causes an erection.

Your doctor can fully discuss the benefits and risks of penile implants with you.


Other things you can do

It is a good idea to follow healthy living guidelines. Doing this will give the treatments you are using the best chance of working.


Other things to know

You do not need to have a hard penis to give a partner pleasure. Having sex is not just about having erections or penetrative sex. And you don’t need to have an erection to ejaculate or have an orgasm.

There is more than one way to have sex or experience sexual pleasure. You can take time to try new things, and find other ways of experiencing and giving pleasure. This could include oral sex, mutual touching, using sex toys such as a dildo or vibrator, watching erotic films or reading erotic books. When trying new things, it is usually best to do so gradually. That way you and your partner can make sure you both feel comfortable.

Back to Effects of treatment on a man's sex life

The male body and sex

It may help to understand more about your body and how it becomes sexually aroused.

Effects of surgery on men

Any surgery can affect your sexuality. Surgery to any sexual areas of the body may cause noticeable changes.