Penile Rehabilitation after Prostate Cancer

Prostate Cancer and Sexual Function

As techniques to treat prostate cancer have improved, the incidence of side effects has lessened substantially. Unfortunately, serious effects on a penis owners sexual function, particularly his ability to get an erection, remains an almost universal problem. However as penile rehabilitation is more widely accepted, more penis owners return to their pre-treatment function.

Penises exercise themselves! Yes you heard right, a penis naturally has 3-5 erections each night, whilst its owner is sleeping peacefully. This is the body's way of taking the penis to the gym. All muscles need exercise and the penile muscles are no different.  

With absent erections, the health of the penile tissues is adversely affected. Lack of tissue stretching, and low oxygenation leads to damage to the smooth muscle cells and the development of fibrosis. Such changes may cause permanent ED, penile shortening and Peyronies disease (change in shape).

There is now good evidence that early use of medication and/or exercises to restore erections after prostate cancer treatment and other pelvic problems that cause ED, can improve the chances of recovery of erectile function; this is known as “penile rehabilitation.”                                         

Shortening of the penis is thought to be due to retraction with tissue fibrosis during the healing phase. Regular erection or use of a vacuum pump can be useful in preventing this. 

It is not all bad news though as many penis owners report orgasm being more intense following prostate cancer treatment and it is possible to have an orgasm with a flaccid (non erect) penis.

Book a consult with Melissa, Sharon or Kendall to assist you in this area. 

Penile-Rehabilitation-after-Prostate-Cancer1
There are solutions!

Here are some of the treatment options:

Medications

Phosphodiesterase type 5 inhibitors (PDE5i) medications such as Viagra (Sildenafil), Spedra (Avanafil) and Cialis (Tadalafil) are useful in many men. PDE5’s improve blood flow and increase erections. They are generally not helpful if there is no erection but can be used after surgery even when erections are yet to start to keep penile tissue healthy. Some men, including those on certain heart medications may be unsuitable for PDE5’s. ‘On demand’ medication involves taking a full dose of a PDE5i, such as Viagra (Sildenafil), to achieve or boost an erection. Desire and sexual stimulation are necessary for the medication to work.

Injection Therapy

Intracavernosal injections (ICI) offer an alternative for men who are unsuitable for PDE5i or who do not respond to them. ICI’s do not require the nerves to be functioning, so they have a low failure rate. The injections relax smooth muscle, increasing blood flow to the penis. Interested men will be helped to overcome the apprehension of self-injecting and be taught how to inject into the penis. Melissa, Sharon and Kendall can  teach you how to draw up and administer the medication, how to titrate the dose and provide ongoing support for you. You wont believe it until you try, but it does not hurt. 

Vacuum Devices

Vacuum devices are cylindrical tubes placed over the penis, air is pumped out of the cylinder and as the pressure builds up blood is drawn into the penis. To aid in preserving penile tissue health in men who can’t get erections, vacuum devices should be used regularly. Vacuum devices can be used on demand with a constriction ring placed to keep the erection long enough for sexual intercourse. The constriction band must only be on for 30 minutes at a time. These devices can be purchased from medical suppliers and most sex shops. Some health funds will reimburse you for the purchase of the device. You will need instructions from a qualified health professional on how to use these devices. We recommend the Vacurect or the Bathmate - both available in the RSHC shop or at a consult. Melissa, Sharon and Kendall can help with these. 

Penile Prosthesis

Men who are unsuitable for, or fail the above-mentioned treatments, may wish to discuss the option of a permanent penile prosthesis. A prosthesis is a mechanical device implanted into the penis, which is activated via an implanted activation button in the scrotum. It involves a surgical procedure, but once implanted can offer a long-term solution for erectile dysfunction. Melissa, Sharon and Kendall can discuss the prosthesis and procedure in detail with you and provide a referral to a surgeon.

Injection therapy: What is it?

Intracavernosal injections (ICI) are a great treatment option for men post prostatectomy who are waiting for return of erections. ICI is also a good option for men who have had non-nerve sparing surgery or who have been unresponsive to tablet medication.

How will I learn how to do this?

You will have one initial education session with your practitioner to learn how to safely perform an ICI. This appointment will include the following:

  • Normal mechanism of erections
  • Erectile dysfunction
  • Sexual re-navigation
  • Education about the medication, side effects and contraindications
  • Practice drawing up, preparing and injecting a model penis
  • Drawing up and titrating the dose of medication
  • Preparing the site for injection on yourself
  • Injecting yourself
  • Education on troubleshooting injection management and priapism.
How do I know how much to use?

It is crucial that you follow direct instructions from your practitioner, you should never inject more medication than you have been told to or give yourself a ‘top up dose’ should the initial dose not work. You will be in close contact with your practitioner to titrate the dose to a level which is appropriate for you. It can be a time consuming and somewhat frustrating process titrating the dose until you find the dose that is right for you, but it is crucial that we work up the dose slowly to avoid complications. You must not inject more than once in a 24-hour period. You should feel some effect of your injection within 5-15 minutes and the erection may last for anywhere up to an hour. Within 2 hours, you should have no erection.

Is there discomfort with the injections?

Some people experience pain from ICI, if this is the case, we will work with you and the compound pharmacy to change the medication. You may experience bruising from the injection, we teach you where to inject and how to apply pressure to the injection site to minimise this. Some people experience headaches and dizziness from the ICI, you can take Panadol and lay down if this happens.

What are the potential side effects?

Some people get scar tissue from the injections, it is important to follow instructions from your practitioner regarding injection technique. You must rotate the site of the injection and monitor your penis for lumps and bumps or curvature, which can indicate scaring. If you are using injections for a prolonged period, you need to have regular check-ups (6-monthly) with your practitioner to check for scar tissue.

What to expect at your appointment

Due to the multifaceted nature of ED, expect to be asked multiple questions. You may require to have tests arranged to determine causes of the problem. If you have a partner, it will be beneficial to bring them to the appointment with your practitioner as they often have a lot of questions and concerns. You may also require a physical examination, including that of the genitals.

When is the best time to have your first appointment?

Ideally, you will see your practitioner before you start prostate cancer treatment so you can discuss what to expect from a sexual function point of view and know what you will need to do to optimise recovery. However, if you have already had treatment, it is never too late to start the journey.

Our Locations Why do we have so many locations and online services available?

This enables us to serve you better and closer to your home or work. We don’t want distance to be a barrier to access. We apologise if this is confusing, if you have any difficulty, please email admin@rshealth.com.au with preferred location and practitioner.

Palmyra

Antony Street Medical Centre

Joondalup

Body Sense Physio

Joondalup

Genesis Care

West Leederville

Western Urology

Mandurah

Total Concept Physiotherapy

Bunbury

InSync For Life

Margaret River

Margaret River Medical Centre