Erectile Dysfunction Treatments and Penile Rehabilitation Programs Aimed at Assisting Sex after Prostate Surgery or Treatment.
Penile rehabilitation is the phrase used to describe the process of using drugs and or devices in order to preserves erectile tissue health and minimizes erectile tissue damage following a radical prostatectomy or radiation procedure. It is understood that by increasing levels of oxygen to those nerves responsible for producing erections, this may in turn increases the likelihood of erectile function recovery.
Whilst the early application of penile rehabilitation treatments may promote improvement in spontaneous erections sufficient to allow sexual relations, the failure to pursue early post-prostatectomy treatments for erectile dysfunction is widely thought to contribute to higher rates of erectile problems after prostate surgery.
The good news:
More than ever before, there are treatments available to men that have been shown to be successful in treating erectile dysfunction.
Pharmacological treatments commonly prescribed for penile rehabilitation and erectile function recovery include: (Click on links to read detailed descriptions).
- Penile Vibratory Stimulation ;
- Vacuum erection devices ;
- Phosphodiesterase Type 5 Inhibitors (Sildenafil [Viagra], Tadalafil [Cialis] and Vardenafil [Levitra]); and
- Intracavernous injections (penile injections).
Evidence shows that early use of these treatments can improve the recovery of post-operative erectile function as well as levels of sex life satisfaction, however none of the treatments mentioned below have been found to have permanent value.
The not so good news:
Despite many prostate cancer survivors pre-operatively reporting an interest in receiving treatment for post-radical prostatectomy-related erectile dysfunction, studies show that as many as 50% of men freely decide from the onset not to proceed with any form of therapy.
Of those that commence therapy, almost 75% will discontinue treatment within 18 months.
The benefits of specialist assistance versus no specialist assistance:
With regards to men that were willing to trial the use of pills, injections and/or vacuum pumps, our own published scientific research in this area found that :
- Men who receive specialist advice for their postoperative erectile dysfunction are more likely to report being very satisfied with treatment outcomes and were more likely to continue treatment for erectile dysfunction.
- By comparison, men who do not receive specialist advice were far more likely to be unsatisfied with reported levels of treatment satisfaction, with the majority of these men being either being non-committed towards continuing treatment or having ceased treatment altogether.
- Men who receive detailed instruction (preferably in the presence of a sexual partner), sexual counselling and medical follow ups every three months, are likely to experience higher levels of treatment satisfaction and continued use.
- Men reported that physical, psychological and social adaptation to life with postoperative erectile dysfunction, and their need for PTED, were highly influenced by the strength and nature of relationships they had with their partners.
- Treatment compliance was influenced by partner support and involvement in the penile rehabilitation process, partner acceptance of treatment selection, and the importance partners placed on maintaining an active sexual relationship.
- Apart from sexual communication, relationships in which partners had demonstrated a willingness to actively assist participants in incorporating treatments within sexual activities were more likely to lead to higher levels of treatment satisfaction and adherence.
- In contrast, men reporting low levels of sexual communication and involvement in treatment selection and acceptance were more likely to withdraw from treatment use.
Penile Vibratory Stimulation
Penile erection is a nerve reflex. Millions of nerve receptors line the surface of your penis. Their stimulation trigger centers in the spinal cord and brain to start a process that lead to penile erection, firmness and ejaculation.
With specific frequency and amplitude, Penile Vibratory Stimulation safely stimulates these sensors. Through gentle and painless vibrations, Penile Vibratory Stimulation helps initiate the flow of blood into your penis and stimulates the muscles that keep it there longer, making it more rigid.
Medical vibrators like the Viberect® (Reflexonic, USA) generate high amplitude necessary for scientific nerve stimulation and can help generate sexual reflexes. Nerve stimulation after 2-3 minutes strong activates spinal cord sensors that originate the injured Cavernous nerves and instruct it to "wake up from sleep". If done on a daily basis, this has shown in much neurophysiology literature to help in regeneration of nerves and functional recovery. This modality can help treat men with erectile dysfunction and urinary incontinence at all 3 fronts:
- Improve nerve conduction to the penis
- Improve blood flow (Pudenda Cavernous reflex and Bulbo Cavernous reflex),
- Help strengthen muscles around the penis that act as physiological "penis rings"
Men who use Penile Vibratory Stimulation on daily basis report progressive improvement in rigidity and spontaneous night time erections. In addition, vibratory stimulation can help correct poor and lack of orgasm after prostate cancer treatments.
To learn more about Penile Vibratory Stimulation please visit Viberect.com.au
Vacuum erection devices
Vacuum erection devices (Vacuum devices) are often used as first-line penile rehabilitation therapies. A Vacuum device generally takes the form of a tube that is placed over the penis, to which a vacuum pump is attached, resulting in increased penile blood ﬂow and oxygenation of nerve and muscle tissues.
Whilst men often will be willing and able and "making the time" to use a vacuum device whilst on leave from work, once work resumes some men will consider vacuum device usage to be impractical and it is often abandoned.
Phosphodiesterase Type 5 Inhibitors (PDE5's)
PDE5's (include Viagra, Cialis and Levitra) are often prescribed as first-line oral agents to treat erectile dysfunction due to their ease of use and perceived clinical value.
Whilst PDE5 use has improved erectile functioning in up to 70% of cases, levels of erectile recovery success levels have been reported in some studies to be as low as 29%.
Factors that affect levels of treatment success include, age, treatment dosage, the extent of damage to penile nerves, and the amount of time between surgery and the commencement of treatment for erectile dysfunction
As easy as they are to use, researchers have found inappropriate use of these drugs to occur in as many as 56% of men. Treatment glitches included patients being prescribed incorrect treatment dosages, improperly taking medication with a full stomach immediately following a meal; taking medication immediately before the initiation of sexual activity and not knowing that sexual stimulation was mandatory towards achieving an erection.
Intracavernous injections (ICI)
Intracavernous injections are a standard treatment of erectile dysfunction in cases where the use of medications (such as Viagra) have been found to be unsatisfactory.
Understandably, patients are often negative towards injection treatments due to the common perception that they are painful and they interfere with the spontaneity of intercourse.
Time, developing courage and the assistance of supportive partners, are critical for treatment execution. For some men, self-injection is considered too large a challenge to overcome, so often, their partners assist in the administration of injection treatments.
Studies show however that for some men, once they were able to overcome their fears of penile injection, the use of injections have allowed them to experience increases in levels of sexual confidence and satisfaction as well as improvements in relationships with partners.
Ease of use and treatment obstacles
Within our own research, we have found that men will experience varying degrees of difficulty with different treatments for erectile dysfunction. Pills are generally seen as being the least challenging of treatments to take, vacuum pumps the most cumbersome, and injections the most physically and psychologically threatening.
To make an appointment:
To make an appointment or to speak directly to a sexual health professional about any device you have purchased, sex after serious or chronic illness (including cancer), treatments for erectile problems or any other sexual or relationship matter:
Telephone Sydney: (02) 8065 6762 Monday to Friday during office hours or
*Please note that a doctor's referral is not necessary in order to make an appointment.