The Quest for the Prodigal Hard-On

BY RALPH BLUM

There is no doubt that all the main prostate cancer treatments—surgery, radiation or hormone therapy—are likely to affect erections. And although many men who are diagnosed with prostate cancer are older, and may therefore already be subject to the ordinary fatigue and malfunction of nature’s ultimate erector set, the degree to which sexual function returns—or fails to return—after treatment is still a matter of major concern for a number of us.

 

There is no set formula or predictable schedule for recovery of sexual function after prostate cancer treatment. If you choose surgery, your chance of recovering potency is partly dependent on the experience and skill of your surgeon. The minuscule nerves that control erections are located dangerously close to the prostate, and damage to or actual removal of those nerves during surgery causes permanent erectile dysfunction. Viagra or Cialis only works if the nerves can be spared. And even with successful nerve-sparing surgery it can take up to 12 months for the restoration of the natural ability to have an erection.

 

The radiation options—seed implants or IMRT—are associated with a significantly better chances for maintaining erectile dysfunction. But the reality is that radiation therapy still can cause erectile dysfunction because of the inflammation or scarring that occurs around the nerves.

 

Hormone therapy, another treatment alternative, causes total dissolution of sex drive, and you don’t even care that it’s gone! Fatigue, joint pain, depression and hot flashes are not exactly a turn-on either. And yet even without a libido, an erection can be achieved through the manipulation of modern pharmacology—that is if you can dredge up enough desire to give it a try for your partner’s sake—but even with a pharmacological assist, personal satisfaction is often seriously diminished.

 

There is, moreover, a “use it or lose it” caveat: many doctors who specialize in erectile dysfunction encourage sexual activity as soon as possible after treatment (or in the case of hormone therapy during treatment) on the grounds that the nerves and muscles that control erections can atrophy if they are not used for a long period of time.

 

If prostate cancer has already affected your ability to achieve erection, there are various options that might help—penile injections, a vacuum pump device, implantable pellets, or penile implants. I will present the pros and cons of these methods for inducing an erection in my next Blog. In the meantime, keep in mind that there are ways you can express your love for your partner and attain sexual gratification that don’t include penetration. Ways that include intimacy and tenderness, lest we forget.