If you have prostate cancer, your focus is usually on treatment options. But there’s one often overlooked, but important, adjunct therapy: penile rehabilitation therapy.
Penile rehabilitation is about more than just getting erections back after prostate cancer surgery, says Amy Pearlman, MD, a urologic surgeon who specializes in medical and surgical treatments for erectile dysfunction in Coral Gables, Florida. “It’s a structured program designed to keep the penis healthy and functioning at its best.”
Penile rehabilitation generally involves one or all of the below treatments:
Oral medications. Your doctor may prescribe a type of drug called phosphodiesterase type 5 (PDE5) inhibitors. These boost blood flow to the penis. They include sildenafil (Revatio, Viagra), tadalafil (Adcirca, Chewtadzy, Cialis), and vardenafil (Levitra, Staxyn).
Vacuum devices. These are devices that you attach to your penis that allow blood to flow into the area so you can get an erection. Once you have one, you’ll slip a constrictive band at the base of your penis to help keep you hard.
Penile injections. These are medications that you inject directly into your penis to get an erection. Your doctor may recommend them if oral medications don’t work.
All three play a role in penile rehabilitation, which is often a possibility for people with prostate cancer at any age. “The penis is like any other organ and like any other muscle,” Pearlman says. “With use and exercise, it stays healthier. Without it, it atrophies. That is why penile rehabilitation matters across the lifespan.”
Why It’s Not Just for Younger Men
Most men diagnosed with prostate cancer are over the age of 65. In fact, the average age of diagnosis of men is 67. It’s rare in men younger than 40.
“The vast majority of men who undergo penile rehabilitation for prostate cancer are in their 60s or 70s, sometimes even 80s,” says Stanton Honig, MD, the director of men’s health at Yale School of Medicine in New Haven, Connecticut.
But penile function after prostate cancer treatment doesn’t depend on age alone. “Men who had good erections prior to surgery tend to do better than those who didn’t,” he says.
Other factors include whether you have a history of:
- High blood pressure
- High cholesterol
- Type 2 diabetes
- Smoking
Men who don’t have any of these risk factors tend to do better than those who have at least two, Honig says.
Everyone who undergoes prostate cancer treatment should be counseled on penile rehabilitation therapy, says Run Wang, MD, a urologic surgeon at MD Anderson Cancer Center in Houston, Texas. “The goal is to help preserve penis size and the quality of erectile tissue at any age, regardless of whether or not a man is still sexually active."
What Are the Benefits of Penile Rehab for Older Men?
Studies on penile rehabilitation have been mixed. There’s not strong evidence that it can help significantly with erectile dysfunction, says Wang. But there may still be benefits for older men, including the following:
It can help to prevent or reduce size loss. After prostate cancer surgery, some men see a loss of penile length due to nerve damage and decreased blood flow to the area. Research shows that men treated with PDE5 inhibitors after prostate cancer surgery have significantly less reduction in penile length than those given a placebo.
It helps to boost blood flow. Better circulation in your penis means healthier tissue. Since men treated for prostate cancer often don’t get regular erections on their own, their penile tissue doesn’t get enough oxygen. That can cause scarring. The more blood flow you get going to your penis, the less likely scarring is.
It increases confidence and quality of life. This is important even if you’re not sexually active. “Feeling comfortable with one’s body has a powerful impact on self-esteem,” Pearlman says.
Are There Any Risks of Penile Rehab for Older Men?
Penile rehabilitation is generally considered very safe, but like any treatment or therapy, it can carry risks. These include:
Medication side effects. The most common ones among PDE5 inhibitors are headaches and facial flushing. These often get better once you’ve been on the medication for a few weeks. To help minimize any side effects, stay hydrated and avoid alcohol, too.
Penile bruising. Vacuum pumps can cause bruising, especially if they’re used incorrectly. Other side effects include:
- Penile discoloration
- Your penis feeling cold
- Slight pain or pressure from the constriction ring
- Discomfort during ejaculation (The constriction ring prevents the flow of semen, which may feel strange)
One of the best ways to try to avoid these side effects is to use the pump a few times in your doctor’s office, Pearlman says. “When patients try a vacuum pump under guidance, they often light up seeing their penis engorge in real time,” she says. “It’s a confidence booster.” You’ll also feel better if you know how to use the device comfortably and safely.
A long-lasting erection. If you use penile injections, you have a higher risk of developing priapism. This is an erection that lasts too long. If it lasts for hours, it can damage the tissue and lead to permanent erectile dysfunction. If you have an erection for more than three hours, call your doctor. They may want you to take pseudoephedrine HCI, which constricts or narrows your blood vessels. If that doesn’t help, you’ll need to go to the emergency room.
Penile pain. Both vacuum devices and penile injections can cause pain if not used correctly. “Penile injections use a tiny needle that shouldn’t cause pain,” Honig says. “If it does, patients may be doing injections in the wrong area: It should be done on the side of the penis, where there are very few pain fibers.” If you still have trouble, do the injections a couple of times in your doctor’s office.
Can Penile Rehab Help Men With Late-Stage Prostate Cancer?
Penile rehab has the potential to help anyone with prostate cancer, whether they’re diagnosed in the early stages or with more advanced cancer. Late-stage prostate cancer is often treated with androgen deprivation therapy (ADT). Since it lowers testosterone levels, it can cause penis shrinkage, too.
But medications, vacuum devices, or injections sometimes don’t work as well for people with late-stage prostate cancer who are on multiple therapies. Penile implants might help: surgically inserted devices that help you get an erection. Much like a natural erection, penile implants cause your penis to stiffen. Sex should feel the same as it did before the procedure. It shouldn’t impact your ability to have an orgasm and ejaculate.
Breaking the Stigma
If you have sexual problems after prostate cancer surgery, you may feel embarrassed to talk to your doctor about it. But that feeling is normal. Many other men feel the same way. In fact, only about 1 in 3 men sought out treatment in one study of participants with erectile dysfunction. Your doctor may not automatically bring it up, either. “Most specialists are focused on cancer management, not on sexual function,” Wang says.
But that doesn’t mean you have to stay quiet. You should feel comfortable asking your doctor about penile rehabilitation before you begin treatment. You can also ask for a referral to a men’s health urologist. These are doctors who specialize in conditions like erectile dysfunction. They’ll be comfortable talking about it with you.
“I describe the penis as a sponge that needs water daily or as a bicep that needs exercise,” Pearlman says. “People understand these analogies. I also normalize it by emphasizing that keeping the penis healthy is not only about sex but about tissue health.”
If you still feel anxious about penile rehabilitation, try a common treatment such as a vacuum device in your doctor’s office. That can help you feel more comfortable. “When men see and feel the changes, they realize this isn’t taboo or embarrassing — It’s simply health care,” Pearlman says.
Penile rehabilitation is about more than erections: It’s a way to preserve your penile health.
“It’s for prostate cancer patients of all ages, and in all stages of health,” Honig says. “The earlier you start it, the better.”
