11 Common Challenges in Penile Rehab and How to Overcome Them

If you have prostate cancer, you may have your prostate gland removed in a surgery called a radical prostatectomy. Nearly all men who have the surgery have erectile dysfunction (ED) for a year or more after surgery. To regain function in your penis, your doctor likely will recommend penile rehabilitation. Penile rehab involves medication, devices, or both. Here are 11 challenges to be aware of while going through penile rehab. Overcoming them may help you heal and become intimate again. 

If the cancer or surgery damages nerves or blood vessels in your penis, your sexual function might be affected. Along with erectile dysfunction, you could have painful erections, dry orgasms, urine leaks, or tightness in your pelvic floor or area between your scrotum and anus. You may notice changes in the sensation, size or shape of your penis, such as a curved penis (Peyronie’s disease). These effects may be temporary or long-lasting. Going through penile rehab may help you recover some function.

Penile rehab starts soon after surgery and continues for 12-18 months. To increase blood flow for healing and erections, your doctor may prescribe pills, such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra, Staxyn). If the pills don’t work, you may give alprostadil (Caverject) or papaverine injections into the base of your penis. Or you may insert intraurethral pellets (alprostadil suppositories) into your urethra. And you’ll exercise your penis with devices. A penis pump creates an erection. A penile traction device stretches or straightens your penis.

Pills prescribed for penile rehab – avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra, Staxyn) – may cause headaches, flushing of your skin, nausea, or diarrhea. More serious side effects include priapism – an erection that lasts longer than four hours. If that happens, go to the emergency room. If left untreated, priapism could cause permanent erectile dysfunction. Sudden loss of vision or hearing have been reported, too. Call your doctor right away if you have trouble with your vision or hearing.

Injections used for penile rehab may cause your penis to tingle. You may notice swelling, bruising, or bleeding where you give yourself the shot. Those effects may be a sign that you injected your medication just under the skin. The injection must go deeper. After injecting, put pressure on the injection site to prevent bruising or bleeding. Massage your penis to help the medicine spread. Inject it properly to lower the risk of scar tissue forming inside your penis. That can lead to painful, curved erections. 

Penis pumps are vacuum devices that draw blood into the penis to make it swell and harden. A constriction band keeps the blood in your penis so you can have sex. Don’t use too much pressure in the vacuum or leave the constriction band on for longer than 30 minutes, or you can damage your penis. Penis pumps are available over the counter for several hundred dollars, but check with your doctor before buying one. After surgery, your device may be covered by insurance. Or you can use funds from a health savings account to cover the cost.

If erections just aren't happening with meds or a penis pump, a penis implant can be surgically inserted. Inflatable systems require you to squeeze a pump that sits in the loose skin of your scrotum to create an erection. Semi-rigid implants are silicone rods inserted into your penis. You’ll always be semi-erect. You create a full erection by bending the rods into position. Penis implants don’t change your sensation, orgasms, or ejaculations. Over time, parts may fail, skin may erode, and infections are possible. Repeat surgeries may be needed for repair or removal of your implant. 

Meds and devices used for penile rehab don't strengthen weak muscles in your pelvic floor. To make those muscles stronger, do Kegel exercises every day. Here's how: Squeeze the muscles that you use to stop urinating midstream. Hold the squeeze for three seconds, release, and repeat. Try to do 10 to 15 in a set. Work up to three sets per day, such as when you’re brushing your teeth or just after urinating (not during). You can do Kegels standing, sitting, or lying down.

Just like with physical rehab for an injured joint, penile rehab – taking your meds, exercising your penis, and doing Kegels – needs to be done consistently. Your doctor may tell you to create three erections every day or at least three times per week. Each erection should last a minute or two. The blood flow helps to keep the tissue in your penis healthy. For comfort, trim your pubic hair and keep lubricating jelly on hand. Follow your doctor’s instructions for taking your medications. And don’t forget good nutrition, regular exercise, and sleep!

After your prostate gland removal, you may worry about future episodes of cancer. It’s also common to grieve over the changes in your sex life. Having thoughts like, "I can’t please my partner" can affect your confidence, cause performance anxiety or intimacy issues with your partner, or lead to depression. Penile rehab is done not only to improve your sexual function but also your quality of life. Talk to your doctor about including counseling as part of your penile rehab.

Penile rehab doesn't have to involve sexual activity. But connecting with your partner in a loving way while using your devices may help you feel aroused. And that can bring blood into your penis, which benefits healing even if you don't achieve a spontaneous erection. Let your partner know when you'd like to be intimate and want their help during your penile rehab. If you feel embarrassed, say so. Letting your partner be part of your healing routine may help you become even closer. Support is critical for your healing.

Nearly 90% of urologists offer penile rehab after prostate gland removal surgery. Before having your prostate gland removed, ask your surgeon about starting penile rehab. You may be referred to a penile rehab clinic. You and your doctor will discuss what combinations of treatments to try. Be honest with your doctor about what's working (or not) for you, so you and your doctor can adjust your treatment plan. You're more likely to regain function of your penis when your treatment plan is right for you, you stick to the routine, and you have frequent check-ins with your doctor.