Erection Problems: Causes and Treatments

Erectile dysfunction (ED) is the most common sexual problem that men have after cancer treatment. Erections happen when a man’s nervous system sends signals from the brain and spinal cord to special nerves in the pelvic area. Important nerves run between a man’s prostate and rectum. The nerves tell spongy tissue inside the penis to relax so that blood can flow in. As blood pressure builds inside the penis, it closes off veins that drain blood away. The blood pressure inside the penis makes it hard.

Cancer treatment can interfere with erections in several ways. Here are the most common: 

  • Major surgery in the pelvis can damage the nerves that cause erection, for example radical surgery for prostate, bladder, or colorectal cancer. 

  • Surgery in the pelvis may also damage the inflow of blood to the penis. 

  • Radiation aimed at the pelvic area can reduce blood flow to the penis.

  • Cancer treatments can decrease the hormone testosterone, which promotes sexual desire and erections. These treatments include hormone therapy for prostate cancer, some types of chemotherapy, radiation to the brain, or treatments that damage both of a man’s testicles (surgery or radiation). 

Finding the best treatment for ED usually takes some patience and willingness to try different options. 

  • Most men either do not seek help for cancer-related erectile dysfunction (ED) or are dissatisfied with the treatments they try. 

  • Pills like Viagra® or Cialis® seldom restore firm, reliable erections if cancer surgery or radiation has done major damage to nerves and blood vessels in the penis. 

  • Treatments like vacuum erection pumps or penis injections work better, but most men still stop using them after a few months. 

  • Men’s satisfaction is highest after having surgery to put in a bionic pump system (penile prosthesis), but only a small percentage of men have this procedure. 

  • Beware of some male sexual health clinics that push expensive treatments that are not backed by research, like injecting stem cells into the penis, or low intensity shockwave therapy. 

  • Many couples are happy to enjoy sexual caressing even if a man cannot get and keep firm erections.

  • Some partners dislike the idea of a medical treatment for ED or fear it will harm a man’s health. It can help to involve your partner in deciding on an ED treatment. 

  • A combination of medical treatments and sexual counseling can also produce better outcomes for some individuals or couples. 

If you are experiencing erectile dysfunction, share your concerns with your oncologist or urologist. They can discuss what options might be possible for you.