By Madeleine Castellanos, M.D.
With prostate cancer making up about 30% of all cancers in men, it's not surprising that over 100,000 men in the United States per year require complete removal of their prostate in what is called a radical prostatectomy. One of the complications of this type of prostate surgery is loss of erectile functioning, which can be quite disheartening for many men and their partners.
The blood vessels that are responsible for getting an erection are controlled by nerves that direct them to have a more constricted tone (flaccid) or to have relaxation of the smooth muscles of the arteries and allow an increase in blood flow (leading to erection). These nerves branch out of the bottom of the spinal cord and make their way down to the arteries. They pass on each side by the prostate and are found right up alongside the gland. In removing or resecting the prostate, these nerves can get cut, thereby interfering with the transmission of messages to the arteries they innervate.
Whenever possible, urologists attempt to perform a nerve-sparing procedure that would carefully dissect around these nerves in order to leave them intact, but remove the prostatic tissue. Even when the nerves are spared, there can be damage due to the inflammation that results after surgery to either the nerves or the arteries and from lack of oxygen to the tissues because of decreased blood flow. A very important component of treatment after surgery involves penile rehab in order to encourage and maintain erectile functioning.
Although most all urologists give their patients recommendations for rehab to preserve erectile functioning, it is often not emphasized enough and less than half of these patients follow through with their rehab on a timely basis. The principle of "use it or lose it" comes into play and preservation of erectile functioning is severely impaired when these men do not participate with their rehab.
Since the goal of penile rehabilitation is increased blood flow, PDE5 inhibitors such as Viagra, Cialis and Levitra are most commonly used. Injections that are given with a very tiny needle into the base of the penis can be used if these PDE5 inhibitors don't produce the desired result. Vacuum pumps in combination with cock rings are also an option that helps draw blood into the penis and encourage continued erections. The body responds positively to increased blood flow creating increase in nitric oxide, more available oxygen to the tissues and promoting healthy tissue growth rather than scar tissue.
With proper rehab, a man can usually return to having penetrative sex with his partner in as little as six weeks. I would encourage any man being counseled by his urologist to have prostate surgery to discuss nerve-sparing techniques, as well as to engage in penile rehab as soon as possible after surgery to keep the best possible erection. Please don't let fear or embarrassment keep you from maintaining your sexual functioning.