Prostate-cancer treatment causes ED because the nerves involved in erection border the gland. Surgery often cuts these; radiation frequently damages them.
A special surgical approach called nerve-sparing prostatectomy can push your ED risk below that of radiation. Studies report "functional" erections in 60 to 80 percent of men who have nerve-sparing surgery. Just don't expect miracles: At best, nerve-sparing surgery leaves men with erections not quite as firm as they were before surgery. In addition, nerve-sparing surgery may not be possible if the tumor is located near a nerve line.
Surgery plus erection drugs
Several studies show that erection drugs help restore erectile function, but usually only after nerve-sparing prostatectomy. Here's why:
Erection medications work by coaxing more blood into the penis. If a man doesn't have enough nerve function to enable erection, the amount of blood in the penis won't matter; no nerve function means no erection. Nerve-sparing surgery, by contrast, allows a man to retain nerve function, so erection drugs can help.
Italian researchers analyzed 11 studies of men who took erection drugs after prostatectomy. After conventional surgery, erection medication helped 15 percent of them. (That's because conventional surgery sometimes preserves the nerves.) After nerve-sparing surgery, however, the drugs helped about 50 percent of the men.
Bottom line: For the best chance of preserving sexual function, opt for nerve-sparing surgery, then use erection medication.
Men don't need erections to enjoy pleasurable orgasms
Different nerves control erection and orgasm. So even when prostate-cancer treatment damages or destroys the erection nerves, those that govern orgasm usually remain intact. Yes, it's an adjustment to have a flaccid penis stimulated to orgasm. But in an erotic context with sufficient stimulation by hand, mouth or vibrator, it's entirely possible.
A recent Canadian study shows that sex therapy helps couples resume sex after prostate-cancer treatment. The 77 couples who participated in the study enjoyed "significant gains in sexual function." To find a sex therapist near you, visit the American Association of Sexuality Educators, Counselors and Therapists; the Society for Sex Therapy and Research; or the American Board of Sexology.
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