Regaining Erectile Function After Prostate Cancer

Customers sometimes share how erectile dysfunction affected them after treatment, what they tried, and what worked. This account is from one of them, in his own words.

Some background about me: I'm 73 years old, very active, and a lifelong farmer trained in mechanics. I also operate a recycling enterprise that composts stable waste and makes animal bedding from clean wood scraps, mulch from tree waste and stumps, and food-waste composting.

In 2007 I was diagnosed with prostate cancer after routine tests showed a slightly elevated PSA (prostate-specific antigen). A biopsy confirmed an early-stage cancer, and in October 2007 I had robotic surgery to remove the prostate gland. Before surgery I had no symptoms of any kind. After surgery I had complete ED and incontinence. With time the incontinence improved; the ED did not.

At four months after surgery I was prescribed penile injections. They were better than nothing, but I was sensitive to the medicine and had a severe ache from it. I then learned about using a vacuum device with a constriction ring and began figuring out how to restore usable erectile function.

I hope sharing this shortens the learning curve for others. I have been active in two face-to-face prostate cancer support groups for many years. Sharing what works — and listening to what works for others — has been useful.

ED is treatable. Four basic approaches cover most of what men try:

1. Mild ED often responds to oral medication.
2. For more severe ED, penile injections can be effective if you can tolerate an injection into the penis and the medicine. Dose and placement need to be exact. They are fairly expensive and have limits on how often they can be used.
3. A vacuum device with a constriction ring can create an erection without drugs and without frequency limits, and it can help restore length when nocturnal erections are absent. Used with oral medication or with natural erections, constriction rings also help maintain the erection when you change position or when anxiety about losing it would otherwise cause loss.
4. Penile implants — inflatable tubes in the penis with a pump in the scrotum and a reservoir in the lower pelvis — are effective. They remove any remaining natural erection ability and usually reduce penile length slightly.

Every man with ED will try different treatments until he finds what works for him. These are the practices that have helped me most.

Joint showers

A counselor suggested joint showers, because ED affects both partners and reduces ordinary intimate contact. With both partners agreeing, it is a practical way to rebuild contact without making every encounter a sexual demand. It should not be an automatic prelude to sex unless both agree.

Standing favors blood flow to the penis, and being with a naked partner supplies visual and tactile stimulation, so the exercise also shows whether any erectile response remains. Some men I know who believed they had complete ED found they still had some response during this exercise. It can also reassure a partner that she is still desired.

Pumps and constriction rings

I have found a vacuum pump and constriction ring effective for getting and maintaining an erection. Technique matters.

Do not pump up before foreplay. If you do, by the time your partner is ready, the penis will be cold. Cold tissue at penetration is uncomfortable for the partner and can end the attempt.

Your partner should tell you when she is ready for you to pump. Try different lubricants, including warming ones, and ask what she prefers. While you are pumping, a small vibrator can occupy her time.

Prepare beforehand:

• Install the constriction ring on the vacuum tube
• Have lubricant ready
• Trim or shave the base of the penis to help the vacuum seal

When ready to pump, use lubricant generously on the penis and scrotum. Good lubrication makes the process quicker and helps stretch out skin folds. Just before inserting the penis into the tube, stretch it with a milking action a few times to push some blood toward the tip and lengthen the shaft.

Insert the penis into the tube and start the vacuum. Pump to a comfortable level, release some pressure, then pump again to the desired level. Do not release the vacuum before sliding the constriction ring off the tube. With vacuum still applied, pull outward on the tube and push the ring off, then release the vacuum. Keeping vacuum while sliding the ring off holds the ring tight against the body, which maximizes length and reduces a hinge effect (a weak bend point) at the base of the penis.

Remove the ring within 30 minutes.

Stability and sensation with Xialla

I have substantial venous leakage, so I prefer a wider, stretchy ring for fit. Using a Pos-T-Vac Hex ring together with Xialla gives me the fit I need and better stability.

I slide the Xialla ring onto the vacuum pump first, then the Pos-T-Vac Hex ring. After pumping to an erection, I slide the Hex ring and then the Xialla ring onto the penis. With Xialla against the body I get a tighter seal. With the Hex ring alone, the ring moved during intercourse; with Xialla, the strap holds it in place.

The other useful effect for me was sensation. With the Xialla strap around the testicles and against the perineum, I had ejaculatory sensation I had not had since surgery. Without a prostate there is no semen, so orgasm is weaker than before surgery. Pressure from the strap made a real difference.

I hope this helps other men find a workable approach after prostate cancer treatment.

If you have questions about anything in this article, write to us at hello@xialla.com. We read and answer every message.