ERECTIONS ∙ 4 minutes read

A doctor explains what to do if you have erectile dysfunction after cancer treatment

By Kirsty Mason | Medically reviewed by Dr Luke Pratsides

Cancer treatment can damage the nerves and alter the hormones in your body. These bodily functions are vital for achieving a healthy erection, so it’s no surprise that many cancer treatments are linked to erectile dysfunction. We spoke to our lead GP, Dr Luke Pratsides, to find out why cancer treatment can be harmful to erections and what can be done to tackle the problem.

For a man to achieve and maintain an erection, a complex set of physiological events must take place. So, when the biological makeup of the body is disrupted in some way - either through surgery, chemotherapy, or radiotherapy - you’re more at risk of experiencing erectile dysfunction (ED). ED can be psychological and is common in people with anxiety or depression

A common physical cause, which is usually underpinned by nerve damage or hormonal variations, is cancer treatment. Cancer treatment may also lead to psychological erectile dysfunction, especially in men who have undergone an orchidectomy (removal of a testicle). Some types of cancer treatment, such as a prostatectomy, put you at greater risk of developing ED, especially if the nerves that run alongside the prostate gland are damaged during the surgery.

There are several treatment options available, with the most suitable largely dependent on the type of treatment you’ve had and your individual circumstances. You may be recommended erectile dysfunction medication, or more radical methods of treatment, such as a vacuum pump. For support and advice while going through cancer treatment or recovering from the side effects of the medication, Orchid is a charity for men experiencing testicular, prostate or penile cancer.

Our lead GP, Dr Luke Pratsides, talks us through the types of cancer treatment that commonly cause ED, and what can be done to tackle the problem.

1. Erectile dysfunction after prostate surgery

Prostate cancer is the most common form of cancer in men. Treatment for the condition includes a radical prostatectomy, which is the removal of the prostate gland. ED problems after surgery are common with the procedure also putting men at risk of ejaculation issues. Prostate Cancer UK found that 76% of men treated for prostate cancer went on to experience ED.

“Prostate surgery frequently damages the nerve tissue around the prostate gland, as well as harming the muscles and the blood vessels that surround the penis,” explains Dr Luke. “The nerve tissue in this area is critical because it receives messages from the brain which signal when to be erect. The extent of the damage depends on factors such as the location of the cancer and precision of the surgery. Even very accurate surgeons may be forced to damage the nerves, at least in part, to ensure that all the cancer is removed during the prostatectomy. If the cancer is located in an appropriate place, the surgeon may be able to avoid nerve damage. This is known as nerve-sparing surgery. You still need time to heal after this type of surgery and could still experience ED.”

Although damage to the nerves is common during a prostatectomy, there are treatments available. “If damage to the nerve tissue is extensive, then it will be much more difficult to regain control over erections,” says Dr Luke. “It can take weeks or even years before a man regains full erectile control. Some men will never be able to achieve an erection on their own. But that’s not to say that the condition can’t be improved with treatment. The first course of treatment is usually erectile dysfunction medication, such as sildenafil, Viagra, or tadalafil. All these treatments are PDE5 inhibitors, which essentially means that they allow more blood to flow to the penis.”

If typical erectile dysfunction medications don’t work for you, there are more unusual methods of treatment available. “Another method of treatment is penile injections. This is an injection that goes directly into the base of the penis. The shot of medicine encourages blood flow and should prompt an erection after about 10 minutes. If this is the best treatment for you, a doctor will explain how to administer the treatment yourself.”

Sometimes, there’s too much nerve damage to encourage an erection, even with ED tablets or penile injections. In this case, you might be recommended an external method of treatment. “A more unusual method of treatment is a vacuum pump,” says Dr Luke. “This is a device that mechanically encourages an erection by creating a vacuum around the penis that promotes blood flow. The erection is retained using a rubber ring that wraps around the base of the penis to ensure the blood remains inside it. If this doesn’t work for you, there are extreme cases where you can have a surgical procedure to manually create an erection.”

2. Erectile dysfunction after radiotherapy

It can take years before the damage caused by radiotherapy can have a noticeable effect on your erections, with some men developing ED up to 2 years after treatment. Around 50% of men will develop radiotherapy-induced ED within 5 years of receiving treatment. There are several ways radiotherapy that’s centred in the pelvic area might harm your erections. 

“Radiation can damage the nerves in the pelvic area, as well as the blood vessels that are connected to the penis,” explains Dr Luke. “Radiotherapy could also lead to a reduction in testosterone levels, which is associated with reduced libido. This can result in erectile dysfunction.”

The likelihood that you’ll experience ED after radiotherapy depends on several factors. “The extent to which the nerves and arteries are damaged depends largely on the intensity of the treatment,” explains Dr Luke. “Radiotherapy also reduces sperm production and can leave some men infertile. It’s advisable to store your sperm in a sperm bank if you want to father a child in the future.”

ED treatments after radiotherapy include erectile dysfunction medication, penile injections and vacuum constriction devices.

3. Erectile dysfunction after chemotherapy

Some men experience ED during chemotherapy and for a short while afterwards. “Chemotherapy can cause ED,” says Dr Luke. “This is because some chemotherapy drugs reduce the production of testosterone in your body, which lowers libido, resulting in erectile dysfunction. Fatigue from the chemo drugs could also be responsible for a lowered libido, as well as the psychological burden of going through cancer treatment.”

Levels of testosterone production should return to normal after ceasing treatment. “Men usually regain sexual function a few weeks after finishing treatment,” says Dr Luke. “If the problem persists, you should speak to your doctor and consider other causes of ED, such as anxiety about the disease.”

4. Erectile dysfunction after an orchidectomy

Performance anxiety after cancer treatment is a neglected topic but many men experience this form of ED.

“Although physical complications after an orchidectomy (which is the removal of one or both testicles) can occur, I often find patients suffer from performance anxiety after the operation,” says Dr Luke. “The change to their body might lead to body image anxiety, which is a common cause of erectile dysfunction. I recommend psychological therapy to deal with the changes and speak openly about your concerns to your partner.”

Numan has teamed up with Savoo and Orchid - a charity that offers a range of support services for the 50,000 men diagnosed with prostate, testicular and penile cancer each year, to raise awareness for men's health. 

The bottom line

It’s common for cancer treatment to disrupt the hormonal balance in your body or damage the nerves - both of which are important functions for an erection. Although major damage to nerves can be difficult to treat, most men will regain erectile function eventually or be able to use products that help them to get an erection.

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