Erectile dysfunction after surgery to remove the prostate (radical prostatectomy) has traditionally been attributed to nerve damage that theoretically should heal over time.
But it can take as long as two years for the nerves to recover enough for a man to have an erection without the aid of drugs or devices. By that time, other damage may have occurred, according to an article in the latest issue of Perspectives on Prostate Disease.
The Harvard Medical School bulletin notes that when the penis is flaccid for long periods of time, it is deprived of a lot of oxygen-rich blood. Recent research suggests that this low oxygen level causes some muscle cells in the penis’s erectile tissue to lose their flexibility. The tissue gradually becomes more like scar tissue, interfering with the penis’s ability to expand when it’s filled with blood.
Therefore, the traditional advice given to men — to wait for erectile function to return on its own — may not be adequate. Simply put, erections seem to work on a use-it-or-lose-it basis. To prevent the secondary damage that may occur if the penis goes too long without erections, researchers now think it’s better to restore erectile function soon after prostate removal. Treatment options include using a vacuum pump device or taking erectile dysfunction drugs by mouth or by injection into the penis.
According to Dr. Marc Garnick, editor in chief of Perspectives on Prostate Disease and a Harvard oncologist, "Although the evidence supporting this ‘penile rehabilitation’ isn’t perfect, you may want to ask your doctor about the options. Such early intervention may help increase the odds that you will regain erectile function."
Also covered in the 48-page report:
– Alternative therapies for prostate cancer
– Handling a prostate cancer relapse
– Surgical options for benign prostatic hyperplasia
A year’s subscription to Perspectives on Prostate Disease is available for $99 (for print and electronic versions; $89 for electronic only) from Harvard Health Publications, the publishing division of Harvard Medical School.