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What Are My Options for Treating Erectile Dysfunction?

I am 80 years of age and have not had an erection for at least three years. I had prostate treatment in the hospital in 2009 and have had trouble ever since. I have spoken to my doctor and urologist about my problem and did get two prescriptions for Viagra, which didn't help. Are other options available?

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Erectile dysfunction is the repeated inability to achieve or maintain an erection firm enough for sexual intercourse. It is not uncommon for men to develop erectile dysfunction after treatment for prostate cancer. This is because such treatments can injure nerves and arteries near the penis, leading to erection problems.
The risk for erectile dysfunction after prostate cancer treatment, and how long the problem may persist, depend on a number of factors. Such factors include age, the type of treatment, and whether a person had erection problems before treatment.
For example, some studies have reported that up to 100 percent of men will develop some degree of erection problem after radical prostatectomy (a surgical procedure in which the prostate gland is removed). The actual risk, however, depends largely on the type of surgery and whether the nerves that control erection are removed or spared. In addition, older men are more likely to develop erectile dysfunction after a prostatectomy, and less likely to regain the ability to get an erection.
Erectile dysfunction also has been reported to occur in up to 80 percent of men after radiation therapy. As opposed to the immediate erection problems that may occur after prostate surgery, erectile dysfunction from radiation therapy usually develops slowly over time.
Other prostate cancer treatments can also commonly cause erection problems. Cryosurgery, which involves freezing the prostate gland, can permanently damage the nerves that control an erection. Hormone therapy stops the body from producing testosterone or blocks the action of testosterone, which can lead to erectile dysfunction or a decreased interest in sexual activity (sex drive, or libido).
Regardless of the cause, there are several treatment options for men experiencing erection difficulties after prostate cancer treatment. The most common treatment is the use of medications known as phosphodiesterase type-5 (PDE5) inhibitors. Viagra® (sildenafil citrate) is an example of a PDE5 inhibitor. Other currently available PDE5 inhibitors include:
All of these medications work in the same way. Essentially, they enhance the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow into the penis. It is this increased blood flow that causes an erection.
Even though the PDE5 inhibitor class of medicines all work the same, it is possible that a person will respond to one PDE5 inhibitor and not another. Therefore, if one of the medications does not work for you, you can talk to your healthcare provider about trying another one. Unfortunately, there is no way to know beforehand whether a particular PDE5 inhibitor will work for an individual person without first trying it.
If another PDE5 inhibitor does not help you get an erection, you can talk to your healthcare provider about other treatment options. These include:
  • Injections
  • Vacuum devices
  • Penile prostheses.
Medication can be injected into the penis to help widen the blood vessels, thus improving penile blood flow and causing an erection. Injections are often tried in cases where PDE5 inhibitors are not successful. Injectable erectile dysfunction medications include:
  • Papaverine hydrochloride
  • Phentolamine
  • Alprostadil (Caverject®).
Mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. These devices can be used alone or in combination with other erectile dysfunction treatment.
Penile prostheses can help restore erection in many men with ED after other treatments have failed. Possible problems with these implants include mechanical breakdown and infection.
In summary, erectile dysfunction is common after prostate cancer treatment. However, there are several viable treatment options. If one treatment does not work, your healthcare provider may be able to recommend something else. It may take time, but with your healthcare provider's guidance and a discussion of what you want and expect from treatment, you and your healthcare provider can find the best treatment for your individual situation.
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