Counselling and talking therapies

Your GP is trained to deal with ED but they (and your cancer team) can also refer you to cognitive behavioural therapy (CBT). Sex therapy and other types of counselling are also an option, though there may be a long wait so you may prefer to find a private accredited therapist through the British Association of Counsellors and Psychotherapists.

These therapies can help you manage how you feel about the changes you are going through, and help you think through how they impact your relationships. If you find it hard to communicate with your partner or are concerned about the impact of these changes on your relationship, you may be able to access couples therapy on the NHS or find someone privately.

Support groups

Cancer Care Map provides details of a range of support groups for people with cancers that may affect people’s lives. (Go to Cancer Care Map and type ‘erectile dysfunction’ as the keyword. Prostate Cancer UK provides a listing of prostate cancer support groups. The relationship charity Relate provides sex therapy, while the College of Sexual and Relationship Therapists provides a range of factsheets and information about therapies.

Author: Dipl. Biol. Esther Witte| Reviewer: Dr. Christian Keinki

Sources:

• Homepage. (2022). Cancer Care Map. https://www.cancercaremap.org/
• NHS website. (2021a, November 18). Erectile dysfunction (impotence). Nhs.Uk. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
• NHS website. (2022b, May 30). What does a sex therapist do? Nhs.Uk. https://www.nhs.uk/common-health-questions/sexual-health/what-does-a-sex-therapist-do/
• Sexual problems | Prostate cancer | Cancer Research UK. (2019). Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/hormone-symptoms/sex-hormones-relationships
• Carter, J., Lacchetti, C., & Rowland, J. H. (2018). Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation Summary. Journal of Oncology Practice, 14(3), 173–179. https://doi.org/10.1200/jop.2017.028134
• sda.uk.net. (2016). Sexual Advice Association. http://www.sda.uk.net/ed
• British Association for Counselling and Psychotherapy. (2022, July 6). British Association for Counselling and Psychotherapy. https://www.bacp.co.uk/
• Support groups. (2022). Prostate Cancer UK. https://prostatecanceruk.org/get-support/support-groups
• Spencer, M. (2021, October 27). COSRT Factsheets: PDF Downloads: Information for the public on therapy. Cosrt. https://www.cosrt.org.uk/factsheets/

What are the treatment options?

Erectile dysfunction isn’t something that you have to live with. The sooner you talk to your treatment team, the better the chances of improving your sex life. Your doctor can suggest several interventions.

PDE-5 inhibitors: These drugs dilate the blood vessels and allow more blood to flow into your erectile tissue. They are taken in tablet form and last for several hours. They are effective if nerve bundles are preserved and sexual arousal is present when they are used. However, they can have undesirable side effects on the heart and circulation and must not be taken with some heart medications.

Penile injection therapy or MUSE: Penile injection therapy or erectile tissue auto-injection therapy and MUSE (medicinal urethral system for erection) are two therapies based on the body’s own messenger substance prostaglandin E1. With penile injection therapy, you have to inject the medication directly into the erectile tissue or into the urethra with MUSE using a rod. Overdoses can lead to painful permanent erections. Erectile tissue auto-injection therapy and MUSE are also effective for severed nerves.

Mechanical aids: If you don’t want to or are not allowed to take medication, vacuum erection aids are an alternative. You insert your member into a plastic cylinder and create a vacuum with a pump. The vacuum helps to fill the erectile tissue with blood. A penis ring is then placed at the root of the stiff member to stop the blood from flowing back. This keeps the penis stiff. There are hardly any side effects to worry about with mechanical aids. However, a penis ring should be removed after 30 minutes at the latest so that the blood flow in the erectile tissue is normal again and no damage occurs.

Pelvic floor training: The muscles in the pelvic floor support the flow of blood into the penis. They can also help you maintain an erection for longer. Regular pelvic floor exercises support these muscles and can relieve erection problems, especially in combination with other therapies.

Author: Dr. Volker Henn| Reviewer: Dr. Christian Keinki

Sources:

• How Cancer Can Affect Erections | Adult Males with Cancer. (2020). American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-men-with-cancer/erections-and-treatment.html
• Difficulty getting an erection | Prostate cancer | Cancer Research UK. (2019). Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/sex-relationships/difficulty-getting-erection
• Yetman, D. (2020, November 20). What Are the Most Common PDE5 Inhibitors? Healthline. https://www.healthline.com/health/pde5-inhibitors
• Roland, J. (2020, March 5). Erectile Dysfunction Injections: How to Inject, What to Expect, and More. Healthline. https://www.healthline.com/health/erectile-dysfunction-injections
• Alprostadil (Urethral Route) Proper Use – Mayo Clinic. (2022). MayoClinic. https://www.mayoclinic.org/drugs-supplements/alprostadil-urethral-route/proper-use/drg-20138507?p=1
• Erectile Dysfunction (ED): Causes, Diagnosis & Treatment. (2019). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#:%7E:text=Mechanical%20aids,penis%20and%20causes%20an%20erection.
• Case-Lo, C. (2018, September 17). Exercises to Eliminate Erectile Dysfunction. Healthline. https://www.healthline.com/health/erectile-dysfunction/exercises

It’s important to know that pleasure is not just limited to sexual intercourse and orgasms. Our brains have a special area called the diencephalon, which can be activated by emotions, sensory perceptions, and thoughts. This means that we can experience sensuality and intimacy in many different ways.

There are various ways to express affection and connection with others, and create a sense of closeness. These can include having deep conversations where we express our wishes and needs, sharing imaginative and romantic experiences, practicing hobbies together, and making plans for the future.

Other ways to experience pleasure and intimacy can include gentle touching, oral stimulation, tender massages, and exploring erotic fantasies. By focusing on creating these intimate moments with our loved ones, we can build strong connections and deepen our relationships.

Author: Dipl. Biol. Esther Witte| Reviewer: Dr. Christian Keinki

Sources:

• Homepage. (2022). Cancer Care Map. https://www.cancercaremap.org/
• NHS website. (2021a, November 18). Erectile dysfunction (impotence). Nhs.Uk. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
• NHS website. (2022b, May 30). What does a sex therapist do? Nhs.Uk. https://www.nhs.uk/common-health-questions/sexual-health/what-does-a-sex-therapist-do/
• Sexual problems | Prostate cancer | Cancer Research UK. (2019). Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/hormone-symptoms/sex-hormones-relationships
• Carter, J., Lacchetti, C., & Rowland, J. H. (2018). Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation Summary. Journal of Oncology Practice, 14(3), 173–179. https://doi.org/10.1200/jop.2017.028134
• sda.uk.net. (2016). Sexual Advice Association. http://www.sda.uk.net/ed
• British Association for Counselling and Psychotherapy. (2022, July 6). British Association for Counselling and Psychotherapy. https://www.bacp.co.uk/
• Support groups. (2022). Prostate Cancer UK. https://prostatecanceruk.org/get-support/support-groups
• Spencer, M. (2021, October 27). COSRT Factsheets: PDF Downloads: Information for the public on therapy. Cosrt. https://www.cosrt.org.uk/factsheets/

Erectile dysfunction is a common concern for individuals undergoing prostate cancer treatment. Several procedures, such as complete removal of the prostate gland or radiation treatment, can lead to damage to blood vessels and nerves, which can cause this issue. While hormone deprivation treatment does not directly affect physical functioning, it can impact your desire and interest in sexual activity.

Fortunately, there is a nerve-sparing surgical method that has been developed to help alleviate the problem. However, it’s important to know that even with this method, 2 to 4 out of 10 individuals may still experience erection problems after surgery. Additionally, it’s worth noting that radiation treatment can cause erectile dysfunction that may not appear for a few weeks or months.

Author: Dr. Volker Henn| Reviewer: Dr. Christian Keinki

Sources:

• How Cancer Can Affect Erections | Adult Males with Cancer. (2020). American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-men-with-cancer/erections-and-treatment.html
• Difficulty getting an erection | Prostate cancer | Cancer Research UK. (2019). Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/sex-relationships/difficulty-getting-erection
• Yetman, D. (2020, November 20). What Are the Most Common PDE5 Inhibitors? Healthline. https://www.healthline.com/health/pde5-inhibitors
• Roland, J. (2020, March 5). Erectile Dysfunction Injections: How to Inject, What to Expect, and More. Healthline. https://www.healthline.com/health/erectile-dysfunction-injections
• Alprostadil (Urethral Route) Proper Use – Mayo Clinic. (2022). MayoClinic. https://www.mayoclinic.org/drugs-supplements/alprostadil-urethral-route/proper-use/drg-20138507?p=1
• Erectile Dysfunction (ED): Causes, Diagnosis & Treatment. (2019). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#:%7E:text=Mechanical%20aids,penis%20and%20causes%20an%20erection.
• Case-Lo, C. (2018, September 17). Exercises to Eliminate Erectile Dysfunction. Healthline. https://www.healthline.com/health/erectile-dysfunction/exercises