Penile Rehabilitation

Treatment of pelvic cancers such as prostate, bladder or rectal cancer can affect the ability to get erections.

New evidence is emerging that to maximise erectile function recovery after major pelvic surgery (e.g. radical prostatectomy) or pelvic radiation, undergoing penile rehabilitation may be beneficial.

At Men’s Health Melbourne, we work in co-ordination with your surgeon or your radiation oncologist to develop a tailored plan to try and improve your erections.

Why do some men get erection problems after prostate cancer treatment?

There are several different reasons why some men suffer erection problems after cancer treatment. One of the main factors is that during surgery, and even during radiation to the prostate, the structures that help give you erections (such as the erection nerves) may be injured. This is because the erection nerves sit right on the prostate and even if you have had “nerve sparing surgery”, the nerves can still become ‘bruised’ as they are dissected away from the prostate.  When the erection nerves are not working as they should, the penis cannot get adequate erections.  

What is the background to penile rehabilitation?

Almost all men, whether they realise it or not, have been getting regular nocturnal erections every night ever since they were a teenager.  Why this happens is unclear but one theory is that the penis needs to get regular erections to keep the penile tissues healthy.  Regular erections bring in fresh, oxygenated blood and maintain stretch on the penis.

Using an analogy of an injured arm can help explain penile rehabilitation a bit further. If you injure your arm and it is placed in a plaster cast for a few months, then you will notice that after the plaster is removed, your arm muscles have shrunk or “atrophied”.  You then need to do “rehabilitation”, such as physiotherapy and exercises, to get your muscles back to peak shape. 

Similarly, when the penis is unable to do what is does normally, i.e. get regular erections, then the muscles in the penis can also shrink and become atrophied.  However, unlike the muscle in your arm, which is skeletal muscle, the muscle in the penis is a different type of muscle – smooth muscle.  Skeletal muscle (in the arm) has a great capacity to rehabilitate even after prolonged periods of not working.   However smooth muscle (in the penis) can develop irreversible scar tissue as a result of prolonged periods of having minimal or no erections.

What is involved in penile rehabilitation?

With the knowledge that regular erections are important for maintenance of penile health, the goal of penile rehabilitation, therefore, is to maximise erectile function recovery by using techniques that help the penis restore the regular erections it needs to prevent scar tissue from forming.   As mentioned above, getting erections brings in a large amount of oxygenated blood that can help to prevent scar tissue from forming.  Furthermore, when you get an erection, it helps to maintain stretch on the penis, which may help prevent penile shortening.

Another key part of penile rehabilitation is taking a very low dose of regular erection-promoting pills such as Viagra, Cialis or Levitra.   When you take these medications at a very low dose (often just a quarter of a pill) the goal is NOT to get an erection (for that other methods are used), but instead these regular low dose medications should be considered like a “vitamin for the penis”.

It has been found that these drugs are “endothelial protectants”.  Endothelial cells line all blood vessels in the body.  In your penis they are abundant, and inside these cells many of the substances that cause your penis to get an erection are made.  By taking this medication regularly, you are helping to protect these cells that are vital for getting erections and further help to prevent scar tissue from forming.

What types of special techniques are used?

At Men’s Health Melbourne, we base our penile rehabilitation protocol on the Memorial Sloan Kettering Cancer Centre program. This world-renowned cancer centre in New York, USA has pioneered many aspects of penile rehabilitation under the direction of Professor John Mulhall. A/Prof Katz has worked extensively with Prof Mulhall and has seen first-hand the benefits of a comprehensive penile rehabilitation program. The rehabilitation program is tailored to the individual but may involve one or more of the following: erection-promoting pills (Viagra, Levitra, Cialis), penile injection therapy or vacuum devices.

Where can I get more information?

Theurologists or radiation oncologists treating your cancer are a great place to start. They can help you to decide if penile rehabilitation may be the right treatment for you and can often start you on the program.

If you are still unsure about any aspect of penile rehabilitation, the specialists at Men’s Health Melbourne would be happy to discuss it with you in detail.