Written by Adam Cuthbertson-Chin, Nurse Practitioner
Erectile dysfunction (ED) is a prevalent issue among men over 40. ED can understandably impact your self-perception and overall quality of life.
Addressing erectile dysfunction is a deeply personal journey. At AUA, we endeavour to understand your unique goals, while upholding professional and confidential conduct to provide you with privacy. Whether you aim to achieve erections suitable for sexual activity, maintain penile health and length, satisfy yourself, or boost your self-esteem, we have the expertise to support you throughout your journey of penile rehabilitation and sexual recovery. Furthermore, if you have a partner, their involvement is invaluable, and we encourage you to include them in your appointments if you wish.
What causes erectile dysfunction?
The causes of erectile dysfunction are often multifaceted. Neurogenic ED can result from nerve damage, often due to surgery such as prostate cancer or bowel procedures. Psychological factors like stress, performance anxiety, and depression commonly contribute to ED. Additionally, more serious medical conditions such as vascular and metabolic disorders (e.g. narrowed arteries, high blood pressure, diabetes), hormonal imbalances (like low testosterone), and the use of prescription or recreational drugs, smoking, and alcohol consumption can also lead to ED.
Achieving an erection involves a complex interplay of vascular, hormonal, neurological, and psychological factors. The corpora cavernosa, two spongy tissue tubes running along the length of the penis, play a crucial role. During arousal, the brain communicates with erectile nerves, releasing neurotransmitters that signal the arteries to fill the penile spongy tissue with blood. These tubes expand and pressurise, maintaining the erection until stimulation is complete. Men with healthy erectile function can achieve erections with arousal or stimulation and often experience nocturnal erections during sleep.
Sexual function following radical prostatectomy for prostate cancer
After prostate cancer surgery, ED can occur due to the proximity of the erectile nerves to the sides of the prostate. As such, these nerves can often be damaged with prostate cancer treatments – both surgery and radiotherapy. Even with nerve-sparing surgery, nerve function may take several months and up to two years to fully recover. Recovery varies among individuals and depends on factors such as age, baseline sexual function, other medical conditions, and surgical considerations. There are several interventions available for post-prostatectomy ED, and we’ll work with you to establish your specific goals and create a tailored treatment plan. For many men, the goal is to regain erections suitable for sexual activity, while others, who may not be sexually active, aim to preserve penile length and optimize penile health. Early penile rehabilitation, including pharmacological (tablets and injections) or the use of a vacuum device, is crucial to prevent adverse structural changes like penile fibrosis and loss of length and girth.
Research suggests that a penile rehabilitation program can prevent permanent damage and improve the chances of restoring normal erectile function. We strive to provide you with a fully supportive and collaborative environment to help manage any anxiety related to ED and performance issues, as high anxiety levels can further hinder the ability to achieve and sustain erections.
Erectile dysfunction treatment
Treatment options for ED range from non-pharmacological interventions like vacuum devices to tablet medications, injectable medications, or penile prostheses.
Intracavernosal injections (ICI) involve injecting medication into the penile spongy tissue, producing a rigid erection within minutes. ICI is not dependent on functioning nerves, making it more reliable in achieving an adequate erection, but is dependent on having healthy blood vessels to the area. It’s an excellent choice for men experiencing side effects with tablet medications, or for those where the tablets are not effective, and is particularly helpful in the first few months after surgery whilst the nerves are slowly recovering. It is very common to experience some apprehension of self-injecting, and this will be addressed during the education process in our clinic, providing you with the confidence to continue with the treatment when you’re at home. Penile injections are an option whether you are sexually active or not, as many patients opt for them to maintain self-esteem, self-satisfaction, or restore bodily function.
For men with post-prostatectomy ED, this treatment option is often preferred as it doesn’t depend on functional nerves like tablet medications. Therefore, it’s especially beneficial in the early weeks to months post-surgery during nerve recovery or in the case of a non-nerve sparing surgery.
Our sexual function program at AUA ensures patients receive comprehensive education on medication preparation and safe self-injection. You’ll be supported throughout the process of incorporating penile injections into your life, with a point of contact for troubleshooting.
Surgical options
An alternative approach to addressing ED is with a penile prostheses. This is a surgically implanted device placed into the corpora cavernosa, connected to a fluid reservoir and activation button in the scrotum. It’s a viable option for men who have not responded to less invasive treatments. Penile prostheses are considered a last-line treatment option, as other options become ineffective once the prosthesis is implanted. However once implanted, satisfaction rates are extremely high in this motivated group of patients.
Our Sexual Function Clinic at AUA is run by our Nurse Practitioner, Mr Adam Cuthbertson-Chin, who works in collaboration with our Urologists and possesses extensive knowledge and expertise in assisting men with erectile dysfunction.
For further information, please contact our rooms on (03) 8506 3600.
