For many men who experience erectile difficulties after undergoing treatment for prostate cancer, erectile aids (EAs) such as oral medications (PDE5i), vacuum erection devices (VED), and intra-cavernosal injections (ICI) offer a means of achieving an erection post treatment. However, even though the majority of prostate cancer patients experience erectile difficulties for months, years, or indefinitely after treatment, some choose never to use EAs, and some who use EAs ultimately end up abandoning them.

Why is this? The authors of a recent Journal of Sexual Medicine study used a self-report survey including validated questionnaires to assess the use and perceptions of helpfulness of EAs, as well as the psychological and sexual well-being of 260 North American men who had been treated for prostate cancer. They found the following:

• Approximately 22% of the respondents had never used an EA.
• Forty percent of the participants reported having used only one type of EA, and 38.5% reported having used two or more EAs.
• The most frequently used EA in this study was PDE5i, and 70% of the respondents said that they had used the oral medications “sometimes” or “often.” Of the individuals who had used PDE5i, 24.7% indicated that they were still using it, 18.1% had stopped using it, and the remainder (57.2%) did not specify one way or the other.
• Regarding VED and ICI treatments, 30.4% and 28.9% of the participants reported using them, respectively. At the time of the study, 17.7% of those who had used VED continued to do so, while 26.5% had stopped. As for ICI, 35.1% continued to use the treatment, while 33.8% had abandoned it.

Interestingly, the lesser used ICI treatments were generally perceived to be more helpful for participants than the more widely used oral medications and VED. While the majority of the participants had used PDE5i, approximately 30% reported it to be helpful, and an even smaller proportion of the VED users (22.8%) found the treatment to be helpful. In contrast, 57% of those who tried ICI found the injections to be helpful.

Through an open-ended question (“Do you have any other comments about the use of these treatments (oral medications, vacuum erection device, penile injection, etc.)?”) the researchers unearthed reasons why participants were satisfied/dissatisfied with EAs.

• Those who found EAs helpful pointed to their efficacy in straightforward terms such as “it works well” and “it helped tremendously.” Some also mentioned that EAs allowed them to achieve “quicker” and “firmer” erections that “lasted longer.”
• On the other hand, those who were not wholly satisfied with EAs cited a number of reasons:
  • Side effects including genital pain, headache, congestion, and priapism.
  • A lack of efficacy when the treatment produced no effect for the individual, or when it produced a partial/inconsistent effect that was not sufficient for sexual activity.
  • The inconvenience of stopping sexual activity to use the treatment, as well as the effort and planning required to do so.
  • The feeling of reliance on the EA to achieve an erection.
  • The financial costs associated with obtaining and using EAs.
  • The emotional hurdles of starting to use an EA for sexual activity, including fear and demoralization.

According to the results of this study, the men who tried EAs and found them unhelpful reported poorer psychological and sexual well-being than those who had never tried EAs and those who had tried EAs and found them helpful.

This group’s discouragement with EAs could potentially be mitigated through enhanced pre- and post-treatment patient education efforts. When a person has realistic expectations of the benefits and possible drawbacks of treatment, they are better equipped to make informed health decisions for themselves. Additionally, EA experiences could be improved through ongoing, case-specific problem-solving approaches in which the patient could work with a provider to address any issues that may arise.

Resources:

• Walker, L.M., Sears, C.S., & Santos-Iglesias, P. (2021). Hard Times: Prostate Cancer Patients’ Experiences with Erectile Aids. The Journal of Sexual Medicine, 18(10), 1775-1787. DOI: https://doi.org/10.1016/j.jsxm.2021.07.012.