How erections work – the simple version

If you’re a man, you’ve probably had an erection or two.  They just happen – right?  You wake up in the morning and there’s your old mate, standing to attention.  Your good old, reliable one-eyed trouser snake, popping up whenever you need him.

All is well, until suddenly it isn’t.  According to an Australian study, at least one man in five over the age of 40 has an erection problem.  Everything from anxiety to heart disease can impact Mr Percy’s performance.  If you throw in prostate cancer, things generally get a whole lot more difficult.

It may be tempting to just give up, but please don’t.  It helps to understand what your body does to achieve an erection – who are the team players and what are their main tasks during the game, so to speak.

Your erectile team players

Brain – Team Captain

Something you see, hear, smell, touch, or think gets your brain going.  Arousal starts upstairs (in your brain) before the message heads downstairs to your groin.  Your brain triggers the release of chemicals into your bloodstream that get your body into action.  If your brain isn’t sending any signals, the rest of the team can’t do their job.

Diagram showing brain signals down spinal cord to penis to enable erection
(Image courtesy of National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health)
Blood vessels and Nerves – Team Runners

Once your brain has started the game, it’s up to your Team Runners to get the instructions out onto the field.  Your blood vessels carry the chemical messages through your body.  Your nervous system transmits those messages to the muscles.

Muscles – Team Heavy Lifters

Once your muscles get those instructions from the neurotransmitters (chemicals like neural and endothelial nitric oxide), they can then go to work with the blood vessels in your groin.  Smooth muscles in your penis relax, allowing more blood to flow into your penis.  Spongy tissue inside your penis fills up with the fresh blood and, woo-hoo, Mr Percy rises to the occasion.

What happens after prostate cancer treatment?

As you may know, erections generally take a big hit from prostate cancer treatment.  Even with “nerve sparing” surgery, it can still take around two years (or more) for your erections to return.  They may not ever be as strong or as reliable as they once were.

If you are put on ADT (androgen deprivation therapy – suppression of testosterone), your libido (arousal) will also decrease significantly.  All those silly jokes about the wife “having a headache” might begin to hit a nerve with you.

For many men, one of the hardest parts (sorry, bad pun) is the lack of certainty.  There is no way of knowing for certain how long it will take for you to get your mojo back.  Some men will be luckier than others – even the surgeons can’t really tell who will recover best.

Is there any good news?

Of course there are things that you can do to help your old feller.  In our experience, it’s best to try as many as you can until you find the ones that work for you.  The main options are:-

Vacuum pumps

This is the one to use first of all.  Invest in a good quality, medical grade vacuum pump and you will not be sorry.  There are manual versions and battery-operated devices too.  Alan uses a Vacurect, which works really well and is not too bulky.  Vacuum pumps are non-invasive, effective and cost far less than other treatments overall.

Oral therapies

You’ve all heard of Viagra, right?  It’s just one of the oral therapies available – there’s also Cialis and Levitra.  They don’t work instantly and they do have side effects, but they can be part of a penis rehab strategy.

Injection therapies

Yes, we’re talking about injecting a chemical mixture into your penis.  The needles are really, really fine so that they don’t hurt as much.  Trimix and Caverject are the main two injectables – Alan uses Trimix and it definitely works.

Penile implants

Definitely not for the faint-hearted.  There’s major surgery involved, plenty of painful recovery time, and it isn’t cheap.  However, these devices can be very successful.  We have heard from men who are particularly keen on the certainty that their penile implant gives them – they know that it will work whenever they want it to.

And then there’s some really exciting news!

Here in Melbourne, a new nerve-grafting surgery is being trialled.  Dr David Dangerfield and Professor Chris Coombes are working together on “End-to-side Somatic-to-autonomic Nerve Grafting to Restore Erectile Function and Improve Quality of Life After Radical Prostatectomy”.

For men who have had a radical prostatectomy and have not been able to regain their erections, this new technique is looking really promising.

*** We hope to record a conversation with David and Chris in the near future, so watch this space! ***

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