Can radiation therapy cause erectile dysfunction, and how can patients cope?

Radiation therapy can sometimes cause erectile dysfunction (ED), especially when treating prostate cancer, and the changes may appear months or even years after treatment. ^[1] These effects can include difficulty getting or keeping an erection, changes in orgasm sensation, and reduced semen volume or thickness. ^[2] The risk and severity vary by age, baseline erectile function, and whether structures involved in erections (nerves and blood vessels) are affected. ^[3]

Why ED can occur after radiation

• Vascular changes: Radiation may gradually damage blood vessels that supply the penis, reducing blood flow needed for erections over time. ^[4]
• Delayed onset: Sexual changes often develop slowly, commonly emerging 6–12 months after therapy and can progress over several years. ^[2]
• Individual factors: Older age, preexisting heart disease, high blood pressure, diabetes, and smoking can increase ED risk because these conditions already affect arteries, which radiation can further worsen. ^[5]
• Treatment specifics: Both external-beam radiation (including IMRT) and brachytherapy can be associated with ED, though modern planning aims to minimize exposure to nearby tissues critical for sexual function. ^{[2] [6]}

How common and how long it lasts

Many people treated for prostate cancer experience some decrease in erectile function, and ED can last from a few months to a few years. ^[3] In one series of men receiving external-beam radiation, the proportion reporting the ability to have intercourse dropped notably by one year, reflecting the gradual nature of radiation-related changes. ^[4] These outcomes are variable, and some men improve with targeted rehabilitation and treatment. ^[3]

Coping strategies: Evidence-based options

Optimize overall health

• Manage risk factors: Controlling blood pressure, cholesterol, diabetes, and stopping smoking can improve erectile performance and treatment response. ^[7]
• Open communication: Discuss symptoms early with your care team; timely support reduces distress and speeds access to effective therapies. ^[1]

First-line treatments

• Oral medications (PDE5 inhibitors): Sildenafil (Viagra), tadalafil (Cialis), and related drugs are commonly used to improve erections after cancer therapy. ^[8] These medicines are generally considered safe and effective when used under medical guidance. ^[9]

Penile rehabilitation programs

• Structured rehab: Early, proactive therapy aims to preserve penile oxygenation and regular erections to prevent tissue scarring and atrophy. ^[10] Programs may start before or shortly after treatment and are tailored to baseline function and personal goals. ^[11]
• Combination approaches: Evidence supports early and assertive use of therapies oral medications, penile injections, vacuum devices to speed and improve recovery of sexual function. ^{[12] [13]}

Devices and injections

• Vacuum erection devices (VED): A penis pump draws blood into the penis to create an erection; a constriction band helps maintain it during intercourse, and the device has low systemic risk. ^[14]
• Intracavernosal injections: For men who do not respond to pills, injections can reliably produce erections and are often included in rehabilitation protocols. ^[12]

Surgical options

• Penile prosthesis: When other treatments are not effective, inflatable or semi-rigid implants can restore reliable erections; this option is typically considered after trying less invasive measures. ^[14]

Practical tips for recovery

• Start early and be consistent: Regular erections spontaneous, medication-assisted, or device-assisted help maintain penile health during recovery. ^[10]
• Expect gradual change: Improvements may take months; setting realistic expectations reduces anxiety and helps adherence to therapy. ^[3]
• Partner involvement: Including a partner in discussions and rehab can improve satisfaction and coping during recovery. ^[12]
• Report new symptoms: Pain with ejaculation, major changes in orgasm, or persistent ED should be shared with your team to adjust therapy. ^[2]

When to seek help

If erections worsen over months after radiation or do not improve with first-line treatments, ask for referral to a sexual health specialist or a dedicated penile rehabilitation program. Specialists can adjust medication, add devices or injections, and tailor a plan to your goals and medical history. ^{[7] [10]}