Erectile Dysfunction and Cancer: How Common, Why It Happens, and What Helps

Erectile dysfunction (ED) is a common issue among men during or after cancer treatment, and it can affect quality of life. ^[1] Many male survivors report trouble getting or keeping an erection, with risk especially higher after prostate treatments and certain other therapies. ^[2] [PM21]

How Common Is ED with Cancer?

• ED is the most frequent sexual problem reported by male cancer survivors. ^[1]
• Men treated for prostate cancer (surgery, radiation, hormone therapy) often experience ED, sometimes immediately after surgery or gradually after radiation. ^[3] [PM22]
• Across oncology settings, sexual function changes are widespread: estimates suggest 40–85% of male survivors may experience sexual dysfunction, including ED. [PM19]

These figures can vary by age, baseline health, cancer type, and exact treatment received. It’s helpful to view ED as a multifactorial, often treatable consequence of cancer and its care. [PM21] [PM19]

Why Does ED Happen? Key Causes

Multiple pathways can lead to ED in cancer settings, and more than one may apply at the same time. [PM21]

• Treatment-related nerve and vessel injury: Prostate surgery can affect the nerves and blood supply critical for erections; radiation may cause later-onset changes leading to ED. [PM22] [PM25]
• Hormonal changes: Androgen-deprivation therapy and post–stem cell/bone marrow transplant hypogonadism (low testosterone) can reduce libido and erections. ^{[4] [5]}
• Pelvic surgeries or radiation for bladder, rectal, or other pelvic cancers can disrupt erectile pathways. [PM21] [PM25]
• Smoking-related vascular damage: Head and neck or lung cancers often share smoking exposure, which itself is linked to ED. ^{[3] [6]}
• Psychological stress and relationship factors: Anxiety, depression, body-image changes, and communication challenges can worsen or sustain ED. [PM21] ^[7]
• General health contributors: High blood pressure, high cholesterol, and diabetes can compound ED risk, and should be optimized. ^{[8] [9]}

Management: What Actually Helps

Effective care starts with a full assessment and then a stepwise plan tailored to medical and psychosocial needs. ^{[10] [8]}

1) Optimize Modifiable Risks

• Manage blood pressure, lipids, and blood sugar where applicable; stop smoking and limit alcohol. ^{[8] [9]}
• Evaluate and treat low testosterone (hypogonadism) when appropriate and not contraindicated. [PM19]

2) Address Psychosocial Factors

• Counseling or sex therapy can ease anxiety, improve communication, and rebuild intimacy. [PM19] ^[7]
• Involving partners and normalizing conversations about sex can improve outcomes. ^{[11] [12]}

3) First‑Line Medical Treatments

• Oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil) are standard first-line for ED and have strong evidence. ^{[8] [9]}
• These medicines may be used as part of early “penile rehabilitation” after prostate treatment to support recovery. [PM22]

4) Second‑Line and Device Options

• Vacuum erection devices can help draw blood into the penis and are commonly used, including during rehabilitation. [PM22] [PM28]
• Urethral suppositories (alprostadil) or intracavernosal injections can produce reliable erections when pills are insufficient. [PM19]
• Penile implants (prostheses) are a durable surgical option when other therapies do not work. [PM22]

5) Specialist Programs

• Dedicated male sexual medicine services provide integrated medical, device-based, and psychosocial care for cancer survivors. ^{[2] [13]}

---

Quick Comparison of Common ED Options

Option	How it works	When used	Notes
PDE5 inhibitors (e.g., sildenafil, tadalafil)	Enhance penile blood flow	First-line	Check heart meds and contraindications; part of rehab after prostate care. [8] [PM22]
Vacuum erection device	Mechanical negative pressure draws blood	First/second-line or adjunct	Useful during recovery; noninvasive. [PM22]
Urethral suppository (alprostadil)	Local vasodilator	Second-line	For those who don’t respond to pills. [PM19]
Intracavernosal injections	Direct vasodilator into corpora	Second-line	High efficacy; training needed. [PM19]
Testosterone therapy	Restores low levels	Selected men with hypogonadism	Avoid if contraindicated (e.g., active certain cancers); specialist guidance. [PM19]
Penile implant	Surgical device	Refractory cases	High satisfaction when other treatments fail. [PM22]

---

What to Expect Over Time

• After prostatectomy, ED may appear immediately, with gradual recovery depending on nerve-sparing and rehabilitation; after radiation, ED may develop later. [PM22] [PM25]
• Early, structured rehabilitation can help preserve tissue health and speed functional recovery. [PM22]
• Psychological support throughout survivorship improves adherence and sexual well-being. ^[7] [PM19]

---

Practical Steps You Can Take

• Talk to your oncology or urology team early about sexual side effects and goals; early planning matters. ^[14]
• Ask for referral to a male sexual medicine program for coordinated care, including medication, devices, and counseling. ^{[13] [2]}
• Work on heart and metabolic health and consider smoking cessation, as vascular health is central to erections. ^{[8] [9]}
• Include your partner when comfortable; open communication improves success. ^[11]

---

Key Takeaway

ED is common during and after cancer treatment, with causes ranging from nerve and vascular changes to hormones and psychological factors, and there are well-established treatments and rehabilitation strategies that can help most men. ^[1] [PM22] Early conversation and a personalized plan significantly improve outcomes. ^[14] [PM19]