The Journey of Mr. Tan and Erectile Dysfunction Treatment: It was late at night. Sixty-three-year-old Mr. Tan was resting on his bed, reading the newspapers. His wife of more than 30 years joined him, putting her arms onto his lap.
In the past, Mr. Tan would have responded to his wife’s subtle request for physical intimacy.
But tonight, as with other similar occasions in recent months, all he felt was a sense of helplessness and guilt.
He and his wife had not had any sexual intercourse in nearly a year because no matter how hard he tried, he could not achieve an erection.
Mr. Tan thus quietly removed his wife’s arms from his lap and turned his back to her.
Bedroom scenarios similar to this had been played out multiple times since Mr. Tan developed severe erectile dysfunction following treatment for prostate cancer.
It all started about a year ago when Mr. Tan saw his urologist for urinary difficulties and was found to have an elevated PSA (prostate-specific antigen) level, a sign that he may have prostate cancer.
He underwent a prostate biopsy and was diagnosed with prostate cancer.
It came as a big shock to him, as everything had been going smoothly in his life. He was happily married, and his two grown-up sons were doing well in their jobs.
He had good relationships with his employer and colleagues at work and was looking forward to retiring in a few years, when he will have more time to travel with his wife and enjoy life.
However, Mr. Tan wasted no time in solving his problem. As his cancer was detected early, when the cancer is still localized within the prostate, he could go for treatments aimed at curing it.
Upon his doctor’s advice, he chose to undergo robotic surgery to remove his prostate.
Before the operation, he was counseled on the various risks such as bleeding, wound infection, and urinary incontinence.
Erectile dysfunction was one of the complications mentioned as it can happen to 60 per cent of patients after surgery.
It did not seem that important to Mr. Tan at that time, as his focus was on finding a cure for his cancer. He thus did not give it much thought.
After the successful operation, Mr. Tan’s PSA level dropped to undetectable levels, and his doctor was optimistic that the prostate cancer had been completely removed.
Mr. Tan’s cancer was quite extensive, so much of the tissues surrounding the prostate, including nerves that facilitate erections, had to be removed.
After his operation, Mr. Tan was given medication to improve blood flow to his penis.
After waiting for months, he saw no signs of his erections coming back, not even an increase in the size of his penis when he tried to stimulate it.
Mr. Tan looked quite down when I saw him in the clinic. Now that he was past fearing his cancer, he wanted to go back to a normal life.
He had a close physical relationship with his wife.
Although Mr. Tan’s wife was understanding about his condition, he felt bad for not fulfilling his role as a husband.
I evaluated Mr. Tan with a duplex ultrasound of his penis. During this test, the penis is injected with a strong medication that can increase blood flow to it so that blood pressure in it can be measured.
Mr. Tan could achieve only a partial erection, which was too weak for penetration.
I shared with Mr. Tan that, in severe erectile-dysfunction cases, where all medications had failed, the only option left to restore sexual function was a penile implant, which is known also as a penile prosthesis.
This device is inserted surgically into the spongy bodies of the penis and hidden under the skin with no exposed parts.
There are two types of implants. The first type is called a semi-rigid or malleable implant, which is similar to a rigid metallic rod that can be straightened and bent easily.
During intercourse, the man will straighten the implant. Otherwise, he can keep it bent.
The second type of implant is called an inflatable implant, which is driven by a hydraulic system.
It consists of two inflatable pieces that are implanted into each side of the penis; a control pump placed in the scrotum; and a reservoir that is buried under the belly.
When you pump it, water from the reservoir will flow into the inflatable pieces to create a hard and erected penis.
After intercourse, the user can press a release button on the pump to release the fluid from the inflatable pieces so that the penis will become soft again.
The inflatable implant is generally preferred because it can create an erection that is closer to normal.
The sensation of the penis is usually not affected by the implant because the sensory nerves are left intact.
So a man with an implant can still experience orgasm. A good implant can last more than 10 years.
Mr. Tan discussed this option with his wife.
While the couple loves each other and were prepared to live the rest of their lives without sexual relations, both felt a sense of emptiness. Somehow, life did not feel complete.
Mr. Tan eventually underwent surgery for the insertion of an inflatable penile prosthesis and was discharged from the hospital after a two-night stay.
He could pass urine normally but was asked not to manipulate the device during the recovery stage.
Six weeks after the surgery, he was allowed to use it for sexual intercourse.
It was the first time he and his wife experienced sexual intimacy after more than one year, and both felt more fulfilled.
Erectile dysfunction is not an easy problem to manage because of the embarrassment associated with this condition.
Many patients find it difficult to share what they are going through.
There is a common misconception that older people do not engage in sex, but studies have shown that a large number of people remain sexually active beyond their 70s.
With an aging population, prostate cancer and treatment-related erectile dysfunction have become more common.
Mild erectile dysfunction can be treated with medication. In severe cases, in which the nerves supplying the penis had been sacrificed, medication does not work, and penile prostheses remain the gold standard for treatment.
Dr. Joe Lee is a consultant at the department of urology and the director of andrology and male reproductive medicine at the National University Hospital.