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ED post surgery

User
Posted 04 Jun 2023 at 22:14

I am 16 months post surgery.I have used the pump for 13 months for rehabilitation and the rings were not effective to maintain an erection. My consultant initially put me on 50mg viagra twice a week which did not work and then tadalafil which also has not worked. Both had side effect causing swallowing difficulties. I gather from the community that some people are on injections. Wondering what to do next

User
Posted 04 Jun 2023 at 23:40
If you can get engorged using the pump, but cannot maintain an erection once the pump is removed, it may simply be that your technique is not quite right. The most common issues are a) not using a tight enough ring or b) losing the vacuum while transferring the ring from the tube to the base of the penis.

If you struggle to get engorged in the tube, the problem may be that you are not getting a tight enough seal between the end of the tube and your skin - do you trim your pubic hair & use a bit of lube on the end of the tube? Or possibly that you are pumping too quickly and not leaving pauses for the blood to be drawn in. It is very rare for the vacuum pump to not work at all - when it does happen, it is often down to atrophy (the spongy tissue of the penis can no longer expand due to lack of use) but you are unlikely to hve complete trophy in just 16 months.

Assuming that you can get an erection with the pump but it deflates when you transfer the ring, first step may be to contact the manufacturer to see whether they have a sales person / demonstrator in your area who can check your technique and ring size selection. Second option is to ask your GP to refer you to the ED clinic / andrology clinic for your area (if one exists ... the fact that you don't seem to already be under their care makes me think your NHS trust doesn't offer this service).

One way or another, 16 months is a long time and you are now entitled to try injections on the NHS. If the GP says there is no ED clinic in the area, it is your GP's responsibility to prescribe the injections - tell him / her that you would like to try Caverject or Invicorp.

Don't give up on the vacuum pump though! My husband found that a combination of 2 rings worked best for him - he couldn't believe how small the ring needs to be for it to be effective!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Jun 2023 at 11:16

The pump is mainly used for penile rehabilitation (for which you don't need to use the rings). You should continue using it even if you have sex a different way, and it will be doing you some good in keeping the penis functioning, stretchable, etc.

If you want to use the pump for sex, then your technique with the rings may be wrong. It would be worth asking to attend a pump clinic (off-shoot of ED clinic but probably shorter waiting times) to have the pump demoed on you correctly. This doubles the chances of using it successfully at home afterwards.

However, many people don't find the pump very useful for sex, even though it is for penile rehab, preventing shortening, thinning, and fibrosis/Peyronie's disease.

The PDE5 inhibitors can all have the issue with swallowing or acid reflux in some people, because your esophageal muscles also use PDE5 to contract, so PDE5 inhibitors can interfere with swallowing. Sometimes a lower dose of Tadalafil is still enough to make erections work, but not interfere with swallowing.

This leaves the vasodilator drugs used directly on the penis, mostly Alprostadil based, plus Invicorp which is a different pair of drugs. These are injections, and less invasive but often less effective, the MUSE pellet and Vitaros cream. Also, unlike PDE5 inhibitors, they don't need working nerves or even sexual arousal, but because erections generated this way are not triggered by sexual arousal, they don't go away when you get bored with sex, but hang around until the drug disperses. The other issue with these products is they take it in turns to regularly go unavailable, so you may need to learn to use more than one of them.

 
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